Wirksamkeit von Physiotherapie nach einem chirurgischen Eingriff bei lumbaler Spinalkanalstenose

Zusammenfassung

Die Lumbale Spinalkanalstenose (LSS) bezeichnet eine symptomatische Verengung des Spinalkanals aufgrund einer kongenitalen Erkrankung (primäre LSS) oder eines degenerativen Prozesses (sekundäre LSS). Laut Schätzungen unterziehen sich 40 % aller von LSS betroffenen Patienten innerhalb der ersten 10 Jahre einem chirurgischen Eingriff. Ziel dieses Reviews ist, die Effektivität einer Rehabilitation, einschließlich individualisierter Physiotherapie, mit der herkömmlichen Versorgung nach einer Operation der LSS zu vergleichen.

Die Datenbanken CENTRAL, MEDLINE, DIMDI, PEDro und PubMed wurden systematisch nach randomisierten kontrollierten Studien durchsucht, die bis November 2018 durchgeführt wurden. Vier Studien wurden in den Review eingeschlossen. Die Gesamtqualität der Evidenz erwies sich dabei als moderat. Die Interventionen erfolgten unmittelbar während des Krankenhausaufenthalts oder innerhalb von 6–12 Wochen postoperativ und beinhalteten statt individualisierter Physiotherapie lediglich unspezifische Gruppentherapie. Die Kontrollgruppen erhielten herkömmliche Versorgung oder Empfehlungen zum postoperativen Verhalten. Die Analyse ergab keine Unterschiede zwischen den Gruppen in Bezug auf funktionellen Status und Rückenschmerzen kurz- und langfristig. Lediglich bezüglich Beinschmerzen zeigte sich eine signifikante Differenz zugunsten der Interventionsgruppe (SMD –0,22, 95 % KI –0,43 bis –0,01).

Nicht individuelle Physiotherapie zeigt demnach im Vergleich zur herkömmlichen Versorgung keine kurzfristigen Effekte hinsichtlich Funktion und Schmerz, jedoch einen kleinen klinisch relevanten und signifikanten langfristigen Effekt im Hinblick auf Beinschmerzen. Die geringe Anzahl an eingeschlossenen Studien und die moderate Qualität der Evidenz unterstreichen die dringende Notwendigkeit qualitativ hochwertiger Studien, die die Wirkung einer individualisierten, patientenzentrierten und evidenzbasierten Physiotherapie untersuchen.

Abstract

Lumbar spinal stenosis (LSS) is defined as a symptom related to narrowing of the spinal canal due to congenital disorder (primary LSS) or as a result of a degenerative disease process (secondary LSS). Within the first 10 years, an estimate amount of 40 % of patients with LSS undergo surgical interventions. The aim of this review is to compare the effectiveness of rehabilitation including individualized physical therapy with usual care after surgery for LSS.

Databases CENTRAL, MEDLINE, DIMDI, PEDro and PubMed were systematically searched for randomized controlled trials up to November 2018. Four studies were included in this review. The overall quality of evidence was found to be moderate. The interventions commenced directly after hospitalization or between 6–12 weeks post-surgery and comprised group not individualized physiotherapy including exercises for stretching, core training, strengthening or postural stability. Control groups received usual care or recommendations on postoperative behaviour. Analysis revealed no differences between groups at both time points except for leg pain which was significantly different in favour of the intervention group (SMD –0.22, 95 % CI –0.43 to –0.01).

Non-specific physical therapy shows no short-term effect in terms of function and pain, but still a small clinically relevant and significant long-term effect for leg pain compared to usual care. The small number of included studies and the moderate quality of evidence underlines the urge for new study protocols with reasonable and well described forms of physical therapy and patient-oriented outcomes. Further high-quality studies to assess the effects of more individualized patient centered evidence-based physiotherapy are needed.

Schlüsselwörter

lumbal - Stenose - Physiotherapie - postoperativ

Key words

lumbar - stenosis - physiotherapy - postoperative

Publikationsverlauf

Eingereicht: 21. Januar 2020

Angenommen: 09. März 2020

Artikel online veröffentlicht:
18. Mai 2021

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