Importance of the back-cafe concept to rehabilitation after lumbar spinal fusion:: A randomized clinical study with a 2-year follow-up

Study Design. A prospective, randomized, clinical study with a 2-year follow-up. Objectives. To analyze the effect of three different rehabilitation strategies for lumbar spinal fusion patients. Summary of Background Data. Fifteen percent to 40% of lumbar spinal fusion patients are not expected to improve significantly over a 2-year period. Optimization of present forms of rehabilitation could possibly further improve the outcome. Materials and Methods. Between 1996 and 1999, 90 patients who had undergone lumbar spinal fusion were 3 months after surgery randomized to one of three different rehabilitation groups. Video group participants watched a video of exercises for training and were subsequently and only once provided instruction regarding their use. The back-cafe group was provided the same program as the video group, but as a supplement met with a back-cafe with other fusion-operated patients three times over an 8-week period. The training group was provided physical therapy training twice weekly for 8 weeks. Functional outcome was evaluated at 6, 12, and 24 months after surgery by use of the low back pain rating scale and a questionnaire covering daily functions, work status, and a patient's contact with the primary sector. Results. By 2-year follow-up, the back-cafe and video groups had less pain compared with the training group (P<0.03). The back-cafe group was better at performing daily functions such as carrying bags of market items (P<0.01), getting up from a chair (P<0.01), and ascending staircases (P<0.01) compared with the video and training groups. More in the back-cafe group resumed working after surgery compared with the two other groups (P<0.04). The video group had significantly more contacts with general practitioners, physical therapists, and so on compared with the back-cafe and training groups (P<0.001). Conclusion. The patients in the back-cafe group were significantly better at accomplishing a succession of daily tasks compared with the video and training groups 2 years after lumbar spinal fusion. At the 2-year follow-up the training group had a significant pain problem compared with the video and back-cafe groups. The video group had significantly more treatment demands outside the hospital system. This study demonstrates the relevance of the inclusion of coping schemes and questions the role of intensive exercises in a rehabilitation program for spinal fusion patients.