Early active rehabilitation after surgical treatment for lumbar disc herniation. A biopsychosocial function analysis

Introduction. Active rehabilitation initiated directly after surgical treatment after lumbar disc herniation has not previously been evaluated.Aims. The aim was to evaluate the effects of two home training programs, an early active training concept and a less active training program, after surgical treatment for lumbar disc herniation. Patients and methods. Sixty consecutive patients were randomized into 2 treatment groups after surgical treatment for lumbar disc herniation. In Studies I and IV, there was 8 dropouts. Thus, 26 patients received an early active training (EAT) concept with an active pain coping model and 26 patients had a less active training program with a passive pain coping model (control group). In Studies II and III, there were 2 more dropouts in the control group. An unbiased observer examined patients in both groups on the following occasions: before surgery, within a week after surgery and 3, 6, 12 and 52 weeks after surgery. The clinical assessment included the following measurements: range of motion of the lumbar spine, length of the hamstring muscles, prevalence of a positive SLR test and location and intensity of pain. The psychometric assessment included the Multidimensional Pain Inventory (MPI), Beck Depression Inventory (BDI) and State and Trait Anxiety Inventory (STAI). Sick leave and medication use was documented. Follow-up questionnaires were sent to the patients 1-3 and 5-7 years after surgery. Results. Pain intensity decreased significantly in both groups after surgery. At 6 weeks follow-up the prevalence of a positive SLR was significantly less in the EAT group. At 12 weeks follow-up range of motion of the lumbar spine was significantly increased in the EAT group. Scores of pain interference in the MPI questionnaire decreased significantly more in the EAT group at 12 and 52 weeks. Scores of state anxiety decreased in both groups. 5-7 years after surgery, 35 patients had returned to work and 32 patients were satisfied with the treatment outcome. In a discriminant analysis, the predictive value of the psychometric assessment showed that a combination of BDI, STAI and VAS correctly classified 78% of the patients that were dissatisfied 1-3 years after surgery and 76% of the satisfied patient. Patients who were dysphoric before surgery (BDI exceeding 9) did as well as nondysphoric patients 5-7 years after surgery.Conclusions. The early active training program had a positive effect on the physical parameters at the 6 and 12 week follow-ups, that subsided 52 weeks after surgery. Pain interference was significantly more improved in the EAT group 12 and 52 weeks after surgery. Psychometric analysis and pain intensity was a valuable tool for predicting the outcome of surgical treatment for lumbar disc herniation. The preoperative state of depression did not influence the long term results. The reoperation rate for lumbar disc herniation was not greater in patients treated in the early active training program 5-7 years after surgery

The inter-rater reliability of a standardised classification system for pregnancy-related lumbopelvic pain

Pregnancy-related lumbopelvic pain has varying clinical presentations and effects among subgroups. Different lumbopelvic pain subgroups require different specific management approaches which require the differentiation between lumbar and pelvic girdle pain (PGP). Thirty-one consecutive pregnant women with non-specific lumbopelvic pain were evaluated by two examiners and classified into lumbar pain, PGP, or combined pelvic girdle and lumbar pain. A standard history about different positions/activities of daily life such as bending, sitting, standing, walking, and lying, was followed by a standardised mechanical assessment of the lumbar spine (Mechanical Diagnosis and Therapy), including tests of repeated end-range movements to standing and lying, pelvic pain provocation tests (distraction test, posterior pelvic pain provocation test, Gaenslens test, compression test, and sacral thrust) a hip-rotation range-of-motion test, the active straight-leg-raising test, and a neurological examination. Agreement for the three syndromes (lumbar pain, PGP, or combined pelvic girdle and lumbar pain) was 87% (27/31), with a kappa coefficient of 0.79 (95% CI 0.60-0.98). It was possible to perform the classification procedure throughout pregnancy. There was substantial agreement between the two examiners for the classification of non-specific lUrnbopelvic pain into lumbar pain and PGP in pregnant women.Original Publication:Annelie Gutke, Gunilla Kjellby-Wendt and Birgitta Öberg, The inter-rater reliability of a standardised classification system for pregnancy-related lumbopelvic pain, 2010, MANUAL THERAPY, (15), 1, 13-18.http://dx.doi.org/10.1016/j.math.2009.05.005Copyright: Elsevier Science B.V., Amsterdamhttp://www.elsevier.com

Symptoms, care consumption, and healthcare costs in hospitalized patients during the first wave of the COVID-19 pandemic.

BackgroundWe aimed to assess symptomatology post discharge from the hospital in patients with COVID-19 treated during the first wave of the COVID-19 pandemic, and to follow care consumption and healthcare costs six months post discharge.MethodsThis study was a descriptive observational study over time. Data were retrieved from the Sahlgrenska University (SU) hospital registry for patients admitted to an SU hospital during March 2020 to August 2020. Of these, 1014 received a questionnaire approximately six weeks post discharge regarding symptoms. Data regarding care consumption were retrieved from the registry in the Region Västra Götaland for 529 (52.2%) patients who completed the questionnaire. Of these, 466 patients were included in the analysis of care consumption.ResultsThere was a reported decrease in mobility from admission to discharge in both men (p = 0.02) and women (p = 0.01). The costs of inpatient care amounted to a total of 9 601 459.20 Euro (EUR). Symptoms were reported in 436 (93.6%) patients post discharge, of which weight loss during COVID-19 was most common in both men (n = 220, 77.5%) and women (n = 107, 58.8%). During six-month follow-up, 409 (87%) patients consumed care. Of the registered visits, 868 (27.1%) were related to a COVID-19 diagnosis. The total sum of outpatient care (i.e. visits with a registered COVID-19 diagnosis) was 77 311.30 EUR.ConclusionsAt discharge from the hospital, there was a decrease in mobility. Most patients had remaining sequelae post discharge. At six months post discharge, nearly 90% of patients had consumed care, with approximately 20% related to COVID-19. This indicates a persisting need for rehabilitation post discharge from hospital in patients treated for COVID-19

Additional file 1: of Early coordinated rehabilitation in acute phase after hip fracture – a model for increased patient participation

Example of TLS-BasicADL protocol. (PDF 272 kb

Functional capabilities on admission and at discharge, N = 529.

Functional capabilities on admission and at discharge, N = 529.</p

Characteristics of the included patients, N = 529.

Characteristics of the included patients, N = 529.</p

Symptomatology, return to previous occupation and if the patient had sought care post discharge from hospitalization due to COVID-19, N = 466.

Symptomatology, return to previous occupation and if the patient had sought care post discharge from hospitalization due to COVID-19, N = 466.</p