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Lumbar fusion rehabilitation

Title page

Rehabilitation following lumbar fusion surgery: a systematic review

and meta-analysis.

Corresponding author, James Greenwood, BSc(hons), MRes, Internal Box

8, Victor Horsely Dept of Neurosurgery, National Hospital of Neurology and

Neurosurgery, Queen Square, London WC1 3BG. Tel;02034483568 Fax;

02034483340 email; [email protected]

Address for reprints via corresponding author.

Professor Alison McGregor, PhD, Biodynamics Lab, Imperial College London,

Charing Cross Hospital, Charing Cross Campus, London, W6 8RP.

Professor Fiona Jones, PhD, St Georges University of London, Faculty of Health

and Social Care Sciences, 2nd Floor Grosvenor Wing, Cranmer Terrace, London

SW17 0RE.

Jacqueline Mullane, BSc (hons), MSc, Internal Box 8, Victor Horsely Dept of

Neurosurgery, National Hospital of Neurology and Neurosurgery, Queen Square,

London WC1 3BG.

Professor Michael Hurley, PhD, St Georges University of London, Faculty of

Health and Social Care Sciences, 2nd Floor Grosvenor Wing, St Georges

Hospital, Cranmer Terrace, London, SW17 0RE.

Support and Funding; Funding for this protocol and subsequent trial was

provided by the NIHR. This paper presents independent research funded by the

National Institute for Health Research (NIHR). The views expressed are those of

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mailto:[email protected]


the author(s) and not necessarily those of the NHS, the NIHR or the Department

of Health.

Acknowledgements; KB- Kate Brunskill, Librarian, UCL (for her invaluable

professional advice and support in developing and utilising the search

strategy).

Abstract

Study design; Systematic review with meta-analysis.

Objective; To conduct a systematic review and meta-analysis of current

evidence evaluating the effectiveness of rehabilitation following lumbar

fusion surgery (LFS).

Summary of background data; LFS for the management of lower back

pain, with(out) neurogenic leg pain, is increasing as the population ages.

Clinical outcomes commonly lag behind surgical outcomes and 40% of

patients experience significant back related disability 12 months after LFS.

Identifying rehabilitation strategies to improve function and quality of life

following LFS is important.

Methods; A systematic review of databases were searched, including

MEDLINE, CINAHL and grey literature. Studies identified were screened for

inclusion by title and abstract. Full text of eligible/potentially eligible

studies were evaluated against predetermined eligibility criteria. Included

studies were subjected to critical appraisal and risk of bias evaluation. The

GRADE approach to quality of evidence was utilised. A meta-analysis

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comparing usual care with ‘complex rehabilitation’, comprising exercise and

cognitive behavioural therapy, for outcomes relating to pain, disability, fear

of movement and mental health was conducted at short and longer term (<3

and >12 months post-surgery) time points.

Results; Three studies were identified for the systematic review and two

included in the meta-analysis (n=237, female=62%, mean age=55). Low

quality evidence suggests ‘complex rehabilitation’ provides short term

improvement in disability (effect size,-0.85, 95% CI, -1.41, -0.29) and fear

avoidance behaviour (-1.07, 95% CI -1.33, -0.80), compared with usual care.

Low quality evidence exists favouring ‘complex rehabilitation’ over usual

care for longer term disability (-0.84, 95% CI -1.11, -0.58) and fear

avoidance behaviour (-1.40, 95% CI –1.69 to -1.12).

Conclusions; A small number of low quality studies suggest ‘complex

rehabilitation’ reduces short and long term disability and fear avoidance

behaviour following LFS. More, high quality research is required to confirm the

effectiveness of ‘complex rehabilitation’ programmes.

Key words; systematic review, meta-analysis, lumbar fusion, spinal

surgery, rehabilitation, physiotherapy, cognitive behavioural therapy.

OCEBM; Level 1

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Key Points

1. Currently there are high levels of patient dissatisfaction following LFS.

2. ‘Complex rehabilitation’ reduces disability and fear avoidance behaviour in both

short and longer term following LFS.

3. There is a need for high quality, mixed methods studies with economic

evaluation, to better understand patient needs and optimum rehabilitation

strategies following LFS.

Mini abstract

Following lumbar fusion surgery many patients suffer back related disability. We

report a systematic review of evidence evaluating rehabilitation following

lumbar fusion. A meta-analysis comparing ‘complex rehabilitation’, combining

exercise with cognitive behavioural therapy, improved short and long-term

disability and fear avoidance behaviour. High quality research is needed to

confirm this.

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Rehabilitation following lumbar fusion surgery: a systematic review

and meta-analysis.

Introduction;

Lumbar fusion surgery (LFS) is undertaken to rigidly stabilise adjacent

vertebral motion segments. This is commonly undertaken with

simultaneous surgical decompression of affected neural tissue, to relieve

back and/or associated neurogenic leg symptoms [1-3]. Common surgical

indications include spondylolisthesis, disc disease and stenosis [4-6].

In the UK the rate of LFS is increasing, in 2009/10 4036 were performed

increasing by over 60% to 6547 by 2012/13 [7]. A similar trend of

escalating LFS is reported in the USA, particularly in patients over 60 years

[8]. It is suggested that as 30% of the UK population is predicted to be over

60 by 2037 [9] rates of LFS will continue rising.

Following LFS many patients have residual problems. Data from the

Swedish National Spine Register reports that 25% of patients experience

static/worsening pain and 40% are unsure/dissatisfied with outcomes 12

months after LFS [10]. It is timely, therefore, to evaluate mechanisms to

improve post-surgical clinical outcomes.

A recent Cochrane Back Review Group (CBRG) report suggests

rehabilitation (supervised active exercise) following laminectomy surgery

for lumbar stenosis, reduces pain and improves functional status [11]. It is

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not clear if this applies to LFS, with no clear consensus regarding the

efficacy of rehabilitation following LFS [12].

A previous systematic review and meta-analysis found inconclusive, very

low quality evidence for the effectiveness of physiotherapy (exercise,

manual therapy, electrotherapy, cognitive behavioural therapy (CBT))

following LFS, further research was an ‘urgent consideration’ [13].

Objectives

This review was undertaken to appraise the evidence evaluating

rehabilitation strategies, in adults, having undergone LFS for degenerative

conditions. Eligible trials included randomised design, suitable comparator

(eg; usual care) and validated outcome measures related to pain and/or

disability in the short and longer term (<6/>12 months respectively).

Materials and Methods

Protocol and registration

A protocol based on methods described by the CBRG and Cochrane

Handbook [14, 15] was utilised. Reporting was in accordance with the

PRISMA statement [16] and registered with the International Prospective

Register of Systematic Reviews (POSPERO).

Eligibility criteria

Studies describing rehabilitation following LFS, fulfilling the criteria below,

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were included in the review.

Study inclusion criteria.

Design; Randomised Controlled Trial (RCT).

Participants; >16 years, LFS for degenerative conditions.

Intervention; Rehabilitation (physical, psychological or combined).

Comparator; Suitable comparator, eg usual care.

Date; 1974 onwards.

Reporting; Short and long-term (<6 months, >12 months).

Outcome measures; One or more validated measure of pain/physical

function.

Language; any, translation arranged as necessary.

Information sources

The following databases were utilised.

CINAHL, EMBASE, MEDLINE, PEDro, PsycINFO, databases.

Cochrane library; Health Technology Assessment Database, NHS Economic

Evaluation database.

National Research Register, Current Controlled Trial website (York).

Cochrane Back Review Group.

Grey literature.

Hand searches key journals.

Search strategy

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The search strategy employed a 3-phase approach. A scoping search of

MEDLINE, AMED and CINAHL utilising combinations of keywords, lumbar,

fusion and rehabilitation was undertaken. Titles and abstracts of the results

identified specific keywords to develop a comprehensive search strategy,

trialed and modified with librarian assistance (KB). The final phase included

hand searching of key journals and grey literature.

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Table 1; Example search strategy employed for MEDLINE

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Study selection

Two review authors (JG, JM) independently searched the databases. Results

were saved, pooled, duplicates removed and combined with those from grey

literature and hand searches.

Titles were reviewed by one author (JG), rejecting those unrelated to the

topic of interest. Abstracts of the remaining articles (n=34) were obtained,

reviewed by two authors (JG, JM) and graded; eligible, ineligible or

potentially eligible according to the inclusion criteria. Disagreements

between authors were measured (Cohen’s k) and mediated via a third party

(AM, subject and methodological expert) to achieve consensus.

Full text of eligible and potentially eligible abstracts were retrieved and

evaluated independently, by two authors (JG, JM), to determine eligibility

for inclusion in the review. Inter-reviewer agreement was measured

(Cohen’s k). Disagreements between authors were resolved via a 3rd party

mediator (AM) to achieve consensus.

Data extraction

A data extraction form, based on the ‘characteristics of included studies’

table from the Cochrane Handbook, [15] was piloted in parallel with the

development of the search strategy and modified to match the needs of this

review. Data extraction was undertaken independently by two reviewers

(JG, JM). A third reviewer (MH) checked the form against selected studies

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for accuracy of data imputation. Authors of studies included in the review

were contacted for raw data. This was received from one study [17].

Extracted data items

Study design, participants (including surgical indications), interventions,

comparators, primary and secondary outcome measures (short/longer term

time points) and results, including disability, pain, mental health and fear

avoidance behaviour. No simplifications or assumptions were made.

Risk of bias within individual studies

The Cochrane risk of bias assessment tool was used to assess internal

validity and potential sources of systematic error.

Summary measures and synthesis of results

The protocol only allowed inclusion of studies with similar participants,

interventions, comparators and outcomes. The review authors identified

short and longer term outcomes for disability, pain, mental health and fear

avoidance behaviour as suitable for pooled analyses across studies.

Meta-analysis using RevMan [18] software, utilising the inverse variance

model for continuous data (change in mean values from baseline), was

employed. The DerSimonian Laird [19] random effects model was utilised

to accommodate the assumption that the studies were reporting different,

yet related, intervention effects. Confidence intervals (CI) were set at 95%

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and mean change from baseline scores analysed using the standardised

mean difference [15].

The standard deviation (SD) for mean change from baseline was available

for one study [20], raw data provided by the corresponding author was

utilised to calculate this for the other [17].

Risk of bias across studies

Formal risk of bias across studies was not indicated due to the paucity of

studies. Funnel plots were not warranted. The quality of evidence using the

GRADE criteria [21] was reported.

Additional analyses

The lack of studies precluded additional analysis.

Results

Study selection process

Identified databases were searched (JG, JM, 13th/20th October, 2014

respectively). This yielded 1006 results, screened by title, (JG) removing

972 irrelevant papers/duplicates. Abstracts for the 34 remaining articles

were retrieved and reviewed (JG, JM), leaving 13 papers considered

eligible/potentially eligible for full text review. Inter-reviewer reliability

was good (Cohen’s k 0.78).

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Five papers, reporting data from 3 original studies, were selected for

inclusion in the review with very good agreement between authors

(Cohen’s k 0.88).

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Fig 1; Flow chart of study selection process with reasons for rejection

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Study characteristics

Intro

Three papers met the eligibility criteria for inclusion in this review [12] [22]

[17]. All three studies compared usual care with innovative form(s) of

rehabilitation. Christensen et al compared usual care with a ‘back café’

group and a physical training group [12], Abbott et al with ‘psychomotor

therapy’ [22] and Monticone et al with exercise and CBT [17].

Detail of studies

In the study by Christensen et al, [12] participants (n=90, mean age 45)

were randomised to 3 intervention arms. They compared usual care (video

demonstration and single physiotherapy session for explanation of

exercises) with two innovative intervention groups (‘back café’ and physical

training groups). Rehabilitation commenced 3 months after LFS.

The physical training group was offered twice-weekly physiotherapy

appointments (90 minutes each) for supervised exercises over 8 weeks. The

‘back café’ group received usual care (video and advice) and in addition,

was invited to attend a ‘back café’. This consisted of 3 meetings (90 minutes

each) with other LFS patients and a physiotherapist modulator. The

purpose was to exchange experiences related to pain, disability, concerns

regarding rehabilitation and coping strategies.

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A primary outcome measure was not identified but evaluation with the low

back pain rating (LBPR) scale [23] was reported at 3, 6, 12 and 24 months

post LFS.

Abbott et al [22] randomised participants (n=107, mean age 51 years) to

either usual care or ‘psychomotor therapy’. The usual care group (n=54)

received a single session of exercise advice (20 minutes) delivered in

Hospital by a physiotherapist. The ‘psychomotor therapy’ group (n=53)

received usual care and three 90-minute Hospital outpatient appointments

(post-operative weeks 3, 6 and 9). These outpatient visits consisted of

physiotherapist-supervised core stability exercises, education, training in

cognitive coping strategies, relaxation, motivational goal setting and help

managing blocks to recovery/relapses. This combined physical

rehabilitation based on the work of Richardson et al [24] and CBT based on

the work of Linton [25] was coined ‘psychomotor therapy’ by the authors.

Rehabilitation was commenced within 3 weeks of discharge following LFS.

The primary outcome measure was the Oswestry Disability Index (ODI)

reported 3, 6, 12 and 24-36 months post-LFS. Secondary outcomes included

measures of pain, visual analogue scale (VAS), quality of life (QoL),

European Quality of Life Questionnaire (EQ-5D), mental health, the mental

health sub-scale of the Short Form Health Survey (SF-36) and fear

avoidance behaviour, Tampa Scale of Kinesiophobia (TSK).

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Monticone et al [17] randomised participants (n=130, mean age 57) to usual

care or an ‘experimental group’. Usual care consisted of supervised exercise

sessions (90 minutes), 5 times per week, for 4 weeks. The ‘experimental

group’ received usual care and additionally CBT (60 minutes) twice-weekly

for 4 weeks. Rehabilitation commenced after LFS, the exact time is not well

described.

The primary outcome was post-rehabilitation change in ODI score.

Secondary outcomes included TSK, pain, Numerical Rating Scale (NRS) and

QoL, including mental health (SF-36). Outcomes were recorded pre-

treatment, immediately post rehabilitation and at 12 months following LFS.

Summary data for included studies is given in Table 2.

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Table 2; Summary data from included studies evaluating rehabilitation following LFS.

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Table 2; Summary data from included studies evaluating rehabilitation following LFS (cont).

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Table 2; Summary data from included studies evaluating rehabilitation following LFS (cont).

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Risk of bias

The paper by Christensen et al, [12] had a mixture of high and unclear risk

of bias domains. Subsequent publications describing the long term primary

health care demands [26] and economic analysis [27], did not change the

overall risk of bias. Papers by Abbott et al [22] and Moticone et al, [17] had a

lower overall risk of bias, with one unclear and one high risk domain, the

remaining domains being low risk (Fig 2). Agreement between study

authors was good (Cohen’s k 0.72).

The nature of the interventions made blinding participants problematic to

adequately achieve, all three studies had this high-risk domain in common.

This is unlikely to have significantly affected results.

Fig 2; Risk of Bias Summary Table

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Synthesis of results

The reporting of median and range (non-parametric) data in the study by

Christensen et al, [12] precludes its inclusion in the meta-analysis. Abbott et

al [22] and Monticone et al [17] both describe a usual care (exercise) arm

and an experimental (exercise plus CBT) arm. For the purposes of this

review the combined, exercise plus CBT, approach was referred to as

‘complex rehabilitation’. Data were pooled to compare ‘complex

rehabilitation’ versus usual care across comparable outcomes. The

consensus amongst review authors was to pool data for disability (ODI),

back pain (VAS and NRS), mental health (SF-36, mental health sub-scale)

and fear avoidance behaviour (TSK).

The results of 2 individual studies [17, 22] with an unclear risk of bias were

pooled, (n=237, females=62%, mean age=55) to compare mean change from

baseline, at short and longer-term time points, for participants undergoing

usual care versus ‘complex rehabilitation’. Short term follow up in both

studies was immediately post rehabilitation, Abbott reports this as 3

months post LFS [22], Monticone et al reports this as immediately following

the 4 week rehabilitation regime [17]. Pooled data evaluating longer term

follow up was one year following entry into both studies.

In the short term one study showed evidence of significant improvements in

disability, back pain and fear avoidance behaviour [22]. The other study

reported significant improvements in disability, pain (low back and leg),

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fear avoidance behaviour, and mental health [17]. In both cases these

results favoured ‘complex rehabilitation’ over usual care.

Pooled analysis of the two studies suggests a significant short-term effect

for disability (effect size, -0.85, 95% CI -1.41, -0.29, Fig 3a) and fear

avoidance behaviour, (-1.07, 95% CI -1.33, -0.80, Fig 3b) favouring ‘complex

rehabilitation’. Pooled analysis for short-term low back pain (LBP) narrowly

failed to reach levels of significance (-0.71, 95% CI -1.44, 0.01, Fig 3c).

Fig 3a; meta-analysis results, short term disability

Fig 3b; meta-analysis results, short term fear avoidance behaviour

Fig 3c; meta-analysis results, short term low back pain

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Heterogeneity (I2) was high in the pooled analysis for disability (77%, Fig

3a) and LBP (87%, Fig 3c) perhaps contributing to the lack of effect.

Heterogeneity for fear avoidance behaviour was lower (0%, Fig 3b).

In the longer term, (12 months) one study reported significant

improvements in disability and fear avoidance behaviour [22], the other

reported significant improvements in disability, pain (back and leg), fear

avoidance behaviour and mental health [17]. In all cases this favoured

‘complex rehabilitation’.

Pooled analysis revealed levels of statistical significance for disability (effect

size -0.84, 95% CI, -1.11, -0.58, Fig 4a) and fear avoidance behaviour (-1.40,

95% CI -1.69, -1.12, Fig 4b) in favour of ‘complex rehabilitation’.

Fig 4a; meta-analysis results, long term disability

Fig 4b; meta-analysis results long term fear avoidance behaviour

Heterogeneity was acceptable in both meta-analyses.

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The long-term meta-analysis for LBP (Fig 5) did not support any positive

effect of ‘complex rehabilitation’ over usual care.

Figure 5; meta-analysis results, long-term low back pain

Risk of bias across studies

Two studies were included in the meta-analysis [17, 22]. Both studies had

one high risk domain (blinding participants), and one also had an unclear

risk of bias (blinding outcome assessment) [22]. The summary risk of bias

assessment has the majority of information coming from studies with a

low/unclear risk of bias and the overall risk of bias across studies is

therefore unclear (Fig 2).

Discussion

Summary of evidence

Results from this systematic review and meta-analysis suggests patients

undergoing ‘complex rehabilitation’ have lower levels of self reported

disability and reduced fear avoidance behavior compared to patients

receiving usual care for up to 12 months following LFS. Therefore usual

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care as currently provided may contribute to the reported dissatisfaction

with LFS amongst some patients [10].

The results from this review contrast with a previous review which showed

no effect of physiotherapy following LFS [13]. This is most likely due to the

exclusion of the Christensen study [12], and the inclusion of the recent

study by Monticone et al [17]. This enabled a wider comparison between

studies and increased the number of participants in the pooled analyses.

It is proposed that 12.4% represents the minimally important clinical

difference in the Oswestry Disability Index [28]. The studies of Abbott et al

[22] and Monticone et al [17] showed that ‘complex rehabilitation’ could

produce a clinically meaningful reduction in disability in the short and

longer term.

Monticone et al [17] showed the largest reduction in disability (ODI). This is

possibly related to the greater content of the ‘experimental group’

intervention, however dose response relationships in pain rehabilitation

programs for chronic low back pain are contentious [29] . The setting, a

specialised, multi-professional, rehabilitation centre, may also have

contributed to the greater effect size.

Limitations

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The main factor limiting this review is the lack of available studies for

inclusion in the meta-analyses. The strength of evidence, using the GRADE

assessment [21], was low so further research is very likely to have an

important impact on the estimated effect sizes.

The meta-analysis should be interpreted within the context of potential

risks of bias (unclear) across the two included studies. Service

users/providers and commissioners alike should be mindful of this.

There are limitations related to the varied composition of both usual care

and ‘complex rehabilitation’ groups in each study. Both provide a CBT

component as an adjunct to exercise therapy, however the volume of the

‘complex rehabilitation’ intervention is markedly different between studies.

Monticone et al [17] reported a maximum of 38 hours of ‘complex

rehabilitation’ compared with 4.8 hours in the study by Abbott et al [22].

The composition of usual care also varied between studies, Abbott et al [22]

and Christensen et al [12] utilised largely self directed home exercise

regimes following a single session of advice from a physiotherapist.

Monticone et al [17] describe a maximum of 30 hours of supervised exercise

over a period of one month. This variation will have contributed to the

heterogeneity observed and the overall lack of effect in some comparisons.

Conclusions

‘Complex rehabilitation’, comprising exercise and CBT, offers short and

longer term functional benefits to patients following LFS. A lack of high

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quality research in this area remains. If commissioners and surgical teams

are to continue providing LFS, more research needs to be undertaken to

better understand patients post-operative requirements and the optimal

rehabilitation regimens that are best designed to meet these needs.

Further research needs to be of a higher methodological quality, with

clearer reporting, including compliance, which has been shown to be

problematic in comparable works [30]. Mixed methods of evaluation,

proposed as the new gold standard’ of clinical research [31], should be

employed with robust economic evaluation to assess affordability. Recent

guidelines on the process evaluation of complex interventions should be

considered [32].

Studies will need to consider the possible mechanistic underpinning of

interventions and highlight the ‘active’ components of rehabilitation

strategies. The current review demonstrates a significant and meaningful

improvement in physical function and fear avoidance behavoiur,

independent of pain. It is difficult to currently discern whether reported

gains are due to improvements in physical conditioning, psychological

functioning, or both. Further work in this area is needed and there is at least

one protocol [33] and one study published since this review was

undertaken [34] expanding the evidence base.

References

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1. Wiltfong, E., et al., Lumbar interbody fusion: review of history, complications, and outcome comparisons among methods. Current Orthopaedic Practice, 2012. 23(3): p. 193-203.

2. Phillips, F.M., et al., Lumbar spine fusion for chronic low back pain due to degenerative disc disease: a systematic review. Spine, 2013. 38(7): p. E409-22.

3. Martin, B.I., et al., Are lumbar spine reoperation rates falling with greater use of fusion surgery and new surgical technology? Spine, 2007. 32(19): p. 2119-2127.

4. Cole, C.D., et al., Comparison of low back fusion techniques: transforaminal lumbar interbody fusion (TLIF) or posterior lumbar interbody fusion (PLIF) approaches. Current reviews in musculoskeletal medicine, 2009. 2(2): p. 118-26.

5. Fairbank, J., et al., Randomised controlled trial to compare surgical stabilisation of the lumbar spine with an intensive rehabilitation programme for patients with chronic low back pain: the MRC spine stabilisation trial. BMJ, 2005. 330(7502).

6. Gibson, J.N. and G. Waddell, Surgery for degenerative lumbar spondylosis: updated Cochrane Review. Spine, 2005. 30(20): p. 2312-20.

7. HES Online, T.i., The health and social care information centre, http://hesonline.nhs.uk. 2014. Accessed 20th Jan 2014.

8. Deyo, R.A., et al., United States Trends in Lumbar Fusion Surgery for Degenrative Conditions. Spine, 2005. 30: p. 1441-5.

9. Statistics, O.f.N., National Population Projections, 2012-based Statistical Bulletin. 2013.

10. Stromqvist B, F.P., Hagg O, et al., Follow-up of Lumbar Surgery in Sweden 2007, The Swedish National Spine Register. The Swedish Spinal Surgery Society, 2007. available at http://www.4s.nu/pdf/.

11. McGregor, A.H., et al., Rehabilitation following surgery for lumbar spinal stenosis. Cochrane Database of Systematic Reviews, 2013. 12.

12. Christensen, F.B., I. Laurberg, and C.E. Bunger, Importance of the back-cafe concept to rehabilitation after lumbar spinal fusion: a randomized clinical study with a 2-year follow-up. Spine, 2003. 28(23): p. 2561-9.

13. Rushton, A., et al., Physiotherapy rehabilitation following lumbar spinal fusion: a systematic review and meta-analysis of randomised controlled trials. BMJ Open, 2012. 2(4).

14. Furlan, A., Pennick, V Bombardier, C, van Tulder, M, 2009 Updated Method Guidelines for Systematic Reviews in the Cochrane Back Review Group. Spine, 2009. 34(18): p. 1929-41.

15. Higgins JPT, G.S.e., Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0 [updated March 2011]. The Cochrane Collaboration, 2011: p. Available from http://www.cochrane-handbook.org.

16. Moher D, L.A., Tetzlaff J, Altman DG, The PRISMA Group (2009), Preferred Reporting Items for Systematic Reviews and Meta-Analyses: The PRISMA Statement. PLoS Med, 2009. 6(7): p. e1000097. doi:10.1371/journal.pmed.1000097.

17. Monticone, M., et al., Management of catastrophising and kinesiophobia improves rehabilitation after fusion for lumbar spondylolisthesis and

29

http://www.cochrane-handbook.org/

http://www.cochrane-handbook.org/

http://www.4s.nu/pdf/

http://hesonline.nhs.uk/


stenosis. A randomised controlled trial. European Spine Journal, 2014. 23: p. 87-95.

18. Review Manager, R.C.p., Version 5.3. Copenhagen: The Nordic Cochrane Centre, The Cochrane Collaboration. 2014.

19. DerSimonian, R., Laird, N, Meta-analysis in clinical trials. Controlled Clinical Trials, 1986. 7: p. 177-188.

20. Abbott, A.D., R. Tyni-Lenne, and R. Hedlund, Early rehabilitation targeting cognition, behavior, and motor function after lumbar fusion: a randomized controlled trial [with consumer summary]. Spine, 2010. 35: p. 848-857.

21. GRADE, W.G., Grading quality of evidence and strength of recommendations. BMJ, 2004. 328: p. 1490-4.

22. Abbott, A.D., R. Tyni-Lenne, and R. Hedlund, Early rehabilitation targeting cognition, behavior, and motor function after lumbar fusion: a randomized controlled trial. Spine, 2010. 35(8): p. 848-57.

23. Claus Manniche, K.A., Birgitte Lauritsena, Henrik Vinterberga, Svend Kreinerb, Alan Jordanc, Low Back Pain Rating scale: validation of a tool for assessment of low back pain. Pain, 1994. 57(3): p. 317-326.

24. Richardson C, H.P., Hides J, Therapeutic Exercise for Lumbopelvic Stabilization. A Motor Control Approach for the Treatment and Prevention of Low Back Pain. 2nd Edition, Edinburgh, 2005. Churchill Livingston.

25. Linton, S., J, Understanding Pain for Better Clinical Practice: A Psychological Perspective. 1st Edition, Edinburgh, 2005. Elsevier.

26. Soegaard, R., et al., Lumbar spinal fusion patients' demands to the primary health sector: evaluation of three rehabilitation protocols. A prospective randomized study. European Spine Journal, 2006. 15(5): p. 648-56.

27. Soegaard, R., et al., Cost-effectiveness evaluation of an RCT in rehabilitation after lumbar spinal fusion: a low-cost, behavioural approach is cost-effective over individual exercise therapy. European Spine Journal, 2008. 17(2): p. 262-71.

28. Carreon, L.Y., et al., Differentiating minimum clinically important difference for primary and revision lumbar fusion surgeries. Journal of Neurosurgery Spine, 2013. 18(1): p. 102-6.

29. Waterschoot, F., Dijkstra, P, Hollak, N, de Vries, H, Geerzen, J, Reneman, M., Dose or content? Effectiveness of pain rehabilitation programs for patients with chronic low back pain: A systematic review. Pain, 2014. 155: p. 179-189.

30. McGregor, A.H., et al., ISSLS prize winner: Function After Spinal Treatment, Exercise, and Rehabilitation (FASTER): a factorial randomized trial to determine whether the functional outcome of spinal surgery can be improved. Spine, 2011. 36(21): p. 1711-20.

31. Miller, W., Cradtree, B, Denzin, N, Lincoln, Y, Clinical research: the handbook of qualitative research. Thousand Oaks, CA: Sage, 2000.

32. Moore G, A.S., Barker M, Bond L, Bonell C, Hardeman W, Moore L, O’Cathain A, Tinati T, Wight D, Baird J, Process evaluation of complex interventions: Medical Research Council guidance. MRC Population Health Science Research Network, London, 2014.

33. Greenwood, J., G, McGregor, A, Jones, F, Hurley, M, V, Evaluating rehabilitation following lumbar fusion surgery (REFS): study protocol for a randomised controlled trial. Trials, 2015. 16: p. 251.

30


34. Rolving, N., Nielsen, C, V, Christensen, F, B, Holm, R, Bunger, E, Oestergaard, L, G, Does a Preoperative Cognitive-Behavioral Intervention Affect Disability, Pain Behavior, Pain, and Return to Work the First Year After Lumbar Fusion Surgery? Spine, 2015. 40(9): p. 593-600.

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