CLINICAL EFFECTIVENESS OF MDT-ORIENTED MULTIMODAL REHABILITATION FOLLOWING LUMBAR DECOMPRESSION SURGERY: A PROSPECTIVE CONTROLLED STUDY

Objective: To substantiate and evaluate the clinical efficacy of a three-stage medical rehabilitation programme for patients after decompressive surgery on the lumbosacral spine, based on Mechanical Diagnosis and Therapy (MDT) principles, compared to standard therapeutic exercises and basic physiotherapy. Materials and methods: A prospective controlled study enrolled 187 patients (60 men, 127 women; mean age 39.4 ± 9.75 years) who had undergone lumbosacral decompressive surgery for intervertebral disc herniation. Using biased-coin randomisation, patients were allocated to three groups: the main group (n = 63) receiving the developed three-stage rehabilitation programme plus basic therapy; the comparison group (n = 62) receiving standard therapeutic gymnastics; and the control group (n = 62) receiving only basic physiotherapy and balneotherapy. Assessment was performed at three timepoints (T0 — baseline, T1 — post-course, T2 — 6 months) using VAS, Oswestry Disability Index (ODI), Schober test, SAN questionnaire, stabilometry, EMG, and rheovasography. Results: In the main group at T2, VAS pain intensity decreased by 66.0% (from 5.3 ± 1.2 to 1.8 ± 0.8), ODI by 27.4 percentage points (from 46.3% to 18.9%), and Schober test reached normative values (6.1 ± 0.6 cm). Normalisation of statokinesigram area with eyes closed was achieved in 51.7% of main group patients vs. 20.7% in the comparison group and 17.2% in controls (p < 0.05). EMG amplitude of m. gastrocnemius increased from 0.23 ± 0.03 to 0.31 ± 0.04 mV (+34.8%). Rheovasographic index reached the normative range (0.78 ± 0.08). All between-group differences were statistically significant (p < 0.05). Conclusion: The developed three-stage rehabilitation programme based on MDT principles with integrated neurodynamic exercises, stabilisation training, and an educational component demonstrates superior clinical efficacy over standard therapeutic gymnastics and basic therapy in restoring motor activity, reducing pain, and improving neuromuscular control in patients after lumbosacral decompressive surgery