A Cochrane review [Abstract] 1 included 22 studies with 2503 participants. Both men and women were included, and overall mean age was 41.4 years.
Most rehabilitation programmes were assessed in only one study. All participants had received standard discectomy, microdiscectomy and in one study standard laminectomy and (micro)discectomy. Mean duration of the rehabilitation intervention was 12 weeks; eight studies assessed six to eight-week exercise programmes, and eight studies assessed 12 to 13-week exercise programmes. Programmes were provided in primary and secondary care facilities and were started immediately after surgery (n = 4) or four to six weeks (n = 16) or one year after surgery (n = 2). Rehabilitation programmes that started immediately after surgery were not more effective than their control interventions, which included exercise. There were no differences between specific rehabilitation programmes (multidisciplinary care, behavioural graded activity, strength and stretching) that started four to six weeks postsurgery and their comparators, which included some form of exercise. Physiotherapy from four to six weeks postsurgery onward led to better function than no treatment or education only, and multidisciplinary rehabilitation co-ordinated by medical advisors led to faster return to work than usual care.
Statistical pooling was performed only for three comparisons in which the rehabilitation programmes started four to six weeks postsurgery: exercise programmes versus no treatment, high- versus low-intensity exercise programmes and supervised versus home exercise programmes. Exercises were more effective than no treatment for pain at short-term follow-up (SMD -0.90; 95% CI -1.55 to -0.24, five RCTs, N = 272), and exercises were more effective for functional status on short-term follow-up (SMD -0.67; 95% CI -1.22 to -0.12, four RCTs, N = 252) and no difference in functional status was noted on long-term follow-up (three RCTs, N = 226; SMD -0.22; 95% CI -0.49 to 0.04). None of these studies reported that exercise increased the reoperation rate. High-intensity exercise programmes were more effective than low-intensity exercise programmes for pain in the short term (WMD -10.67; 95% CI -17.04 to -4.30, two RCTs, N = 103), and they were more effective for functional status in the short term (SMD -0.77; 95% CI -1.17 to -0.36, two RCTs, N = 103). No significant differences were found between supervised and home exercise programmes for short-term pain relief (SMD -0.76; 95% CI -2.04 to 0.53, four RCTs, N = 154) or functional status (four RCTs, N = 154; SMD -0.36; 95% CI -0.88 to 0.15).
Comment: The quality of evidence is downgraded by study quality (considerable potential for bias in half of the included trials).
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