Table 1 Characteristics of the included studies

Abbott et al. [7]

The purpose of this study was to compare the efficacy of psychomotor therapy focusing on cognition, behavior, and motor relearning to that of exercise therapy during the first 3 months after lumbar fusion

35% F (SG) 31% F (CG)

Psychomotor group:

A 90-min outpatient physical therapy session was also added to the home training program 3, 6, and 9 weeks after the surgery up to 12 weeks post-operatively

Control group:

Patients were given a one-time, 20-min home training program that included dynamic exercises before being diskharged from the hospital to be continued up to 12 weeks post-operatively

ODI

VAS

EQ-5D

BBQ

SF-36

SES

TSK

CSQ-CAT

CSQ-COP

CSQ-ADP

Questionnaire (on Work Status, Sickness Leave, External Health Care Use, Analgesic Use, Treatment Satisfaction, Training Frequency and Reoperation Rates)

Psychomotor therapy showed better results on pain coping, functional disability, self-efficacy, outcome expectancy, fear of movement, and reinjury at 3,6, and 12 months (p < 0.001)

The results were nonsignificant at 2 to 3 years follow-up (p > 0.001)

Psychomotor therapy group’s employment rates were higher, and sickness leave duration of longer than 6 months were significantly less (p < 0.05)

Choi et al. [12]

The purpose of this study is to assess the impact of a postoperative early isolated lumbar extension muscle-strengthening program on pain, disability, return to work, and back muscular strength after lumbar disk surgery

43% F (SG)

55% F (CG)

Early rehabilitation group:

Post-operative protocol was common during the first 6 weeks. Patients started lumbar extension exercise regimen for 12 weeks using MedX 6 weeks after surgery

Control Group:

Advice was given to patients on how to keep a good posture and steer clear of physically demanding tasks.Handouts for simple spinal conditioning exercises to practice at home to be applied after the 2nd week were distributed

ODI

VAS

Lumbar Extensor Power

Cross-sectional area of Multifidus and Longissimus Muscles (mm2)

Questionnaire on Percentage of Return to work (%)

The study group yielded better results on lumbar extensor power, the cross-sectional area of multifidus and longissimus muscle, pain, and the number of returns to work at 4 months (p < 0.05)

There was no significant difference between groups in terms of disability (p > 0.05)

Danielsen et al. [20]

The aim of this study is to evaluate the effect of an early exercise compared with a standard care program

38.5% F (SG)

29.2% F (CG)

Training group:

The training group adhered to the control group's routine for the first 3 weeks. 4 weeks after the surgery, the intervention began. For 8 weeks, the training group participated in a rehabilitation program three times each week. Each exercise had a different number of repetitions, ranging from 2 × 15 at the start to 3 × 30 at the end of the training period. Each training session lasted 40 min

Control group:

After relaxing and recuperating their backs for 2 months following the surgery, the control group engaged in a gentle program of 2 to 3 back exercises at home

VAS

Roland’s Disability Questionnaire

Wonca’s Functional Status Measures

Significant difference was found in favor of the training group regarding pain, disability and functionality at 6 months (p < 0.05), turning nonsignificant after 1 year (p > 0.05)

Control groups were more likely to report an improvement in their own health at both 6 and 12 months (p < 0.05)

Donceel et al. [21]

This study aims to demonstrate how early rehabilitation is primarily concerned with the impact of early mobilization on return to work

N/A

Early rehabilitation group:

Medical advisers examined the patients monthly, starting at 6 weeks post operatively. They used a newly made protocol to motivate the patients and treating physicians toward social and professional reintegration

Control Group:

Patients haven’t received rehabilitation during the post-operative period

Standardized Questionnaire (on Demographic Data, Employment Status, Heaviness of Work, Work Satisfaction, Smoking Behavior, Education, Reported Symptoms Lasting more than 1 year before operation, Back operations in the past, Onset of Back Problems, Location of Pain, Signs of Paresis before intervention, Pending litigation, Period of Work Capacity before surgical intervention)

Rehabilitation-focused group returned to work at a higher rate at 1 year follow-up (p < 0.001)

He et al. [22]

The purpose of this study is to demonstrate the impact of a nurse-led early rehabilitation program on the postoperative recovery of patients having orthopedic robot-assisted minimally invasive lumbar internal fixation for lumbar degenerative lesions

55% F (SG) 52% F (CG)

Nurse-led Early rehabilitation group:

The nurse-led early rehabilitation program including counseling on mental health issues, breathing exercises, abdominal massages, wearing lumbar supports, double bedside help, and tailored diskharge rehabilitation guidance starting on the first day until diskharge was performed

Control group:

After lumbar spine surgery, the standard care paradigm was put into place

ODI

VAS

BI

Patients' Compliance with the Exercise Program on Days 1 and 4 (Full/Part/Non-Compliance)

Postoperative Conditions (Drainage Time, Time from Placement of Surgical Plasma Drainage Tube to Its Removal; Postoperative First Time on The Floor After Surgery, Time from the Completion of Surgery to Return to the Ward o the Time Oof Getting Out of Bed and Standing in Lumbar Support; Postoperative Hospitalization Time, Time from the Completion of Surgery to diskharge.)

Complication Rates

Nurse-led early rehabilitation group significantly had better first time on the floor and shorter hospital stay (p < 0.05)

The probability of constipation and abdominal distension was significantly lower in the observation group (p < 0.05)

At 3 days, pain, functional recovery and daily living ability was better in the study group (p > 0.05)

Control group had better compliance at day 1 and 4 (p < 0.001)

There was no difference between the two groups at 1 month. (p > 0.05)

Kernc et al. [23]

The aim of this study is to evaluate the security and effects of early rehabilitation beginning, including objective measurement outcomes following lumbar spine fusion based on strength training concepts

31% F (SG)

64% F (CG)

Strength training group:

3 weeks following surgery, the strength training group began their rehabilitation. Throughout a period of 9 weeks, patients engaged in twice-weekly exercise with an emphasis on lumbopelvic stability muscle activation. From week one through week five, isometric exercises with a 45-s break in between were used. Exercise lasts for 20, 25, and 30 s if the perceived effort is below 8 on the Borg scale

Control group:

Patients adhered to the typical postoperative regimen, which restricted exercises at that point in the healing process

6MWT

CST

SRH

ODI

VAS

Isometric Trunk Muscle Strength (nanometer)

Intraabdominal Pre-Activation Pattern (seconds)

The early rehabilitation group improved significantly more than the control group at 3 months. (p < 0.05)

No training effects were seen at 18 months (p > 0.05)

Kjellby-Wendt et al. [24]

The purpose of this study was to compare the outcomes of two treatment regimens administered 5–7 years after surgical correction of lumbar disk herniation: one early active training (EAT group) and one less aggressive regimen (control group)

30% F (SG) 23% F (CG)

Early active training group:

Patients received exercises to increase range of motion of the leg. Starting from the 1st day, throughout the course of a 12-week period, the physiotherapist gave instructions to patients 4 times. Patients instructed to increase their physical activity, and detailed instructions on how to manage pain were also given

Control group:

Patients did not do exercises to increase range of motion of the leg, but they did abdominal exercises and exercises to increase flexion and lateral flexion of the trunk were also added 6 weeks after surgery

Starting from the 1st day, throughout the course of a 12-week period, the physiotherapist gave instructions to patients 3 times. They were not instructed to increase their physical activity, and instructions on how to manage pain were also less detailed

The Straight Leg Raising Test (and its Difficulty and Location)

BDI

VAS

Questionnaire (on Remaining Sciatica, Days of Sick Leave

Rate of Return to Work

Early Retirement

Satisfaction with the Procedure)

There was no apparent difference between the groups at 5–7 years follow-up (p > 00.5)

LeBlanc et al. [25]

This study compared the effects of early versus later exercise intervention following a unilateral lumbar microdiskectomy on low back pain intensity, fear avoidance, neurodynamic mobility, and function

58.% F (SG) 53% F (CG)

Early rehabilitation group:

Patients received low back care education during visits 1–2, 4–6, and 8–10 weeks. Group 1 received the initial level of the exercise protocol at 1–2 weeks, and the progressive level at 4–6 weeks

Control group:

Patients received low back care education 3 times at 1–2, 4–6, and 8–10 weeks after surgery. Patients got all exercises (beginning and advanced levels) at 4–6 weeks, along with instructions on how to move from the beginning to the advanced levels

ODI

NPRS

FABQ

PSFS

50-Foot Walk Test

There was no significant difference among groups within each group at 1–2, 4–6, 8–10 weeks after surgery (p > 0.001)

Newsome et al. [19]

The purpose of this study is to find out if starting activities right away after a lumbar microdiskectomy helped patients recover their independence more quickly while posing the same level of risk for consequences

54% F (SG) 27% F (CG)

Early rehabilitation group:

On the first postoperative day, participants received an instruction sheet, exercises, and help getting out of bed, which usually occurred 4 to 5 h following surgery. Beginning 2 h after surgery and continuing ten times on each leg every 30 min, a physical therapist on the spinal ward passively flexed one patient's hip and knee toward the chest within their range of motion and tolerance

Control group:

Participants received the same instruction sheet and exercises on the first postoperative day, as well as assistance to get out of bed on average 4 to 5 h after surgery. Patients in the control group did not perform the passively aided or actively assisted hip/knee flexion exercises

ODI

VAS

Return to Work (weeks)

Short Form McGill Pain Questionnaire

Time from the End of the Operation to the Patient to Becoming Independently Mobile (hours)

The early rehabilitation group showed reduced time to independent mobility and return to work (p < 0.001)

There were no significant differences in disability and pain scores at 4 weeks and 3 months (p > 0.001)

Oestergaard et al. [26]

The aim of this study is to assess if starting rehabilitation 6 weeks following surgery instead of 12 weeks is more cost-effective

47% F (SG)

58% F (CG)

Early rehabilitation (6-week) group:

6 weeks after surgery, the patient started receiving early rehabilitation, which consisted of 4 group sessions and instructions for at-home exercises

Control (12-week) group:

The identical rehabilitation plan, which included four group sessions and instructions for at-home exercises, began for the patients 12 weeks after surgery

ODI

EQ-5D

QALY

Health Care and Productivity Costs (euros)

The improvement regarding functional disability in the 12-week group were significantly better than that in the 6 weeks group at 6 months and 1 year (p < 0.05)

The number of extra hospital admissions and outpatient visits in the 6w-group compared to the 12w-group were considerably higher (p < 0.05)

There was no significant difference between groups regarding cost effectiveness (p > 0.05)

Ozkara et al. [13]

The purpose of this study is to assess the effects of exercise programs on patients who had undergone lumbar microdiskectomy surgery in terms of pain, back impairment, behavioral outcomes, overall health parameters and back mobility

63% F (SG)

53.3%(CG)

Exercise group:

Home based exercises started from the postoperative 1st day, 2 sets of each exercise daily, 3 days a week

Control group:

Control group hasn’t received exercise therapy during the post-operative period

ODI

VAS

BDI

SF-36

At 12 weeks, exercise group significantly improved disability, lower back pain (p < 0.05), but the return to life and patient satisfaction was not significant among groups (p > 0.05)

Oosterhuis et al. [18]

The purpose of this study is to determine whether early rehabilitation after lumbar disk surgery is effective and cost-effective when compared to no referral

57% F (SG)

59% F (CG)

Early rehabilitation group:

Starting the 1st day, patients were given 30-min exercise according to the national guidelines, up to 6–8 weeks

Control group:

Conventional physiotherapy program without rehabilitation was ordered

ODI

FABQ

Global Perceived Effect Scale

Short From 12

EQ-5D-3L

Credibility/Expectancy Questionnaire

Örebro Musculoskeletal Pain Screening Questionnaire

Pain Coping Inventory

There was no significant difference between groups in 26 weeks (p < 0.05)

Zhang et al. [27]

The purpose of this study is to investigate the effects of postoperative functional exercise on patients who had lumbar disk herniation treated with percutaneous transforaminal endoscopic diskectomy

48% F

Early rehabilitation group:

Patients conducted early functional exercises of passive and autonomic activities after their operations including extension and flexion exercises of the lower limbs, toes and neck for 12 weeks. Patients have been called twice in the first 6 weeks to address questions or problems

Control group:

Patients conducted routine functional exercises after their operations

SF-36

Lumbar Function Scale

Spine Stability (Lateral X-Ray)

Lumbar curvature (MRI)

Lordosis index (MRI)

Sacral Inclination Angle (MRI)

Short-term Curative Effects (Excellent/Good/Poor)

Long-term Curative Effects

(Excellent/Good/Poor)

All parameters showed significant improvement in the control group (p < 0.05)