Comparison of Exercise Intervention Effects Following Lumbar Microdiscectomy

Study Overview
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Brief Summary
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Low back pain is common, costly and affecting up to 80% of the population with the lumbar discectomy being a frequent spinal procedure for disc herniations. Pain & mobility impairments persist in patients following microdiscectomy with long term issues of back pain. The question remains as to why some patients recover quickly and without lasting difficulties while other patients persist with prolonged disability following the same surgery. The purpose of this study is to determine how to guide the patient towards full function and evaluate the timing to initiate strengthening, neurodynamics and a walking exercise program.

Detailed Description
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The direction of treatment for low back pain both surgically and conservatively seeks to improve function in both daily and sporting activities for all patients. The patients continuing to suffer from a significant level of pain, disability and reduced function following single level microdiscectomy may benefit from a multi-factorial approach. A reduction in neurodynamic mobility related to dural adhesions is considered to be a contributing factor in this persistent peripheral neuropathic pain. The clinical efficacy of this study will address an exercise protocol post surgery in order to provide an optimal approach in the prevention of scar tissue that may be contributing to persistent pain post microdiscectomy. Mobility and motor control impairments are considered the consequence to the onset of pain. Education, neurodynamics and stabilization exercises are instrumental in the recovery post microdiscectomy with a reduction in pain and disability and the goal towards full functioning. The introduction of a neurodynamic protocol as an early exercise intervention may serve to reduce pain inhibition resulting with improved mobility and motor control. The recording of step count per day following a lumbar microdiscectomy will serve to document daily and physical activity levels following surgery. The purpose of this study is to determine whether or not there is a significant difference in pain levels and lumbar mobility between an early exercise intervention group versus a late exercise intervention group post microdiscectomy.

Official Title
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Comparison of Early Exercise Intervention Versus Late Exercise Intervention on Pain and Neurodynamic Mobility Following Unilateral Lumbar Microdiscectomy: A Randomized Controlled Trial

Conditions
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Injury of Nerve Root of Lumbar and Sacral Spine

Intervention / Treatment
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* Behavioral: Exercise Intervention


Participation Criteria
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Eligibility Criteria
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Inclusion Criteria: Uncomplicated unilateral post-op microdiscectomy L3-4, L4-5, L5-S1 Radicular symptoms within one year of surgical intervention Ability to understand English or French for instructional purposes Able to participate in physical activity Exclusion Criteria: Under the age of 18 years or over the age of 65 years Diagnosis of inflammatory conditions such as rheumatoid arthritis, ankylosing spondylitis Neoplasm Metabolic bone disease Cauda equine syndrome Neurological disorders ie Multiple Sclerosis, Parkinsons Compression of the spinal cord Uncontrolled cardiovascular or respiratory disease Peripheral vascular disease with sensory loss in the foot Discitis Pregnancy Previous spinal surgeries

Ages Eligible for Study
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Minimum Age: 19 Years
Maximum Age: 65 Years

Sexes Eligible for Study
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All

Accepts Healthy Volunteers
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No

Study Plan
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How is the study designed?
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Design Details

Primary Purpose: Supportive Care
Allocation: Randomized
Intervention Model: Parallel Assignment
Masking: None (Open Label)


Arms and Interventions

| Participant Group/Arm | Intervention/Treatment |
| --- | --- |
| Experimental: Early exercise intervention group<br>Education, stabilization and neurodynamic level one exercises will be provided to the intervention group within one to two weeks following a unilateral lumbar microdiscectomy L3-4, L4-5, L5-S1. Within 4-6 weeks, this group will be provided with education, stabilization and neurodynamic level two exercises and a pedometer to monitor step count between week 4 and week 10 following the surgery. | Behavioral: Exercise Intervention<br>* Early versus later stabilization and neurodynamic exercise intervention following a post-op lumbar microdiscectomy<br>|
| Active Comparator: Late exercise intervention group<br>Education, stabilization and neurodynamic level one and two exercises will be provided to the active comparator group within 4-6 weeks following a unilateral lumbar microdiscectomy L3-4, L4-5, L5-S1. Within 4-6 weeks, this group will also be given instructions and a pedometer to monitor step count between week 4 and week 10 following the surgery. | Behavioral: Exercise Intervention<br>* Early versus later stabilization and neurodynamic exercise intervention following a post-op lumbar microdiscectomy<br>|

What is the study measuring?
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Primary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Oswestry Low Back Disability Questionnaire | Pain and function related to low back pain | 3 months | 
| Numeric Pain Rating Scale | Pain related to low back pain | 3 months | 
| Fear Avoidance Beliefs Questionnaire | Psychological barriers related to low back pain | 3 months | 
| Patient Specific Functional Scale | Function related to low back pain | 3 months | 

Secondary Outcome Measures

| Outcome Measure | Measure Description | Time Frame |
| --- | --- | --- |
| Lumbar mobility of flexion and extension | Range of lumbar motion related to low back pain | 3 months | 
| Slump test mobility | Mobility restrictions in the slump test related to low back pain | 3 months | 
| Straight leg raise | Mobility restrictions in the straight leg raise related to low back pain | 3 months | 
| 50 ft Walk test | Time to complete 50 ft walk test | 3 months | 
| Step count per day | Step count per day related to Low back pain | 4 weeks | 
| Return to work | Timing for return to work related to low back pain | 3 months | 

 Terms related to the study
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Keywords Provided by Centre Hospitalier Valida
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exercise, lumbar microdiscectomy