Development and Effects of Early Exercise Program for Lumbar Spine Surgery Patients

Geun Jin Kim; Hye Young Kim

doi:10.7475/kjan.2018.30.3.245

Journal List > Korean J Adult Nurs > v.30(3) > 1099904

Go to TopGo to Top Go to BottomGo to Bottom

TOOLS

Kim and Kim: Development and Effects of Early Exercise Program for Lumbar Spine Surgery Patients

Original Article

Korean J Adult Nurs 2018;30(3):245-254.

Published online: 21 June 2018

DOI: https://doi.org/10.7475/kjan.2018.30.3.245

Development and Effects of Early Exercise Program for Lumbar Spine Surgery Patients

Geun Jin Kim¹, Hye Young Kim^2,

¹Bokwang Hospital, Daegu, Korea

²College of Nursing, Keimyung University, Daegu, Korea

Corresponding author: Kim, Hye Young https://orcid.org/0000-0002-2395-8006 College of Nursing, Keimyung University, 1095 Dalgubeol-daero, Daegu 42601, Korea. Tel: +82-53-580-3934, Fax: +82-53-580-3916, E-mail: hye11533@kmu.ac.kr

Received 12 February 201821 April 2018 Accepted 13 May 2018

This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/3.0/) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.

Abstract

Purpose

The purpose of the study was to develop and pilot test an early exercise program for lumbar spine surgery patients.

Methods

A group of experts developed an early exercise program based on the exercise guidelines of spine hospitals and literature review. Fifty-three lumbar surgery patients were assigned into an experimental group or a control group and both groups participated in a 7-day exercise program. Pain, sleep disorders and daily living activity disorders were measured by self-administered questionnaires. The lower extremity strength was assessed by thigh circumference and the number of standing up from a chair within 30 seconds.

Results

The experiment group had significantly lower scores in back pain and daily living activity disorders than the control group. The number of standing up from a chair significantly increased in the experimental group.

Conclusion

Our early exercise program was effective in decreasing the back pain and daily living activity disorder and increasing the strength of lower extremity among lumbar surgery patients. The early exercise program should be considered as a nursing intervention in clinical settings for lumbar surgery patients.

Keywords: Activities of daily living, Exercise, Lumbar vertebrae, Pain, Sleep

REFERENCES

1. Kim JH, Lee EH, Kim SR, Kim SR. Factors affecting dis-charge delay in lumbar spinal surgery patients who were treated according to a critical pathway. Korean Journal of Adult Nursing. 2016; 28(1):43–52. https://doi.org/10.7475/kjan.2016.28.1.43.

2. Lee EJ, Kwon BA. A study on sports habit and lifestyle of spinal patients by Roland Morris Scale (RMS). The Journal of Korean Society of Safety Education. 2001; 4(2):103–15.

3. Moon HK, Yoon JY, Han GS. Effects of spinal exercise program in the elderly patients after posterior lumbar interbody fusion surgery. The Korean Journal of Sports Medicine. 2008; 26(1):19–26.

4. Kim HY, Eun Y, Song ME. The effects of muscle strengthening exercise for postoperative lumbar spinal surgery on pain exercise self-efficacy, activities of daily living. Journal of Muscle and Joint Health. 2011; 18(2):238–48. https://doi.org/10.5953/JMJH.2011.18.2.238.

5. Jun MH, Jung JY. A follow up study for elderly's disabilities in performing activities of daily life (ADL) after lumbar spinal surgery. The Journal of Korean Academic Society of Nursing Education. 2010; 16(1):140–9.

6. Beak SG, Kim DJ. The effects of isotonic rehabilitation exercise on lumbar extension strength of scoliosis patient. Indian Journal of Science and Technology. 2016; 9(35):1–4. https://doi.org/10.17485/ijst/2016/v9i35/101768.

7. Shim DM, Kim TK, Lim CM, Lee YC, Kim DH. A survey on the exercise program after surgery for the herniated lumbar disc in the hospital websites. Journal of Korean Society of Spine Surgery. 2014; 21(2):57–62. https://doi.org/10.4184/jkss.2014.21.2.57.

8. Lee MJ, Kim ES, Kim H, Lee SM. Effects of a video exercise program for spinal surgery patients on pain, daily living function and educational satisfaction. Journal of Korean Clinical Nursing Research. 2009; 15(3):39–48.

9. Kim DM, Cho JH, Kim YK. A case report on effects of therapeutic exercise after Posterior Lumbar Interbody Fusion (PLIF). The Official Journal of The Korean Academy of Kinesiology. 2012; 14(2):97–105. https://doi.org/10.15758/jkak.2012.14.2.97.

10. Kim DH, Kim SS. The short term effect of early 3-dimension lumbar stabilization exercise after lumbar microdiscectomy. The Korean Journal of Sports Medicine. 2009; 27(1):47–52.

11. Ha DH, Kim TK, Shim DM, Kim CS, Kim TH, Kim DH. Evaluation of the back muscle exercise for the lumbar discectomy patients. Journal of Korean Society of Spine Surgery. 2013; 20(4):143–8. https://doi.org/10.4184/jkss.2013.20.4.143.

12. McGregor AH, Burton AK, Sell P, Waddell G. The development of an evidence-based patient booklet for patients undergoing lumbar discectomy and un-instrumented decompression. European Spine Journal. 2007; 16(3):339–46. https://doi.org/10.1007/s00586-006-0141-9.

13. Mannion AF, Denzler R, Dvorak J, Müntener M, Grob D. A randomized controlled trial of post-operative rehabilitation after surgical decompression of the lumbar spine. European Spine Journal. 2007; 16(8):1101–17. https://doi.org/10.1007/s00586-007-0399-6.

14. McGregor AH, Henley A, Morris TP, Doré CJ. Patients' views on an education booklet following spinal surgery. European Spine Journal. 2012; 21(8):1609–15. https://doi.org/10.1007/s00586-012-2242-y.

15. Oh JJ, Song MS, Kim SM. Development and validation of Korean sleep scale A. Journal of Korean Academy of Nursing. 1998; 28(3):563–72. https://doi.org/10.4040/jkan.1998.28.3.563.

16. Hwang HY. The relationship among pain, depression and sleep disturbance of the elderly with chronic low back pain [master's thesis]. Busan: Catholic University of Pusan;2013.

17. Fairbank JC, Couper J, Davies JB, O'Brien JP. The oswestry low back pain disability questionnaire. Physiotherapy. 1980; 66(8):271–3.

18. Jeon CH, Kim DJ, Kim DJ, Lee HM, Park HJ. Cross-cultural adaptation of the Korean version of the Oswestry Disability Index (ODI). Journal of Korean Society of Spine Surgery. 2005; 12(2):146–52.

19. Lee MY, Kim BJ. Effectiveness of post-operative exercise program on pain and disability activities in patients with lumbar spinal fusion. Journal of Korean Clinical Nursing Research. 2011; 17(3):388–98.

20. Jeon JG, Kim MJ. The effects of early exercise program on the pain, disability and balance on undergo single-level lumbar discectomy. Journal of Korean Academy of Orthopaedic Manual Therapy. 2009; 15(2):80–7.

21. Danielsen JM, Johnsen R, Kibsgaard SK, Hellevik E. Early ag-gressive exercise for postoperative rehabilitation after discectomy. Spine. 2000; 25(8):1015–20. https://doi.org/10.1097/00007632-200004150-00017.

22. Lee YH. Effect of exercise after surgery on pain, muscle strength of legs, and disability of daily living activity of patients with lumbar spinal disease [master's thesis]. Daejeon: Chungnam University;2012.

23. Shim HJ, Kim JS, Kim KH. Factors affecting sleeping patterns among hospitalized elderly. Journal of Korean Society of Spine Surgery. 2008; 20(4):573–87.

24. Lee SJ. Effect of exercise after surgery on self-efficacy and activities of daily living of spine surgery patients [master's thesis]. Gwangju. Chonnam University;2004.

25. Filiz M, Cakmak A, Ozcan E. The effectiveness of exercise programs after lumbar disc surgery: a randomized controlled study. Clinical Rehabilitation. 2005; 19(1):4–11. https://doi.org/10.1191/0269215505cr836oa.

26. Arja H, Jari Y, Hannu K, Olavi A, Arto H, Ulla T, et al. Pain, trunk muscle strength, spine mobility and disability following lumbar disc surgery. Journal of Rehabilitation Medicine. 2003; 35(5):236–40. https://doi.org/10.1080/16501970306096.

27. Hong Y, Kim YK, Park SH. The effects of Lumbar stablilization exercise program using mcgill and sahrmann on living fitness and activities of daily living in elderly women. Journal of the Korean Association of Certified Exercise Professionals. 2013; 15(2):23–33.

28. Ozkara GO, Ozgen M, Ozkara E, Armagan O, Arslantas A, Atasoy MA. Effectiveness of physical therapy and rehabilitation programs starting immediately after lumbar disc surgery. Turkish Neurosurgery. 2015; 25(3):372–9. https://doi.org/10.5137/1019-5149.JTN.8440-13.0.

29. Marco P, Jack MG, Walter TA, Steven B, Denise EB, Timothy SC, et al. Effect of structured physical activity on prevention of major mobility disability in older adults: the life study randomized clinical trial. JAMA. 2014; 311(23):2387–96. https://doi.org/10.1001/jama.2014.5616.

Table 1.

Contents of Early Exercise Program

Time frame after surgery	Contents	Repetition (times)	Demonstration and education time (minutes)	Methods
Within 24 hours	Stretching, ankle exercise	10	20	Stretching
Within 24 hours				- Just stretch your arms and legs straight up and down in supine position.
2nd day	Stretching	10	25	Ankle exercise
	Ankle exercise Knee flection exercise			- After taking the supine position, one leg was pulled up and the flexion of the foot was contracted for 10 seconds.
				Knee flection exercise
				- Draw up one's knees and take a deep breath for 10 seconds.. repeat alternation.
3rd and	Stretching	20	35	Femoral adductor muscle exercise
4th days	Ankle exercise Knee flection exercise Femoral adductor muscle exercise			- Open my leg enough to get a pillow. Then put a pillow between the two knees. Then tighten the pillow so that it does not come off. Thereafter, it is maintained for 10 seconds.
5th and	Stretching	20	40	Abdominal muscle exercise
6th days	Ankle exercise Knee flection exercise Femoral adductor muscle exercise Abdominal muscle exercise			- Stand knee at supine position and open your legs to shoulder width. Then give strength to the upper abdomen and lift the head and hold for 10 seconds.
7th day	Stretching	20	50	Pelvic girdle exercise
	Ankle exercise Knee flection exercise			- Slowly raise your hips so you do not feel any pain.
	Femoral adductor muscle exercise Abdominal muscle exercise Pelvic girdle exercise			- Gradually raise your buttocks so that your knees, waist and shoulders line up in a straight line. hold for 10 seconds.

Table 2.

Homogeneity of General Characteristics between Experimental Group and Control Group (N=53)

Characteristics	Categories	Exp. (n=27)	Cont. (n=26)	χ² or t	p
Characteristics	Categories	n (%)	n (%)	χ² or t	p
Gender	Men	12 (44.4)	10 (38.5)	0.19	.659
Gender	Women	15 (55.6)	16 (61.5)
Age (year)	60	16 (59.3)	8 (30.8)	0.91	.339
Age (year)	≥60	11 (40.7)	18 (69.2)
Spouse	Yes	19 (66.7)	15 (57.7)	0.92	.336
Spouse	No	8 (33.3)	11 (42.3)
Living with	Alone	10 (37.0)	8 (30.8)	2.62	.269
	With children, spouse	9 (33.4)	14 (53.8)
	With spouse	8 (29.6)	4 (15.4)
Religion	Yes	9 (33.3)	8 (30.8)	0.62	.430
Religion	No	18 (66.7)	18 (69.2)
Education level	≤ Elementary school	12 (44.4)	10 (38.5)	2.13	.712
Education level	≥ Middle school	15 (55.6)	16 (61.5)
Occupation	Yes	16 (59.3)	10 (38.5)	2.29	.130
	No	11 (40.7)	16 (61.5)
Current smoking status	Yes	9 (33.3)	7 (26.9)	0.25	.611
Current smoking status	No	18 (66.7)	19 (73.1)
Medical diagnosis	HNP	19 (70.4)	15 (57.7)	1.05	.789
	Spinal stenosis	4 (14.8)	6 (23.1)
	HNP+Spinal stenosis	2 (7.4)	2 (7.7)
	Spondylolisthes	2 (7.4)	3 (11.5)
Level of lumbar site	1 Level	13 (48.1)	17 (65.4)	4.10	.250
	2 Level	9 (33.3)	4 (15.4)
	3 Level	5 (18.6)	5 (19.2)
Pain control (including PRN)	Yes	6 (22.2)	7 (26.9)	0.15	.691
Pain control (including PRN)	No	21 (77.8)	19 (73.1)
Chronic disease	Yes	18 (66.7)	16 (61.5)	0.15	.697
Chronic disease	No	9 (33.3)	10 (38.5)
Experience of surgery (number)	0	8 (29.6)	11 (42.3)	1.60	.449
	1	13 (48.1)	9 (34.6)
	2	6 (22.3)	6 (23.1)

Exp.=experimental group; Cont.=control group; HNP=herniated nucleus pulposus; PRN=pro re nata.

Table 3.

Homogeneity of Site of Pain, Sleep Disorders, Activities of Daily Living, Strength of Lower Extremity between Experimental Group and Control Group (N=53)

Characteristics	Categories	Exp. (n=27)	Cont. (n=26)	t	p
Characteristics	Categories	M± SD	M± SD	t	p
Site of pain	Back	4.18±1.30	3.69±1.19	1.43	.157
Site of pain	Leg	2.88±1.01	2.73±1.15	0.53	.597
Sleep disorders		27.14±6.21	29.46±8.24	-1.12	.266
Activities of daily living		11.62±2.30	12.23±1.94	-1.02	.311
Strength of lower extremity	Femoral circumference	41.40±5.87	40.46±3.21	0.72	.473
Strength of lower extremity	30-second chair test	5.22±0.21	4.73±0.77	1.74	.088

Exp.=experimental group; Cont.=control group.

Table 4.

Effects of Early Exercise Program between Experimental Group and Control Group (N=53)

Characteristics	Categories	Groups	Pretest	Posttest	Differences	t	p
Characteristics	Categories	Groups	M± SD	M± SD	M± SD	t	p
Site of pain	Back	Exp.	4.18±1.30	2.48±1.01	1.70±0.29	2.07	.004
		Cont.	3.69±1.19	3.26±1.87	0.43±0.68
	Leg	Exp.	2.88±1.01	1.92±1.00	0.96±0.01	-1.18	.240
		Cont.	2.73±1.15	2.19±1.09	0.54±0.06
Sleep disorders		Exp.	27.14±6.21	25.51±5.74	1.63±0.47	-1.36	.180
Sleep disorders		Cont.	29.46±8.24	27.34±7.88	2.12±0.36
Activities of daily living		Exp.	11.62±2.30	9.40±1.39	2.22±0.91	-2.14	.037
		Cont.	12.23±1.94	10.15±1.40	2.08±0.54
Strength of lower extremity	Femoral circumference	Exp.	41.40±5.87	42.70±3.92	1.03±1.95	1.75	.086
		Cont.	40.46±3.21	41.08±2.70	0.62±1.96
	30-second chair test	Exp.	5.22±1.21	6.51±1.25	1.29±0.04	4.50	.001
		Cont.	4.73±0.77	5.15±1.59	0.42±0.82

Exp.=experimental group (n=27); Cont.=control group (n=26).

TOOLS

Similar articles