Therapeutic Exercises and Educational Sessions After Microdiscectomy for Disc Herniation
Condition: Minimally Invasive Surgical Procedures; Disk, Herniated
MeSH terms: Intervertebral Disc Displacement
Study type: Interventional

Summary: 
      The basic purpose of current research is to evaluate the comparative effectiveness of
      therapeutic exercises and educational sessions after microdiscectomy through Minimally
      Invasive Surgery for disc herniation. A Randomized trial will be conducted on 60 patients
      from Ghurki hospital , divided into two groups. Simple random sampling will be utilized as
      sampling strategy. Assessment of physical activities of daily living and quality of life will
      be performed before and after 8 weeks of post intervention surgery through Oswestry
      Disability Index, Physical activity survey , SF 36 and Subjective Quality of Life scale
      respectively . A follow up assessment will be performed after 6 months. Analysis will be done
      through SPSS 21.
    

Detailed description: 
      The increasing number of spinal injuries and pathologies directs the need of technological
      advancement in spinal surgeries and its approaches in Pakistan. Among various expansion in
      surgical procedures; minimally invasive surgery of spine has gaining more advantage for
      spinal decompression, spinal fusion and instrumentation over lumbar, thoracic and cervical
      spine areas considering multilevel pathology.(1) Minimally invasive spine surgery (MISS), has
      attracted increasing attention within the last decade. The common thread between all
      minimally invasive spine surgeries is use of smaller incisions and less deterioration of
      surrounding soft tissue, typically results in less pain after surgery and a faster recovery
      with reduced length of stay at hospital. The patient reported functional outcome after this
      procedure was found to be better in comparison with the open approach procedures.(2)
      Therapeutic exercise post-operatively was programmed to maximize recovery and to minimize
      potential future problems including disability and improving quality of life. Three different
      approaches for post-operative management has been practiced including: 1. Recovery phase: 4
      to 16 weeks of limited activity following the surgery, 2. eliminating post-operative activity
      restriction leads to enhanced short-term outcomes for patients after limited open discectomy,
      3. Incorporating therapeutic exercise intervention program.(3) The purpose of therapeutic
      exercise post-operatively was to maximize recovery and to minimize potential future problems
      including disability and improving quality of life. (4)The therapeutic intervention program
      comprises of two components: patient education and exercise therapy based on protocols by
      clinical expertise considering the philosophy of surgeon. Patient education comprises of a
      one hour counseling session. Therapeutic exercise program encompasses trunk strengthening
      exercises (both isometrics and dynamics) along with core stabilization exercises and
      endurance training. (5)
    

Intervention name(s): Patient Education Session; Therapeutic Exercise plus educational session
Intervention type(s): Other; Other
Intervention description(s): The intervention of Patient Education will be designed individually according to the patient's need who have undergone lumbar microdiscectomy procedure through MIS. The basic purpose of the educational session will be to inform the participants about their pre operative and current back condition and discuss methods to care for their back. The session will be given for one hour and face to face interaction will be ensured twice a week. Initially the post operative education plan and instructions will be formulated, reviewed and finalized by the operating surgeon.; Therapeutic exercises include strength and endurance training and mat exercises. Strengthening exercises of the trunk extensors will be initiated first and then endurance exercises will be targeted. Mat exercises will be performed to strengthen the back and lower musculature. Treatment will be given twice a week for almost three months. Individualized educational sessions will be performed in the same way as conducted in the other group. Progression of the exercises and the rest periods will be incorporated according to the status of patient.
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Outcomes Assessor)
Primary purpose: Treatment
Keywords: Back Pain; Exercise Therapy; Functionality; Microdiscectomy; Patient Education; Quality of Life