Change in lumbar dysfunction in surgical patients and the effect of two exercise programs

Kelley, Susannah M (2005). Change in lumbar dysfunction in surgical patients and the effect of two exercise programs MPhil Thesis, School of Health & Rehabilitation Sciences, The University of Queensland.

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Author Kelley, Susannah M
Thesis Title Change in lumbar dysfunction in surgical patients and the effect of two exercise programs
School, Centre or Institute School of Health & Rehabilitation Sciences
Institution The University of Queensland
Publication date 2005
Thesis type MPhil Thesis
Supervisor Warren Stanton
Julie Hides
William Ryan
Total pages 153
Collection year 2005
Language eng
Subjects 11 Medical and Health Sciences
Formatted abstract

Surgical excision of protruded disc material is a widely accepted technique for the relief of sciatica, however many patients complain of persistent lower back pain (LBP) following this procedure. In addition to the actual mechanical source of the LBP, it has been proposed that the possible harmful effects of surgery on the lumbar multifidus muscle, which is an important stabiliser of the spine, may be a factor in the development of ongoing LBP. The size of multifidus has been used as a measure of muscle function in previous studies and has been found to be affected by acute and chronic LBP. The purpose of the present study was firstly to determine the effect of LBP (n= 19) on the size of multifidus and to monitor the effects of surgery on the size of the muscle over one year compared to a group of normal male subjects (n= 10). The second aim of the study was to determine if two interventions: usual care (walking program and education), and usual care and a specific stability program influenced the size of multifidus and self-report outcomes. In order to achieve these goals 1 9 patients (aged 20-55 years) were randomised into two groups, each receiving a four week treatment program. Outcome measures of pain (pain visual analogue scale for back and leg pain, McGill Pain Questionnaire), function (Roland Morris disability questionnaire and Oswestry low back pain disability questionnaire), general health, straight leg raise and lumbar multifidus cross-sectional area were taken prior to surgery (T0) and then at 2 weeks post-surgery (T2)), 6 weeks post-intervention (T6)) and 52 weeks follow-up (T52) post-surgery. Baseline measurements revealed that there was no significant difference between the groups for the physical and self-report outcome measures. However, there was a group difference for the length of pre-operative LBP and leg pain, with the usual care and specific stability exercises group having significantly longer pre-operative symptoms. The size of multifidus was found to be statistically smaller in the chronic LBP subjects pre-operatively compared with normal subjects (p=0.01). However, surgery did not increase multifidus atrophy in terms of cross-sectional area. When the results from the two intervention groups were compared at one year follow-up, no statistical difference was found for any of the outcome measures. This result may be a reflection of the small sample size in this pilot trial. Based on a sample size estimate from these results future studies will require 30-35 subjects per group in order to achieve statistical significance at p<0.05 (I tailed) with 80 per cent power for the outcome measures. The two groups had the same level of pain, disability and general health. In particular the size of multifidus was not affected by either intervention. This remained unimproved at one year in both groups. The recurrence of LBP and the return to work status at one year was similar between groups. Preoperatively the Pearson' s correlational analysis revealed that LBP had a significant negative correlation with the size of multifidus. A t the one year follow-up the correlation had changed, with leg pain having a negative correlation with multifidus size. The size of multifidus also correlated with function. It was a negative correlation, indicating that smaller muscle size predicted a worse outcome. Further studies are required to determine if a longer period of intervention or higher load exercises will restore the size of multifidus to normal and prevent ongoing LBP following surgery. 

Keyword Lumbar vertebrae
Backache -- Exercise therapy
Back -- Surgery
Additional Notes Variant title: Effect of two exercise programs following back surgery
Orignal thesis number: THE18562

Document type: Thesis
Collection: UQ Theses (RHD) - UQ staff and students only
Citation counts: Google Scholar Search Google Scholar
Created: Fri, 01 Feb 2013, 11:14:21 EST by Mr Lachlan Wong on behalf of Scholarly Communication and Digitisation Service