Physiotherapy Post Lumbar Discectomy: Prospective Feasibility and Pilot Randomised Controlled Trial

Objectives To evaluate: acceptability and feasibility of trial procedures; distribution of scores on the Roland Morris Disability Questionnaire (RMDQ, planned primary outcome); and efficient working of trial components. Design and Setting A feasibility and external pilot randomised controlled trial (ISRCTN33808269, assigned 10/12/2012) was conducted across 2 UK secondary care outpatient physiotherapy departments associated with regional spinal surgery centres. Participants Consecutive consenting patients aged >18 years; post primary, single level, lumbar discectomy. Interventions Participants were randomised to either 1:1 physiotherapy outpatient management including patient leaflet, or patient leaflet alone. Main Outcome Measures Blinded assessments were made at 4 weeks post surgery (baseline) and 12 weeks post baseline (proposed primary end point). Secondary outcomes included: Global Perceived Effect, back/leg pain, straight leg raise, return to work/function, quality of life, fear avoidance, range of movement, medication, re-operation. Results At discharge, 110 (44%) eligible patients gave consent to be contacted. 59 (54%) patients were recruited. Loss to follow up was 39% at 12 weeks, with one site contributing 83% losses. Mean (SD) RMDQ was 10.07 (5.58) leaflet and 10.52 (5.94) physiotherapy/leaflet at baseline; and 5.37 (4.91) leaflet and 5.53 (4.49) physiotherapy/leaflet at 12 weeks. 5.1% zero scores at 12 weeks illustrated no floor effect. Sensitivity to change was assessed at 12 weeks with mean (SD) change -4.53 (6.41), 95%CI -7.61 to -1.44 for leaflet; and -6.18 (5.59), 95%CI -9.01 to -3.30 for physiotherapy/leaflet. RMDQ mean difference (95%CI) between change from baseline to twelve weeks was 1.65(-2.46 to 5.75). Mean difference (95%CI) between groups at 12 weeks was -0.16 (-3.36 to 3.04). Participant adherence with treatment was good. No adverse events were reported. Conclusions Both interventions were acceptable, and it is promising that they both demonstrated a trend in reducing disability in this population. A randomised controlled trial, using a different trial design, is needed to ascertain the effectiveness of combining the interventions into a stepped care intervention and comparing to a no intervention arm. Findings will guide design changes for an adequately powered randomised controlled trial, using RMDQ as the primary outcome

Les retombées d’une étude en réadaptation : un exemple concret appliqué à des jeunes adultes entendants ayant grandi avec des parents sourds

Cet article décrit les retombées d’une étude sur la participation sociale de jeunes adultes ayant grandi avec des parents sourds au plan des services cliniques offerts à ces familles à l’Institut de réadaptation en déficience physique de Québec (IRDPQ), et relate les actions entreprises par l’équipe clinique afin de mettre sur pied une association CODA (de l’acronyme anglais Children of Deaf Adults) dans la province de Québec. À la suite de cette étude, la pertinence du service d’aide aux devoirs pour les enfants d’âge scolaire a été confirmée. De plus, l’orthophoniste de l’équipe a élargi son champ d’intervention : la capacité langagière des enfants entendants est évaluée tant en français qu’en langue des signes québécoise (LSQ) et l’usage de la LSQ est promu encore davantage, par la valorisation auprès des parents sourds du rôle de transmetteurs de leur langue. Toutefois, l’étude a fait ressortir que certains besoins des codas d’âge adulte étaient demeurés jusqu’ici non comblés par les services de réadaptation, notamment au plan psychosocial. Les démarches ayant mené à la mise sur pied d’une association CODA (appelée CODA Québec) ont débuté à la fin de l’année 2008 avec un colloque ayant regroupé 65 participants (sourds, codas et conjoints entendants). Par la suite, avec le soutien de l’IRDPQ, les conditions légales de l’association ont été fixées et des collaborations avec le milieu communautaire sourd ont été établies, et ce, dès la fin de 2009. La réalisation du projet de participation sociale que constitue la mise sur pied de CODA Québec confirme que les résultats de recherche ont non seulement eu des effets directs sur les interventions cliniques, mais ont également permis aux intervenants d’identifier un besoin de même que les moyens d’y répondre, ce qui en bout de ligne, permettra aux codas de se reconnaître et de s’entraider.This article describes the benefits of a study on social participation of young adults who grew up with deaf parents in terms of clinical services provided to these families at the Quebec City Rehabilitation Institute (Institut de réadaptation en déficience physique de Québec or IRDPQ)and reviews the actions undertaken by the clinical team in order to set up an association for CODA (Children of Deaf Adults) in the province of Quebec. This study confirms the relevance of homework assistance services offered to school age children. Moreover, the team speech therapist’s scope of action was expanded; the language capacities of hearing children are now assessed both in French and QSL. This further promotes the use of QSL and enhances the hearing child’s role in the transmission of their deaf parent’s language. However, this case study highlights the needs of adult CODAs that are not being met by rehabilitation services, particularly at a psycho-social level. Approaches leading to the creation of an association for CODA (called CODA Québec) were initiated at the end of 2008 through a seminar involving 65 participants (deaf people, CODAs and hearing spouses). Subsequently, with the support of IRDPQ, the association’s legal requirements were determined and collaborations with the deaf community were established by the end of 2009. The establishment of CODA Québec has not only had direct effects on clinical interventions, but has also allowed stakeholders to identify a need as well as the means to respond, which will ultimately allow codas to recognize and support each other