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Open Access Study protocol

Outcome of physiotherapy after surgery for cervical disc disease: a prospective randomised multi-centre trial

Anneli Peolsson1*, Birgitta Öberg1, Johanna Wibault1, Åsa Dedering23, Peter Zsigmond4, Lars Bernfort5, Ann-Sofi Kammerlind16, Liselott CG Persson7 and Håkan Löfgren8

Author Affiliations

1 Department of Medical and Health Sciences, Physiotherapy, Faculty of Health Sciences, Linköping University, SE-58183 Linköping, Sweden

2 Department of Physical Therapy, Karolinska University Hospital, Stockholm, Sweden

3 Department of Neurobiology, Care Sciences and Society, Division of Physiotherapy, Karolinska Institutet, Stockholm, Sweden

4 Department of Neurosurgery, Linköping University Hospital, Linköping, Sweden

5 Department of Medical and Health Sciences, Health Care Analysis, Linköping University, Linköping, Sweden

6 Futurum the Academy for Healthcare, County Council Jönköping, Jönköping, Sweden

7 Division of Physiotherapy, Department of Health Sciences, Lunds University, Lund, Sweden

8 Neuroorthopedic Centre, Ryhov Hospital, Jönköping, Sweden

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BMC Musculoskeletal Disorders 2014, 15:34  doi:10.1186/1471-2474-15-34

Published: 6 February 2014

Abstract

Background

Many patients with cervical disc disease require leave from work, due to long-lasting, complex symptoms, including chronic pain and reduced levels of physical and psychological function. Surgery on a few segmental levels might be expected to resolve disc-specific pain and reduce neurological deficits, but not the non-specific neck pain and the frequent illness. No study has investigated whether post-surgery physiotherapy might improve the outcome of surgery. The main purpose of this study was to evaluate whether a well-structured rehabilitation programme might add benefit to the customary post-surgical treatment for cervical disc disease, with respect to function, disability, work capability, and cost effectiveness.

Methods/Design

This study was designed as a prospective, randomised, controlled, multi-centre study. An independent, blinded investigator will compare two alternatives of rehabilitation. We will include 200 patients of working age, with cervical disc disease confirmed by clinical findings and symptoms of cervical nerve root compression. After providing informed consent, study participants will be randomised to one of two alternative physiotherapy regimes; (A) customary treatment (information and advice on a specialist clinic); or (B) customary treatment plus active physiotherapy. Physiotherapy will follow a standardised, structured programme of neck-specific exercises combined with a behavioural approach. All patients will be evaluated both clinically and subjectively (with questionnaires) before surgery and at 6 weeks, 3 months, 6 months, 12 months, and 24 months after surgery. The main outcome variable will be neck-specific disability. Cost-effectiveness will also be calculated.

Discussion

We anticipate that the results of this study will provide evidence to support physiotherapeutic rehabilitation applied after surgery for cervical radiculopathy due to cervical disc disease.

Trial registration

ClinicalTrials.gov identifier: NCT01547611

Keywords:
Intervertebral disc; Spine; Neck; Rehabilitation; Physical therapy