The Added Value and the Efficacy of Preoperative Physiotherapy on Degenerative Diseases of the Lumbar Spine: A Systematic Review.
Manna Jacopo, Fanigliulo Ciro, Giardulli Benedetto and 2 others
Preoperative physiotherapy showed no significant difference from usual care in back pain, leg pain, or disability three months after lumbar spine surgery.
The evidence comes from six small trials, all rated high risk of bias, and is very low certainty.
Key findings
1Three meta-analyses pooling back pain, leg pain, and disability at 3-month follow-up found no difference between the preoperative physiotherapy group and the control group.
2All six included trials were rated high risk of bias, and the overall certainty of the evidence was very low under the GRADE framework.
3The few significant pre-surgery improvements seen in individual studies (one in back pain, one in hospitalisation) were not sustained after surgery.
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What it does not show
All six trials were rated high risk of bias, mainly because of how outcomes were measured. Only 545 participants across six small trials (73 to 197 each), so the meta-analyses had wide confidence intervals and the authors rate the evidence very low certainty. The interventions were very different from one trial to the next: cognitive-educational therapy, a home-based exercise programme, and a multimodal approach. It is not possible to tell which component, if any, would have made a difference. Two of the six studies reported results as medians with interquartile ranges, and the reviewers had to assume a normal distribution to convert them for pooling, which may have introduced bias. In one trial, 43% of patients did not attend the minimum number of required sessions, and in another some participants withdrew for personal reasons, so the delivered dose was lower than intended. Outcomes were reported in aggregate; no trial stratified results by age, sex, comorbidity, or frailty, so it is impossible to tell whether a specific subgroup might benefit. One of the six included studies is a follow-up of another included study, so the effective number of independent trials is five.
Declared interests
The authors declare no conflicts of interest and report no funding.
The easy way to misread this
Do not read the single significant pre-surgery pain finding or the hospitalisation reduction as evidence that preoperative physiotherapy works. The pooled meta-analyses found no difference in back pain, leg pain, or disability, and the pre-surgery improvements that did appear in individual trials were not maintained after surgery.
Summarised by AI from the full paper, without a clinician reviewing it. Check it against the source before it changes what you do. Read it on PubMed →