The effect of early rehabilitation after lumbar spine surgery: a systematic review and meta-analysis

Evidence-based data are required to provide insightful information on the timing of rehabilitation after lumbar spine surgery (LSS). The aim of this study is to systematically review the outcomes of early rehabilitation interventions and conduct its meta-analysis in patients after LSS. A total of 1183 articles were retrieved through PubMed (n = 793), Web of Science (n = 721), Scopus (n = 335), and ScienceDirect (n = 83) databases. Fourteen studies were included in the systematic review. The quality analysis and risk of bias assessment of the trials included in the systematic review were performed using the Physiotherapy Evidence Database (PEDro) scoring and classification system. Narrative synthesis and standardized mean difference based pooling results were given for the systematic review and meta-analysis, respectively. The additional benefit of early rehabilitation on physical function was moderately effective (ES: − 0.62, 95% CI − 1.00; − 0.25) at the 1-month follow-up. In terms of pain, early rehabilitation provided additional improvement at 1 month (ES: 0.34, 95% CI − 0.03; 0.71), 3 months (ES: − 0.14, 95% CI − 0.37; 0.10), 6 months (ES: 0.35, 95% CI 0.04; 0.65) and 1 year (ES: 0.21, 95% CI − 0.09; 0.52) follow-up at a low level of evidence. This systematic review demonstrated that early rehabilitation mainly improved disability in the early period (1-month follow-up). Regarding pain, short-term (1 month) and mid-term (6 months) follow-ups showed the most significant additional benefit. The positive effects of starting rehabilitation early after surgery on pain may have positively affected disability, specifically in the early period (1 month).