Author Names
Byungho K, Taeyeong K, Junghoon A, Heecheol C, Dongyun K, Bumchul Y
Reviewer Name
Madison Keller, SPT
Reviewer Affiliation(s)
Duke University School of Medicine, Doctor of Physical Therapy Division
Paper Abstract
Background: Studies have shown late post-operative physical disability and residual pain in patients following lumbar disc surgery despite growing evidence of its beneficial effects. Therefore, rehabilitation is required to minimise the late post-operative complications. Objective: To assess the feasibility of manipulative rehabilitation to improve late post-operative outcomes. Methods: Twenty-one patients aged 25-65 years undergoing lumbar microdiscectomy were randomly assigned to the rehabilitation group (n= 14) or active control group (n= 7) by simple randomisation. Eight rehabilitation sessions were initiated 2-3 weeks after surgery. Thirty-minute sessions were conducted twice weekly for four weeks. Post-operative physical disability and pain were assessed at baseline and at the two-year follow-up. Results: Post-operative physical disability improved more in patients who had undergone rehabilitation than in those who had received control care (63% vs. -23%, P< 0.05). Post-operative residual low back and leg pain were alleviated in the treatment group (26% and 57%, respectively), but intensified in the control group (-5% and -8%, respectively). Conclusions: This study demonstrated the potential of manipulative rehabilitation and importance of post-operative management after lumbar disc surgery. Definitive trials with larger sample sizes are required to confirm the feasibility and potential therapeutic effectiveness of this approach.
NIH Risk of Bias Tool
Quality Assessment of Controlled Intervention Studies
- Was the study described as randomized, a randomized trial, a randomized clinical trial, or an RCT?
- Yes
- Was the method of randomization adequate (i.e., use of randomly generated assignment)?
- Yes
- Was the treatment allocation concealed (so that assignments could not be predicted)?
- Yes
- Were study participants and providers blinded to treatment group assignment?
- No
- Were the people assessing the outcomes blinded to the participants’ group assignments?
- No
- Were the groups similar at baseline on important characteristics that could affect outcomes (e.g., demographics, risk factors, co-morbid conditions)?
- Yes
- Was the overall drop-out rate from the study at endpoint 20% or lower of the number allocated to treatment?
- Yes
- Was the differential drop-out rate (between treatment groups) at endpoint 15 percentage points or lower?
- Yes
- Was there high adherence to the intervention protocols for each treatment group?
- Cannot Determine, Not Reported, or Not Applicable
- Were other interventions avoided or similar in the groups (e.g., similar background treatments)?
- Yes
- Were outcomes assessed using valid and reliable measures, implemented consistently across all study participants?
- Yes
- Did the authors report that the sample size was sufficiently large to be able to detect a difference in the main outcome between groups with at least 80% power?
- Yes
- Were outcomes reported or subgroups analyzed prespecified (i.e., identified before analyses were conducted)?
- Yes
- Were all randomized participants analyzed in the group to which they were originally assigned, i.e., did they use an intention-to-treat analysis?
- Yes
Key Finding #1
Two years post lumbar microdiscectomy, there was a 63% improvement in post-operative physical disability in participants in the osteopathic manipulative treatment (OMT) group, measured with the Roland-Morris Disability questionnaire (RDQ), compared to participants in the active control group which saw a reduction of 23% from their baseline score.
Key Finding #2
The OMT group demonstrated a significant decrease of 26% in low back pain, evaluated with a visual analogue scale (VAS), compared to participants in the active control group which saw a 5% increase in pain.
Key Finding #3
The OMT group demonstrated a 57% decrease in leg pain, evaluated with a VAS, compared to participants in the active control group which saw an 8% increase in pain.
Please provide your summary of the paper
This article evaluated the effect of manipulative therapy on outcomes of late-stage, two-years post-operative, post-lumbar microdiscectomy patients. Participants were randomized into two groups, the osteopathic manipulative treatment (OMT) group and the active control group. Techniques included in the biweekly OMT rehabilitation protocol included myofascial release techniques, osteopathic soft-tissue techniques, osteopathic joint mobilization techniques, counter-strain techniques, neuromuscular techniques, and muscle energy techniques. The active control group included verbal education on a home exercise program and prescription medications for pain and inflammation. The results of this study demonstrate significant improvements in outcomes including low back pain, leg pain, and disability in the OMT group compared to the active control group. However, this study has several limitations. Some of these limitations include lack of blinding of participants and researchers to the groups, lack of placebo group, and a small sample size of 21 participants. Based on the results of this study, there is evidence that OMT is effective in improving patient’s self-reported outcomes in late stage post-operative participants.
Please provide your clinical interpretation of this paper. Include how this study may impact clinical practice and how the results can be implemented.
This study demonstrates the effectiveness of osteopathic manipulative therapy on patients post lumbar disc surgery. However, there are many study limitations to consider when applying this research to clinical practice. Due to the small sample size, the results of this study should be further evaluated with a larger sample size for more generalizable clinical implications. Furthermore, replicating the methods of this study could prove difficult due to the fact that intensity and sequence of treatment techniques were individualized to each participant. It is important to have an individualized, patient-centered approach to treatment, and although the dosing of the treatment was not specified, there was an overall improvement in patient reported outcome measures with the OMT group, showing the effectiveness of this treatment on pain and disability scores.
