Pre-surgery physiotherapy and pain thresholds in patients with degenerative lumbar spine disorders

Sammanfattning: Background: Patients scheduled for spinal surgery often experience long duration of pain, which may influence the pain-regulation system, function and health and have an impact on post-surgery outcome. Prehabilitation potentially augments functional capacity before surgery, which may have beneficial effects after surgery.Aim: The overall aim of the thesis is to study pre-surgery physiotherapy and somatosensory function in patients with degenerative lumbar spine disorders and to explore the patients’ experiences of pre-surgery physiotherapy.Methods: Somatosensory function was measured with quantitative sensory testing (QST). Pre-surgery physiotherapy was evaluated with patient-reported outcome measures (n = 197). Patients’ experiences of how symptoms are explained and their experiences of the influences on back-related health after pre-surgery physiotherapy were explored.Results: Half of the patients reported back or leg pain for more than 2 years. On a group level, the somatosensory profiles were within the reference range. On an individual level, an altered somatosensory profile was found in 23/105 patients, these were older, more often women, and reported higher pain, larger pain distribution and worse SF-36 MCS (mental health component summary). Patients with disc herniation, more sensitive to pressure pain in the hand presurgery, was associated with poorer function, self-efficacy, anxiety and depression score pre-surgery, worse function, self-efficacy and leg pain 3 months post-surgery and worse health related quality of life, self-efficacy, depression score 1 year postsurgery. The results for sensitivity for cold pain were similar, except that it even was associated with poorer function and pain 1 year post-surgery. The pre-surgery physiotherapy group had less back pain, better function, health, self-efficacy, fear avoidance score, depression score and physical activity level than the waiting-list group after the pre-surgery intervention. The effects were small. Both groups improved significantly after surgery, with no differences between groups, except that the higher physical activity level in the physiotherapy group remained at the 1-year follow-up. Only 58% of the patients reported a minimum of one visit for rehabilitation during the 1 year preceding the decision to undergo surgery. Patients experienced that pre-surgery physiotherapy had influenced symptoms, physical function, coping, well-being and social functioning to various degrees. Pre-surgery physiotherapy was experienced as a tool for reassurance and an opportunity to reflect about treatment and lifestyle. The patients mainly used biomedical explanatory models based on image reports to explain their backrelated symptoms. Both broader and more narrow, as well as lack of explanations of symptoms emerged. Further, wanting and sometimes struggling to be wellinformed about symptoms and interventions were described.Conclusions: Being more sensitive to pressure- and cold pain in the hand, as a sign of widespread pain pre-surgery, was associated with poorer function, pain and health at post-surgery in patients with disc herniation. Pre-surgery physiotherapy decreased pain, fear avoidance, improved health related quality of life; and it decreased the risk of a worsening in psychological well-being before surgery. The improvements were small, and improvements after surgery were similar for both groups. At the 1-year follow-up, the physiotherapy group still had a higher activity level than the waiting list group. The pre-surgery physiotherapy was well tolerated. Patients’ reported experiences also illustrates the influence on function, pain and health. Patients experienced that pre-surgery physiotherapy provided reassurance and gave time to reflect on treatments and lifestyle. Symptoms were mainly described in line with a biomedical explanatory model. Those using a broader explanation were confident that physiotherapy and self-management could influence their back-related symptoms.