Author: Philippa Gilbert and Matthew Scott Young

Presented by: Adam Antoniolli at Australian Physiotherapy Conference 2011, Brisbane Convention and Exhibition Centre

 

This study compared clinical outcomes of people following Total Disc Replacement (TDR) who undertook an intensive rehabilitation program compared to a non-structured self-help program. 618 patients with single/multilevel degenerative disc disease who had single/multilevel arthroplasty or hybrid surgery (lumbar arthroplasty and arthrodesis) were prospectively studied. Diagnosis was confirmed by clinical history, MRI, electrophysiological studies, and discography. 184 patients (Mean age 45.3yrs) participated in intensive rehabilitation (Rehabilitation Group). 434 patients (Mean age 48.5yrs) had no organised rehabilitation (Control Group). Twice weekly interventions for 8-12 weeks included patient education, goal setting, psychological reinforcement, neurodynamics and activation of the local stabilisation system of the functional spinal unit –DELORES Rehabilitation Program.  Measures included Visual Analogue Scale (VAS: 0-100) for Back/Leg Pain, Oswestry Disability Index (ODI:0-100) and Roland-Morris Disability Questionnaire (RMDQ:0-50). Patients were assessed pre-operatively and post-operatively (3, 6, 12 and up to 48 months). Data at baseline and 48 months are reported.  Back pain decreased from 71.3 to 16.8 (-76%, Rehabilitation) and from 74.1 to 23.9 (-68%, Controls). Leg pain decreased from 52.2 to 11.1 (-79%, Rehabilitation) and from 57.1 to 17.2 (-70%, Controls). The ODIQ score reduced from 45.5 to 11.5 after rehabilitation (-75%).and from 47.8 to 17.8 in the controls (-63%). RMDQ scores decreased from 16.2 to 2.6 in Rehabilitation Group (-84%) and from 16.1 to 5.0 in Control Group (-69%). Reduced pain and improved function were greater following intensive rehabilitation than following a non-structured self-help program. The clinical benefits of TDR can be enhanced by implementation of the DELORES rehabilitation program.