Early initiation of a strength training based rehabilitation after lumbar spine fusion improves core muscle strength: a randomized controlled trial

Abstract

Background: To analyze the safety and effects of early initiation of rehabilitation including objective measurement outcomes after lumbar spine fusion based on principles of strength training.

Methods: The study recruited 27 patients, aged 45 to 70 years, who had undergone lumbar spine fusion. The method of concealed random allocation without blocking was used to form two groups. The strength training group started rehabilitation 3 weeks after surgery. Patients exercised twice weekly over 9 weeks focusing on muscle activation of lumbopelvic stabilization muscles. The control group followed a standard postoperative protocol, where no exercises were performed at that stage of rehabilitation. Functional outcomes and plain radiographs were evaluated at 3 weeks and subsequently at 3 and 18 months after the surgery.

Results: No hardware loosening of failure was observed in the training group. Both groups improved their walking speed after 3 months (p < 0.01), although improvement in the training group was significantly greater than in the control group (p < 0.01). Moreover, the training group significantly improved after the training period in all isometric trunk muscles measurements (p < 0.03), standing reach height (p < 0.02), and pre-activation pattern (p < 0.05). After 18 months, no training effects were observed.

Conclusions: The study showed that early initiation of a postoperative rehabilitation program based on principles of strength training is safe, 3 weeks after lumbar spine fusion, and enable earlier functional recovery than standard rehabilitation protocol.

Trial registration: The study is registered at the US National Institutes of Health ( ClinicalTrials.gov ) NCT03349580 . The date of registration: November 21, 2017 - Retrospectively registered.

Keywords: Early initiation; Intra-abdominal pressure; Lumbar spine fusion; Randomized controlled trial; Rehabilitation; Strength training.

Conflict of interest statement

Ethics approval and consent to participate

The National Medical Ethics Committee of Slovenia approved the study (No.62/03/14, date 4.4.2014). All patients received written and verbal informed consent about their participation in the rehabilitation program.

Our study adheres to CONSORT guidelines and includes a completed CONSORT checklist.

Competing interests

The authors declare that they have no competing interests.

Publisher’s Note

Springer Nature remains neutral with regard to jurisdictional claims in published maps and institutional affiliations.

Figures

Fig. 1

Consent subject flow diagram

Fig. 2

Six-minute walking test (6MWT) (group mean). p1—difference between the baseline’s and 3 months’ mean for the training group. p2—difference between the 3 months’ and 18 months’ mean for the control group. p3—difference between the baseline’s and 18 months’ mean for the training group. ANOVA1,2—one-way repeated-measures ANOVA between the baseline’s and 3 months’ mean. Horizontal solid and dashed lines indicate the mean expected walking distance (571 m), with 95% CI (± 90 m) in a normal, age-matched population, respectively [21]

Fig. 3

Isometric trunk muscle strength (Nm) (group mean). p1—difference between the baseline’s and 3 months’ mean for the training group. p2—difference between the 3 months’ and 18 months’ mean for the control group. p3—difference between the baseline’s and 18 months’ mean for the training group. p4—difference between the baseline’s and 18 months’ mean for the control group. ANOVA1,2—one-way repeated-measures ANOVA between the baseline’s and 3 months’ mean