Abstract

QUESTION: Is referral for early rehabilitation after lumbar disc surgery effective and cost-effective compared to no referral?

DESIGN: Multicentre, randomised, controlled trial, and economic evaluation with concealed allocation and intention-to-treat-analysis.

PARTICIPANTS: Adults who underwent discectomy for a herniated lumbar disc, confirmed by magnetic resonance imaging, and signs of nerve root compression corresponding to the herniation level.

INTERVENTION: Early rehabilitation (exercise therapy) for 6 to 8 weeks, versus no referral, immediately after discharge.

OUTCOME MEASURES: In line with the recommended core outcome set, the co-primary outcomes were: functional status (Oswestry Disability Index); leg and back pain (numerical rating scale 0 to 10); global perceived recovery (7-point Likert scale); and general physical and mental health (SF12), assessed 3, 6, 9, 12 and 26 weeks after surgery. The outcomes for the economic evaluation were quality of life and costs, measured at 6, 12 and 26 weeks after surgery.

RESULTS: There were no clinically relevant or statistically significant overall mean differences between rehabilitation and control for any outcome adjusted for baseline characteristics: global perceived recovery (OR 1.0, 95% CI 0.6 to 1.7), functional status (MD 1.5, 95% CI -3.6 to 6.7), leg pain (MD 0.1, 95% CI -0.7 to 0.8), back pain (MD 0.3, 95% CI -0.3 to 0.9), physical health (MD -3.5, 95% CI -11.3 to 4.3), and mental health (MD -4.1, 95% CI -9.4 to 1.3). After 26 weeks, there were no significant differences in quality-adjusted life years (MD 0.01, 95% CI -0.02 to 0.04 points) and societal costs (MD -€527, 95% CI -2846 to 1506). The maximum probability for the intervention to be cost-effective was 0.75 at a willingness-to-pay of €32 000/quality-adjusted life year.

CONCLUSION: Early rehabilitation after lumbar disc surgery was neither more effective nor more cost-effective than no referral.

TRIAL REGISTRATION: Netherlands Trial Register NTR3156. [Oosterhuis T, Ostelo RW, van Dongen JM, Peul WC, de Boer MR, Bosmans JE, Vleggeert-Lankamp CL, Arts MP, van Tulder MW (2017) Early rehabilitation after lumbar disc surgery is not effective or cost-effective compared to no referral: a randomised trial and economic evaluation. Journal of Physiotherapy XX: XX-XX].

Original languageEnglish
Pages (from-to)144-153
Number of pages10
JournalJournal of Physiotherapy
Volume63
Issue number3
DOIs
Publication statusPublished - 1 Jul 2017

Fingerprint

Cost-Benefit Analysis
Referral and Consultation
Rehabilitation
Costs and Cost Analysis
Exercise Therapy
Quality-Adjusted Life Years
Back Pain
Leg
Mental Health
Diskectomy
Intervertebral Disc Displacement
Intention to Treat Analysis
Radiculopathy
Art
Netherlands
Randomized Controlled Trials
Quality of Life
Magnetic Resonance Imaging
Pain
Health

Keywords

  • Journal Article
  • low back pain
  • early rehabilitation
  • lumbar disc surgery

Cite this

@article{2cbc2ca8e50b492984828a9a64dee3af,
title = "Early rehabilitation after lumbar disc surgery is not effective or cost-effective compared to no referral: a randomised trial and economic evaluation",
abstract = "QUESTION: Is referral for early rehabilitation after lumbar disc surgery effective and cost-effective compared to no referral?DESIGN: Multicentre, randomised, controlled trial, and economic evaluation with concealed allocation and intention-to-treat-analysis.PARTICIPANTS: Adults who underwent discectomy for a herniated lumbar disc, confirmed by magnetic resonance imaging, and signs of nerve root compression corresponding to the herniation level.INTERVENTION: Early rehabilitation (exercise therapy) for 6 to 8 weeks, versus no referral, immediately after discharge.OUTCOME MEASURES: In line with the recommended core outcome set, the co-primary outcomes were: functional status (Oswestry Disability Index); leg and back pain (numerical rating scale 0 to 10); global perceived recovery (7-point Likert scale); and general physical and mental health (SF12), assessed 3, 6, 9, 12 and 26 weeks after surgery. The outcomes for the economic evaluation were quality of life and costs, measured at 6, 12 and 26 weeks after surgery.RESULTS: There were no clinically relevant or statistically significant overall mean differences between rehabilitation and control for any outcome adjusted for baseline characteristics: global perceived recovery (OR 1.0, 95{\%} CI 0.6 to 1.7), functional status (MD 1.5, 95{\%} CI -3.6 to 6.7), leg pain (MD 0.1, 95{\%} CI -0.7 to 0.8), back pain (MD 0.3, 95{\%} CI -0.3 to 0.9), physical health (MD -3.5, 95{\%} CI -11.3 to 4.3), and mental health (MD -4.1, 95{\%} CI -9.4 to 1.3). After 26 weeks, there were no significant differences in quality-adjusted life years (MD 0.01, 95{\%} CI -0.02 to 0.04 points) and societal costs (MD -€527, 95{\%} CI -2846 to 1506). The maximum probability for the intervention to be cost-effective was 0.75 at a willingness-to-pay of €32 000/quality-adjusted life year.CONCLUSION: Early rehabilitation after lumbar disc surgery was neither more effective nor more cost-effective than no referral.TRIAL REGISTRATION: Netherlands Trial Register NTR3156. [Oosterhuis T, Ostelo RW, van Dongen JM, Peul WC, de Boer MR, Bosmans JE, Vleggeert-Lankamp CL, Arts MP, van Tulder MW (2017) Early rehabilitation after lumbar disc surgery is not effective or cost-effective compared to no referral: a randomised trial and economic evaluation. Journal of Physiotherapy XX: XX-XX].",
keywords = "Journal Article, low back pain, early rehabilitation, lumbar disc surgery",
author = "Teddy Oosterhuis and Ostelo, {Raymond W} and {van Dongen}, {Johanna M} and Peul, {Wilco C.} and {de Boer}, {Michiel R} and Bosmans, {Judith E} and Vleggeert-Lankamp, {Carmen L} and Arts, {Mark P.} and {van Tulder}, {Maurits W}",
note = "Copyright {\circledC} 2017. Published by Elsevier B.V.",
year = "2017",
month = "7",
day = "1",
doi = "10.1016/j.jphys.2017.05.016",
language = "English",
volume = "63",
pages = "144--153",
journal = "Journal of Physiotherapy",
issn = "1836-9553",
publisher = "Australian Physiotherapy Association",
number = "3",

}

Early rehabilitation after lumbar disc surgery is not effective or cost-effective compared to no referral : a randomised trial and economic evaluation. / Oosterhuis, Teddy; Ostelo, Raymond W; van Dongen, Johanna M; Peul, Wilco C.; de Boer, Michiel R; Bosmans, Judith E; Vleggeert-Lankamp, Carmen L; Arts, Mark P.; van Tulder, Maurits W.

In: Journal of Physiotherapy, Vol. 63, No. 3, 01.07.2017, p. 144-153.

Research output: Contribution to JournalArticleAcademicpeer-review

TY - JOUR

T1 - Early rehabilitation after lumbar disc surgery is not effective or cost-effective compared to no referral

T2 - a randomised trial and economic evaluation

AU - Oosterhuis, Teddy

AU - Ostelo, Raymond W

AU - van Dongen, Johanna M

AU - Peul, Wilco C.

AU - de Boer, Michiel R

AU - Bosmans, Judith E

AU - Vleggeert-Lankamp, Carmen L

AU - Arts, Mark P.

AU - van Tulder, Maurits W

N1 - Copyright © 2017. Published by Elsevier B.V.

PY - 2017/7/1

Y1 - 2017/7/1

N2 - QUESTION: Is referral for early rehabilitation after lumbar disc surgery effective and cost-effective compared to no referral?DESIGN: Multicentre, randomised, controlled trial, and economic evaluation with concealed allocation and intention-to-treat-analysis.PARTICIPANTS: Adults who underwent discectomy for a herniated lumbar disc, confirmed by magnetic resonance imaging, and signs of nerve root compression corresponding to the herniation level.INTERVENTION: Early rehabilitation (exercise therapy) for 6 to 8 weeks, versus no referral, immediately after discharge.OUTCOME MEASURES: In line with the recommended core outcome set, the co-primary outcomes were: functional status (Oswestry Disability Index); leg and back pain (numerical rating scale 0 to 10); global perceived recovery (7-point Likert scale); and general physical and mental health (SF12), assessed 3, 6, 9, 12 and 26 weeks after surgery. The outcomes for the economic evaluation were quality of life and costs, measured at 6, 12 and 26 weeks after surgery.RESULTS: There were no clinically relevant or statistically significant overall mean differences between rehabilitation and control for any outcome adjusted for baseline characteristics: global perceived recovery (OR 1.0, 95% CI 0.6 to 1.7), functional status (MD 1.5, 95% CI -3.6 to 6.7), leg pain (MD 0.1, 95% CI -0.7 to 0.8), back pain (MD 0.3, 95% CI -0.3 to 0.9), physical health (MD -3.5, 95% CI -11.3 to 4.3), and mental health (MD -4.1, 95% CI -9.4 to 1.3). After 26 weeks, there were no significant differences in quality-adjusted life years (MD 0.01, 95% CI -0.02 to 0.04 points) and societal costs (MD -€527, 95% CI -2846 to 1506). The maximum probability for the intervention to be cost-effective was 0.75 at a willingness-to-pay of €32 000/quality-adjusted life year.CONCLUSION: Early rehabilitation after lumbar disc surgery was neither more effective nor more cost-effective than no referral.TRIAL REGISTRATION: Netherlands Trial Register NTR3156. [Oosterhuis T, Ostelo RW, van Dongen JM, Peul WC, de Boer MR, Bosmans JE, Vleggeert-Lankamp CL, Arts MP, van Tulder MW (2017) Early rehabilitation after lumbar disc surgery is not effective or cost-effective compared to no referral: a randomised trial and economic evaluation. Journal of Physiotherapy XX: XX-XX].

AB - QUESTION: Is referral for early rehabilitation after lumbar disc surgery effective and cost-effective compared to no referral?DESIGN: Multicentre, randomised, controlled trial, and economic evaluation with concealed allocation and intention-to-treat-analysis.PARTICIPANTS: Adults who underwent discectomy for a herniated lumbar disc, confirmed by magnetic resonance imaging, and signs of nerve root compression corresponding to the herniation level.INTERVENTION: Early rehabilitation (exercise therapy) for 6 to 8 weeks, versus no referral, immediately after discharge.OUTCOME MEASURES: In line with the recommended core outcome set, the co-primary outcomes were: functional status (Oswestry Disability Index); leg and back pain (numerical rating scale 0 to 10); global perceived recovery (7-point Likert scale); and general physical and mental health (SF12), assessed 3, 6, 9, 12 and 26 weeks after surgery. The outcomes for the economic evaluation were quality of life and costs, measured at 6, 12 and 26 weeks after surgery.RESULTS: There were no clinically relevant or statistically significant overall mean differences between rehabilitation and control for any outcome adjusted for baseline characteristics: global perceived recovery (OR 1.0, 95% CI 0.6 to 1.7), functional status (MD 1.5, 95% CI -3.6 to 6.7), leg pain (MD 0.1, 95% CI -0.7 to 0.8), back pain (MD 0.3, 95% CI -0.3 to 0.9), physical health (MD -3.5, 95% CI -11.3 to 4.3), and mental health (MD -4.1, 95% CI -9.4 to 1.3). After 26 weeks, there were no significant differences in quality-adjusted life years (MD 0.01, 95% CI -0.02 to 0.04 points) and societal costs (MD -€527, 95% CI -2846 to 1506). The maximum probability for the intervention to be cost-effective was 0.75 at a willingness-to-pay of €32 000/quality-adjusted life year.CONCLUSION: Early rehabilitation after lumbar disc surgery was neither more effective nor more cost-effective than no referral.TRIAL REGISTRATION: Netherlands Trial Register NTR3156. [Oosterhuis T, Ostelo RW, van Dongen JM, Peul WC, de Boer MR, Bosmans JE, Vleggeert-Lankamp CL, Arts MP, van Tulder MW (2017) Early rehabilitation after lumbar disc surgery is not effective or cost-effective compared to no referral: a randomised trial and economic evaluation. Journal of Physiotherapy XX: XX-XX].

KW - Journal Article

KW - low back pain

KW - early rehabilitation

KW - lumbar disc surgery

U2 - 10.1016/j.jphys.2017.05.016

DO - 10.1016/j.jphys.2017.05.016

M3 - Article

VL - 63

SP - 144

EP - 153

JO - Journal of Physiotherapy

JF - Journal of Physiotherapy

SN - 1836-9553

IS - 3

ER -