Effects of Supervised Rehabilitation on Psychosocial and Participation-Related Outcomes After Lumbar Spine Surgery: A Systematic Review and Meta-Analysis

Background/Objectives: Supervised rehabilitation has been reported to improve motor and functional outcomes after lumbar spine surgery. However, the effects of supervised rehabilitation on psychosocial and participation-related outcomes are still debated. This study aimed to systematically review the effects of supervised rehabilitation on psychosocial and participation-related outcomes in patients after lumbar spine surgery. Methods: A systematic literature search was carried out using PubMed, EMBASE, CINAHL, PEDro, CENTRAL, and Google Scholar databases from inception to March 2024. Randomized controlled trials investigating the effects of supervised rehabilitation on psychosocial and participation-related outcomes after lumbar spine surgery were included. Methodological quality was assessed through the revised Cochrane risk of bias tool for randomized trials. Pooled effects were reported as the standardized mean difference (SMD) with a 95% confidence interval (CI₉₅) or reported qualitatively in the presence of clinical heterogeneity. The certainty of the evidence was rated through the GRADE approach. Results: Fifteen studies (1297 patients) were included. Very low evidence supported supervised rehabilitation to improve quality of life at 1 year (SMD: -0.28; CI₉₅ from -0.49 to -0.07, I² = 32%), while low evidence supported supervised rehabilitation to enhance self-efficacy at 6 months (SMD: -1.13; CI₉₅ from -1.54 to -0.72) and 1 year (SMD -1.03, CI₉₅ from -1.43 to -0.63). No effects of supervised rehabilitation were found on quality of life at 6 months or in terms of fear-avoidance belief, catastrophizing, anxiety, depression, and return to work at 6 months and 1 year (very low to low evidence certainty). Conclusions: Supervised rehabilitation improved quality of life and self-efficacy in patients after lumbar spine surgery. However, the certainty of the evidence ranged from very low to low, and further studies are needed.