Outcome of Physiotherapy Interventions among Patients having Post-Surgical Lumbar Disc Herniation Attended at CRP

Abstract

Background: Conservative approaches are evident to be gold standard management protocol for lumbar disc herniation (LDH), however surgery of LDH is essential in case of certain specification and failed cases of conservative care. As there is no multidisciplinary practice and existing evidence based guideline in the health sector in Bangladesh, referral to physiotherapy for LDH is limited. LDH cases are being treated with surgical approach very often and the post-surgical lumbar disc herniation cases are increasing with a predominance of recurrence within shorter duration. Aim: The aim of the study is to determine the outcome of physiotherapy interventions in post-operative recurrent cases of lumbar disc herniation at CRP; a renounced rehabilitation centre in Bangladesh. Methodology: A mixed study design has been applied, the quantitative analysis has been done by one arm prior and post experimental study design with hospital randomization. The qualitative analysis has been conducted by qualitative content analysis (QCA). Results: From November 2018 to April 2019, 42 respondents were employed, and 30 were analysed for quantitative outcome determination; 6 participants by QCA prior to open ended recorded interview according to algorithmic process. Outcome of physiotherapy in ICF components has been evaluated through comparison of mean difference between pre and post-test evaluation complying statistical significance, 95% CI and effect size. Significant difference has been noted in body structure and functions by pain and disability; in current pain mean 3.63± 1.95, 95% CI (2.92, 4.38), P= .00, effect size 1.86; highest pain state mean 4.23 ± 2, 95% CI (3.47, 4.97), P= .00, effect size 2.11 and lowest state mean 2.44± 1.79, 95% CI (1.78, 3.11), P= xiii

.00, effect size 1.36. In disability ODI mean was 16.93 ± 7.53, 95% CI (14.12, 19.76), P= .00, effect size 2.25. The respondents improved in activity limitations by FABQ fear due to pain mean 8.06 ± 3.87, 95% CI (9.51, 11.39), P= .00, effect size 2.08, fear in work mean 11.53 ± 4.93, 95% CI (6.61, 9.68), P= .00, effect size 2.33, and in total mean 21.36 ± 14.23, 95% CI (16.05, 26.68), P= .00, effect size 1.50. There were changes in bothersome episodes in participation towards livelihood activities in leg pain (z -2.838, P=.005, r= -3), leg paraesthesia (z -4.51, P=.00, r= -5), Leg weakness (z -4.06, P=.00, r= -5) and sit to stand (z -3.86, P=.00, r= -.49). The participants depression due to recurrence that has been reflected by personal factor in ICF had significant changes (z -4.79, P=.00, r= -6) in post-test form baseline evaluation. In all the results the effect size was medium to large. The respondents had mixed responses regarding experience of surgery or Physiotherapy, but they admired physiotherapy as a cost-effective treatment approach and recommended to employ the treatment before the decision of surgery for person suffering from LDH. Conclusion: Till now, this is the maiden study having mixed analysis of outcome for physiotherapy interventions in post-surgical cases of Lumbar disc herniation. The study found significant improvements in recurrent cases of LDH following surgery based on almost all of the parameters of International classification of functioning, disability and health (ICF) with larger impact. Implementation to the findings in imperial phases is recommended to elevate the disability adjacent life years in patients having LDH with or without surgery. Key words: Lumbar Disc herniation, Surgery, Physiotherapy, ICF