Oral Presentation 51st International Society for the Study of the Lumbar Spine Annual Meeting 2025

A pre-, peri- and postoperative rehabilitation pathway for lumbar fusion surgery (REACT): a nonrandomized controlled clinical trial (115579)

Liedewij Bogaert 1 , Tinne Thys 1 , Peter Van Wambeke 1 , Lotte Janssens 2 , Thijs W Swinnen 3 , Lieven Moke 4 , Sebastiaan Schelfaut 4 , Joost Dejaegher 5 , Sieglinde Bogaert 6 , Koen Peers 1 , Ann Spriet 1 , Wim Dankaerts 3 , Simon Brumagne 3 , Bart Depreitere 5
  1. Department of Physical and Rehabilitation Medicine, University Hospitals Leuven, Leuven, Belgium
  2. REVAL Rehabilitation Research Center, Hasselt University, Diepenbeek, Belgium
  3. Department of Rehabilitation Sciences, KU Leuven, Leuven, Belgium
  4. Department of Orthopaedics, University Hospitals Leuven, Leuven, Belgium
  5. Department of Neurosurgery, University Hospitals Leuven, Leuven, Belgium
  6. Department of Movement Sciences, KU Leuven, Leuven, Belgium

Introduction

Following lumbar fusion surgery (LFS), up to 40% of patients experience suboptimal improvements in terms of disability and pain. In addition, return-to-work rates after LFS are low. An evidence-based pre-, peri- and postoperative rehabilitation pathway (i.e. the REACT rehabilitation pathway) was designed to improve clinical outcomes after LFS.

The primary aim of this study was to evaluate the effectiveness of the REACT rehabilitation pathway in reducing disability in patients undergoing LFS, compared to usual care.

 

Methods

A prospective, nonrandomized controlled trial included 72 patients scheduled for one- or two-level LFS for degenerative conditions or adult isthmic spondylolisthesis. Participants were allocated to either usual care (N= 36) or the REACT rehabilitation pathway (N= 36). The REACT rehabilitation pathway includes prehabilitation, early mobilization and avoidance of unsubstantiated postoperative restrictions, early postoperative physiotherapy, patient empowerment, case manager guidance, and support for an early return to activity. The primary outcome was disability; key secondary outcomes were back and leg pain intensity, and return-to-work rate. Additional secondary outcomes included fear of movement, pain catastrophizing, negative emotional states, sit-to-stand performance, analgesic use, length of stay, and adverse events. Data were collected preoperatively and at five time points up to one year postoperatively.

 

Results

Participants in the REACT group demonstrated significantly greater improvements in disability (p= 0.003), and back pain intensity (p= 0.007), but not in leg pain intensity. At one year postoperatively, the return-to-work rate was significantly higher in the REACT group compared to the control group (88% vs 56%, p= 0.034). The REACT group also showed greater improvements in fear of movement (p= 0.038), pain catastrophizing (p< 0.001), combined negative emotional states (p= 0.007), sit-to-stand performance (p= 0.021), and reduced analgesic use (p= 0.001). No significant between-group differences were observed for length of stay (p= 0.095) or adverse events (p= 1.00).

 

Discussion

The REACT rehabilitation pathway resulted in significant greater improvements in disability over time compared to usual care. The significant higher return-to-work rate in the REACT group, is a promising outcome, given its potential socio-economic impact.