Revalideren na een lumbale hernia operatie.

In the Netherlands there are two strategies for rehabilitation of patients following lumbar disc surgery. In some hospitals rehabilitation is restricted to the hospital phase and after discharge there is no more supervised rehabilitation. However, there are also hospitals that continue rehabilitation directly after discharge, during the first 6 weeks after surgery. This rehabilitation is mainly delivered by PTs in a primary care setting. Since January 1st, 2006, patients can also directly access PT without a referral (DTF). Then the PT has to decide after initial assessment if rehabilitation is indicated and some PTs opt for continuation of the rehabilitation while others don’t. So, regardless of the specific procedure (referral by neurosurgeon or DTF) there is wide variation in care. This project will provide an answer to the question whether rehabilitation should be started directly after discharge from the hospital or not, and will guide evidence-based decision making for patients who undergo lumbar disc surgery.

N/A

Measurements will take place at baseline and after 3, 6, 9, 12 and 26 weeks.

Intervention group: Physiotherapy directly after discharge. Patients receive instructions and information regarding appropriate ‘use of body mechanics’ for the whole body and will be taught back protection methods. Depending on a clinical assessment the rehabilitation program will focus on relaxation positions and techniques, stretching exercises in order to increase soft tissue flexibility and joint mobility, and/or stabilizing and strengthening exercises (as tolerated by the patient). Patients will receive a home exercise program as well. The aim is that there will be 6 treatment sessions within the first 6 weeks after discharge from the hospital 6 weeks, but the exact number of sessions is at the discretion of the therapist. After these 6 weeks the patient visits the neurosurgeon, which is customary in the participating hospitals (and in the majority of the hospitals in the Netherlands as well). At the six weeks consultation the neurosurgeons decides whether continuation of therapy is necessary.



Control group: No treatment during 6 weeks after discharge. Also in this group the patient visits the neurosurgeon after 6 weeks. At the six weeks consultation the neurosurgeons decides whether the patient still should be referred to therapy or not.