Descriptive analysis of a 1:1 physiotherapy outpatient intervention post primary lumbar discectomy: one arm of a small-scale parallel randomised controlled trial across two UK sites

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Authors

  • Adam Calcutt
  • Alison Heap
  • Louise White
  • Peter Goodwin

External organisations

  • Department of Physiotherapy, Aneurin Bevan University Health Board, Ebbw Vale
  • Physiotherapy Department, University Hospitals Birmingham NHS Foundation Trust, Queen Elizabeth Hospital, Birmingham
  • Manchester Metropolitan University

Abstract

Objective: There is a lack of high-quality evidence for physiotherapy post lumbar discectomy. Substantial heterogeneity in treatment effects may be explained by
variation in quality, administration and components of interventions. An optimised physiotherapy intervention may reduce heterogeneity and improve patient benefit. The objective was to describe, analyse and evaluate an
optimised 1:1 physiotherapy outpatient intervention for patients following primary lumbar discectomy, to provide preliminary insights.

Design: A descriptive analysis of the intervention embedded within an external pilot and feasibility trial.

Setting: Two UK spinal centres.

Participants: Participants aged ≥18; post primary, single level, lumbar discectomy were recruited.

Intervention: The intervention encompassed education, advice, mobility and core stability exercises, progressive exercise, and encouragement of early return to work/activity. Patients received ≤8 sessions for ≤8 weeks, starting 4 weeks post surgery (baseline).

Outcomes: Blinded outcome assessment at baseline and 12 weeks ( post intervention) included the Roland Morris Disability Questionnaire. STarT Back
data were collected at baseline. Statistical analyses summarised participant characteristics and preplanned descriptive analyses. Thematic analysis
grouped related data.

Findings: Twenty-two of 29 allocated participants received the intervention. STarT Back categorised n=16 (55%) participants ‘not at low risk’. Physiotherapists identified reasons for caution for 8 (36%) participants, commonly risk of overdoing activity (n=4, 18%). There was no relationship between STarT Back and physiotherapists’ evaluation of caution. Physiotherapists identified 154 problems (mean (SD) 5.36 (2.63)). Those ‘not at low risk’, and/or requiring caution presented with more problems, and required more sessions (mean (SD) 3.14 (1.16)).

Conclusions: Patients present differently and therefore require tailored interventions. These differences may be identified using clinical reasoning
and outcome data. Trial registration number: ISRCTN33808269; post
results.

Details

Original languageEnglish
Article numbere012151
JournalBMJ open
Volume6
Issue number11
Publication statusPublished - 9 Nov 2016