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Purpose <p>To evaluate the effectiveness of an evidence-based pre-, peri- and postoperative rehabilitation pathway (i.e. the REACT rehabilitation pathway) on disability in patients undergoing lumbar fusion surgery (LFS), compared to usual care.</p> Methods <p>A prospective, nonrandomized controlled trial included 72 patients scheduled for one- or two-level LFS for degenerative conditions or adult isthmic spondylolisthesis. Participants were allocated to usual care (N = 36) or the REACT rehabilitation pathway (N = 36). The REACT rehabilitation pathway includes prehabilitation, early mobilization and avoidance of unsubstantiated postoperative restrictions, early postoperative physiotherapy, patient empowerment, case manager guidance, and support towards an early return to activity. The primary outcome was disability; key secondary outcomes were back and leg pain intensity, and return-to-work rate. Additional secondary outcomes included fear of movement, pain catastrophizing, negative emotional states, sit-to-stand performance, analgesic use, length of stay, and adverse events. Data were collected preoperatively and at five time points up to one year postoperatively.</p> Results <p>Participants in the REACT group demonstrated significantly greater improvements in disability (<i>p</i> = 0.003), back pain intensity (<i>p</i> = 0.007), and return-to-work rates (88% vs 56%, <i>p</i> = 0.34) compared to the control group. The REACT group also showed greater improvements in fear of movement (<i>p</i> = 0.038), pain catastrophizing (<i>p</i> &lt; 0.001), combined negative emotional states (<i>p</i> = 0.007), sit-to-stand performance (<i>p</i> = 0.021), and reduced analgesic use (<i>p</i> = 0.001). No significant differences were observed in leg pain intensity (<i>p</i> = 0.042), length of hospital stay (<i>p</i> = 0.095) or adverse events (<i>p</i> = 1.00).</p> Conclusion <p>The REACT rehabilitation pathway significantly reduced disability in the first postoperative year after LFS compared to usual care. The most promising result is the significantly higher return-to-work rate in the REACT group.</p>

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A pre-, peri- and postoperative rehabilitation pathway for lumbar fusion surgery (REACT): a nonrandomized controlled clinical trial

  • 期刊论文

  • 发表日期：

    2025年2月16日

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  • Liedewij Bogaert,
  • Tinne Thys,
  • Peter Van Wambeke,
  • Lotte Janssens,
  • Thijs Willem Swinnen,
  • Lieven Moke,
  • Sebastiaan Schelfaut,
  • Joost Dejaegher,
  • Sieglinde Bogaert,
  • Koen Peers,
  • Ann Spriet,
  • Wim Dankaerts,
  • Simon Brumagne,
  • Bart Depreitere

摘要

Purpose

To evaluate the effectiveness of an evidence-based pre-, peri- and postoperative rehabilitation pathway (i.e. the REACT rehabilitation pathway) on disability in patients undergoing lumbar fusion surgery (LFS), compared to usual care.

Methods

A prospective, nonrandomized controlled trial included 72 patients scheduled for one- or two-level LFS for degenerative conditions or adult isthmic spondylolisthesis. Participants were allocated to usual care (N = 36) or the REACT rehabilitation pathway (N = 36). The REACT rehabilitation pathway includes prehabilitation, early mobilization and avoidance of unsubstantiated postoperative restrictions, early postoperative physiotherapy, patient empowerment, case manager guidance, and support towards an early return to activity. The primary outcome was disability; key secondary outcomes were back and leg pain intensity, and return-to-work rate. Additional secondary outcomes included fear of movement, pain catastrophizing, negative emotional states, sit-to-stand performance, analgesic use, length of stay, and adverse events. Data were collected preoperatively and at five time points up to one year postoperatively.

Results

Participants in the REACT group demonstrated significantly greater improvements in disability (p = 0.003), back pain intensity (p = 0.007), and return-to-work rates (88% vs 56%, p = 0.34) compared to the control group. The REACT group also showed greater improvements in fear of movement (p = 0.038), pain catastrophizing (p < 0.001), combined negative emotional states (p = 0.007), sit-to-stand performance (p = 0.021), and reduced analgesic use (p = 0.001). No significant differences were observed in leg pain intensity (p = 0.042), length of hospital stay (p = 0.095) or adverse events (p = 1.00).

Conclusion

The REACT rehabilitation pathway significantly reduced disability in the first postoperative year after LFS compared to usual care. The most promising result is the significantly higher return-to-work rate in the REACT group.