Pre-surgery Physiotherapy for Patients With Specific Low Back Pain
Condition: Lumbar Spine Disc Herniation; Spinal Stenosis; Spondylolisthesis, Grade 4
MeSH terms: Spinal Stenosis; Intervertebral Disc Displacement; Spondylolisthesis; Back Pain; Low Back Pain
Study type: Interventional

Summary: 
      The aim is to study if pre-surgery physiotherapy improves function, pain and health in
      patients with specific low back pain scheduled for surgery. Patients are followed over a two
      year period. A secondary aim is to study what factors predict short and long term outcomes.
    

Detailed description: 
      The design is a randomized controlled trial, where patients are allocated either to
      pre-surgery physiotherapy or waiting-list when scheduled for surgery due to specific low back
      pain (spinal stenosis, disc herniation, spondylolisthesis, disc degenerative disease (DDD)).

      The patients are scheduled for surgery due to specific low back pain diagnosis and randomized
      to either pre-surgery physiotherapy or waiting-list group. Clinical measurement and
      treatment-classification is done before and after intervention.

      Pre-surgery intervention:

      Physiotherapy guided intervention twice a week for nine weeks. The program includes:

        1. Active physiotherapy according to a treatment based classification

             1. Specific exercises and mobilization

             2. Motor control exercises

             3. Traction

        2. Tailor-made general supervised exercise program

        3. Behavioral approach to reduce fear avoidance and increase activity level.

      Both groups receive standardized information about surgery, post-surgery rehabilitation and
      to stay active.

      Surgery in performed according to existing guidelines.

      Measurements:

      Patients fill out a questionnaire at baseline, before surgery (after pre-surgery
      physiotherapy or waiting-list), three months, one and two years after surgery. The
      questionnaire includes self-reported measures for function Oswestry Disability Index (ODI)
      (primary outcome), pain (VAS, pain drawing, pain duration) and health (SF-36, EQ-5D),
      anxiety, depression (HADS), self efficacy, fear avoidance belief questionnaire (FABQ),
      workability, (WAI), expectations, general information of work, sick-leave, lifestyle
      behavior, previous healthcare consumption, patient reported treatment effects, patient
      enablement instrument (PEI), and adverse events.

      Clinical measurement is done before and after intervention. Clinical measurements includes;
      isometric quadriceps strength, walking-test, neurological tests for L4-S1, SI-joint tests,
      Posterior-anterior-test (PA-test), test for centralization, test for aberrant movements.
    

Intervention name(s): Pre-surgery physiotherapy; Waiting-list
Intervention type(s): Other; Other
Intervention description(s): Physiotherapy guided intervention twice a week for nine weeks. The program includes:
Active physiotherapy according to a treatment based classification:
Specific exercises and mobilization
Motor control exercises
Traction
Tailor-made general supervised exercise program
Behavioral approach to reduce fear avoidance and increase activity level.
Standardized information about:
the surgery
post-surgery rehabilitation
to stay active; Standardized information about:
the surgery
post-surgery rehabilitation
to stay active
Allocation: Randomized
Intervention model: Parallel Assignment
Masking: Single (Investigator)
Primary purpose: Treatment
Keywords: physical therapy; lumbar spine surgery; pre-surgical intervention; RCT