Spinal Stenosis Clinical Trial
Official title:
Pre-surgery Physiotherapy for Patients With Specific Low Back Pain , RCT
The aim is to study if pre-surgery physiotherapy improves function, pain and health in patients with specific low back pain scheduled for surgery. Patients are followed over a two year period. A secondary aim is to study what factors predict short and long term outcomes.
The design is a randomized controlled trial, where patients are allocated either to
pre-surgery physiotherapy or waiting-list when scheduled for surgery due to specific low back
pain (spinal stenosis, disc herniation, spondylolisthesis, disc degenerative disease (DDD)).
The patients are scheduled for surgery due to specific low back pain diagnosis and randomized
to either pre-surgery physiotherapy or waiting-list group. Clinical measurement and
treatment-classification is done before and after intervention.
Pre-surgery intervention:
Physiotherapy guided intervention twice a week for nine weeks. The program includes:
1. Active physiotherapy according to a treatment based classification
1. Specific exercises and mobilization
2. Motor control exercises
3. Traction
2. Tailor-made general supervised exercise program
3. Behavioral approach to reduce fear avoidance and increase activity level.
Both groups receive standardized information about surgery, post-surgery rehabilitation and
to stay active.
Surgery in performed according to existing guidelines.
Measurements:
Patients fill out a questionnaire at baseline, before surgery (after pre-surgery
physiotherapy or waiting-list), three months, one and two years after surgery. The
questionnaire includes self-reported measures for function Oswestry Disability Index (ODI)
(primary outcome), pain (VAS, pain drawing, pain duration) and health (SF-36, EQ-5D),
anxiety, depression (HADS), self efficacy, fear avoidance belief questionnaire (FABQ),
workability, (WAI), expectations, general information of work, sick-leave, lifestyle
behavior, previous healthcare consumption, patient reported treatment effects, patient
enablement instrument (PEI), and adverse events.
Clinical measurement is done before and after intervention. Clinical measurements includes;
isometric quadriceps strength, walking-test, neurological tests for L4-S1, SI-joint tests,
Posterior-anterior-test (PA-test), test for centralization, test for aberrant movements.
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