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Twelve-year follow-up of a randomized controlled trial of comprehensive physiotherapy following disc herniation operation

Objective: To evaluate the long-term effects of postoperative comprehensive physiotherapy starting one week after lumbar disc surgery. Design: Twelve-year follow-up of a three-armed, randomized, controlled, single-blinded clinical trial. Setting: Department of Physical Medicine & Rehabilitation. Participants: Of 111 patients following first-time, uncomplicated lumbar disc surgery who participated in the original study and completed the treatment originally allocated, 74 ((67%; 29 (73%) physiotherapy, 22 (58%) sham therapy, 23 (68%) no therapy) completed a 12-year follow-up examination. Interventions: In the original study, patients had been randomly assigned to comprehensive physiotherapy, sham intervention (neck massage), or no therapy. Measures: Low Back Pain Rating Scale; best score 0, worst score 130 points). Results: At 12 years after surgery, the group participating in comprehensive physiotherapy had significantly better functional outcomes, as rated on the Low Back Pain Rating Score, than the untreated group (mean difference: −13.2 (95% CI: (−25.4; −1.0)). Equally, there was a clinically relevant, non-significant difference between the sham therapy and no therapy (mean difference: −12.5 (95%CI: −26.1; 1.1)). Consequently, the Low Back Pain Rating Score outcome did not differ between physiotherapy and sham therapy (mean difference: −0.7 (95%CI: −14.2; 12.8)). Conclusions: Participating in a comprehensive physiotherapy program following lumbar disc surgery may be associated with better long-term health benefits over no intervention, but may not be superior to sham therapy.