Prehabilitation and early rehabilitation after spinal surgery: randomized clinical trial

Objective: To evaluate the outcome after spinal surgery when adding prehabilitation to the early rehabilitation. Design: A randomized clinical study. Setting: Orthopaedic surgery department. Subject: Sixty patients scheduled for surgery followed by inpatient rehabilitation for degenerative lumbar disease. Interventions: The patients were computer randomized to prehabilitation and early rehabilitation (28 patients) or to standard care exclusively (32 patients). The intervention began two months prior to the operation. The prehabilitation included an intensive exercise programme and optimization of the analgesic treatment. Protein drinks were given the day before surgery. The early postoperative rehabilitation included balanced pain therapy with self-administered epidural analgesia, doubled intensified mobilization and protein supplements. Main measures: The outcome measurements were postoperative stay, complications, functionality, pain and satisfaction. Results: At operation the intervention group had improved function, assessed by Roland Morris Questionnaire (P = 0.001). After surgery the intervention group reached the recovery milestones faster than the control group (1-6 days versus 3-13, P = 0.001), and left hospital earlier (5 (3-9) versus 7 (5-15) days, P = 0.007). There was no difference in postoperative complications, adverse events, low back pain and radiating pain, timed up and go, sit-to-stand or in life quality. Patient satisfaction was significantly higher in the intervention group compared with the control group. Conclusion: The integrated programme of prehabilitation and early rehabilitation improved the outcome and shortened the hospital stay-without more complications, pain or dissatisfaction.