Table 2.
Evidence statements derived with respect to activity, work, and rehabilitation following spinal surgery
| Evidence statement | Direct evidencea | Indirect evidenceb |
|---|---|---|
| There is strong evidence that encouragement of mobility and return to full activities as soon as possible after surgery produces better relief of pain, and an earlier return to work | [6, 18, 32, 67] | [32, 61] |
| There is strong evidence that early post-operative rehabilitation programmes improve activities of daily living. Rehabilitation programmes vary considerably, and it is not possible categorically to state which components in what intensity are the most effective | [13, 16, 21, 34–37, 45, 67] | [2, 28, 32, 44, 53, 61] |
| There is strong evidence that early post-operative rehabilitation programmes improve return to work rates/times. Rehabilitation programmes vary considerably, and it is not possible categorically to state which components in what intensity are the most effective, though a focus on information about the course of disability and activity has been shown to be effective | [13, 18, 34–37, 45] | [2, 32, 44, 53] |
| There is strong evidence that early post-operative return to work is generally advantageous, and some studies suggest it can be as early as 1 week (but that will depend on the nature of the work and the surgical procedure). A progressive return to previous duty is desirable. The same evidence indicates that early post-operative return to work is not detrimental (but that may depend on the nature of the work) | [5, 6, 18, 35, 36] | [13, 29, 57] |
| There is some direct evidence and considerable indirect evidence suggesting that early post-operative return to work specifically results in faster recovery and better clinical outcomes | [16] | [2, 13, 29, 32, 35, 36, 44, 53, 61, 67] |
| Work/exercise is good for physical and mental health | [16, 35–37, 44, 45] | |
| Cohort studies show that return to work rates vary from less than 40% to more than 90%, with sickness absence times varying from as little as a day to over 12 months; the determinants include the type of procedure and the timing and nature of rehabilitation | [5, 6, 17, 18] | |
| The rate of recovery (both for clinical and vocational outcomes) is greatest in the first 3 months, with further improvement occurring more slowly | [18, 65] | [27, 50] |
| There is moderate evidence that patients’ expectations and satisfaction are important factors—recovery is facilitated by knowing what to expect | [18, 51] | |
| The concept of ‘let pain be your guide’ to guide reactivation is counterproductive | [18, 43] | [17] |
aStudy (or review) specifically addressing the topic
bStudy (or review) having incidental findings impacting on the topic