• James Greenwood, Alison McGregor, Fiona Jones, Jacqueline Mullane, and Michael Hurley.
• *Biodynamics Lab, Imperial College London, Charing Cross Hospital, Charing Cross Campus, London, UK †St Georges University of London, Faculty of Health and Social Care Sciences, London, UK ‡Internal Box 8, Victor Horsely Department of Neurosurgery, National Hospital of Neurology and Neurosurgery, London, UK §St Georges University of London and Kingston University Faculty of Health and Social Care Sciences, St Georges Hospital, London, UK.
• Spine. 2016 Jan 1;41(1):E28-36.

Study DesignA systematic review with meta-analysis.ObjectiveThe aim of this study was to conduct a systematic review and meta-analysis of current evidence evaluating the effectiveness of rehabilitation following lumbar fusion surgery (LFS).Summary Of Background DataLFS for the management of lower back pain, with(out) neurogenic leg pain, is increasing as the population ages. Clinical outcomes commonly lag behind surgical outcomes and 40% of patients experience significant back-related disability 12 months after LFS. Identifying rehabilitation strategies to improve function and quality of life following LFS is important.MethodsA systematic review of databases were searched, including MEDLINE, CINAHL, and grey literature. Studies identified were screened for inclusion by title and abstract. Full text of eligible/potentially eligible studies was evaluated against predetermined eligibility criteria. Included studies were subjected to critical appraisal and risk of bias evaluation. The GRADE approach to quality of evidence was utilized. A meta-analysis comparing usual care with "complex rehabilitation," comprising exercise and cognitive behavioral therapy, for outcomes relating to pain, disability, fear of movement, and mental health was conducted at short and longer term (<3 and >12 months postsurgery) time points.ResultsThree studies were identified for the systematic review and 2 included in the meta-analysis (n = 237, female = 62%, mean age = 55). Low-quality evidence suggests that "complex rehabilitation" provides short-term improvement in disability [effect size, -0.85, 95% confidence interval (95% CI), -1.41 to -0.29] and fear avoidance behavior (-1.07, 95% CI -1.33, -0.80), compared with usual care. Low-quality evidence exists favoring "complex rehabilitation" over usual care for longer term disability (-0.84, 95% CI -1.11 to -0.58) and fear avoidance behavior (-1.40, 95% CI -1.69 to -1.12).ConclusionsA small number of low-quality studies suggest that "complex rehabilitation" reduces short and long-term disability and fear avoidance behavior following LFS. More, high-quality research is required to confirm the effectiveness of "complex rehabilitation" programs.Level Of Evidence1.

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