Abstract:
Background: Conservative approaches are evident to be gold standard management
protocol for lumbar disc herniation (LDH), however surgery of LDH is essential in
case of certain specification and failed cases of conservative care. As there is no
multidisciplinary practice and existing evidence based guideline in the health sector in
Bangladesh, referral to physiotherapy for LDH is limited. LDH cases are being treated
with surgical approach very often and the post-surgical lumbar disc herniation cases
are increasing with a predominance of recurrence within shorter duration.
Aim: The aim of the study is to determine the outcome of physiotherapy interventions
in post-operative recurrent cases of lumbar disc herniation at CRP; a renounced
rehabilitation centre in Bangladesh.
Methodology: A mixed study design has been applied, the quantitative analysis has
been done by one arm prior and post experimental study design with hospital
randomization. The qualitative analysis has been conducted by qualitative content
analysis (QCA).
Results: From November 2018 to April 2019, 42 respondents were employed, and 30
were analysed for quantitative outcome determination; 6 participants by QCA prior to
open ended recorded interview according to algorithmic process. Outcome of
physiotherapy in ICF components has been evaluated through comparison of mean
difference between pre and post-test evaluation complying statistical significance,
95% CI and effect size. Significant difference has been noted in body structure and
functions by pain and disability; in current pain mean 3.63± 1.95, 95% CI (2.92,
4.38), P= .00, effect size 1.86; highest pain state mean 4.23 ± 2, 95% CI (3.47, 4.97),
P= .00, effect size 2.11 and lowest state mean 2.44± 1.79, 95% CI (1.78, 3.11), P=
xiii
.00, effect size 1.36. In disability ODI mean was 16.93 ± 7.53, 95% CI (14.12, 19.76),
P= .00, effect size 2.25. The respondents improved in activity limitations by FABQ
fear due to pain mean 8.06 ± 3.87, 95% CI (9.51, 11.39), P= .00, effect size 2.08, fear
in work mean 11.53 ± 4.93, 95% CI (6.61, 9.68), P= .00, effect size 2.33, and in total
mean 21.36 ± 14.23, 95% CI (16.05, 26.68), P= .00, effect size 1.50. There were
changes in bothersome episodes in participation towards livelihood activities in leg
pain (z -2.838, P=.005, r= -3), leg paraesthesia (z -4.51, P=.00, r= -5), Leg weakness
(z -4.06, P=.00, r= -5) and sit to stand (z -3.86, P=.00, r= -.49). The participants
depression due to recurrence that has been reflected by personal factor in ICF had
significant changes (z -4.79, P=.00, r= -6) in post-test form baseline evaluation. In all
the results the effect size was medium to large. The respondents had mixed responses
regarding experience of surgery or Physiotherapy, but they admired physiotherapy as
a cost-effective treatment approach and recommended to employ the treatment before
the decision of surgery for person suffering from LDH.
Conclusion: Till now, this is the maiden study having mixed analysis of outcome for
physiotherapy interventions in post-surgical cases of Lumbar disc herniation. The
study found significant improvements in recurrent cases of LDH following surgery
based on almost all of the parameters of International classification of functioning,
disability and health (ICF) with larger impact. Implementation to the findings in
imperial phases is recommended to elevate the disability adjacent life years in patients
having LDH with or without surgery.
Key words: Lumbar Disc herniation, Surgery, Physiotherapy, ICF
Description:
This thesis is submitted in partial fulfillment of the requirements for the Degree of Master of Science in Physiotherapy 2017, Bangladesh Health Professions Institute, Faculty of Medicine, the University of Dhaka, Bangladesh: