The relationship between number of sessions and clinical results in lumbar symptomatic spondylolisthesis.

BACKGROUND AND OBJECTIVE - The relationship between the number of sessions and the therapeutic effect has not been adequately investigated either in non-specific LBP, or in symptomatic lumbar spondylolisthesis (SPL). The aim of this study was to evaluate the effectiveness of 5-8 vs. 9-12 sessions of physical therapy treatments on the reduction of symptoms on Grade I symptomatic lumbar SPL. MATERIALS AND METHODS - A retrospective cohort study of 64 consecutive patients admitted for physical therapy with symptomatic lumbar grade I SPL was conducted. All participants were retrospectively assigned to one of two groups, receiving either 5-8 or 9-12 sessions (experimental or control group, respectively) of physical therapy treatments. Outcome measures were the Numeric Rating Scale for pain (NRS), the Oswestry Disability Index in its Italian version (ODI-I) for disability, the Prone Bridge Test (PBT) and the Supine Bridge Test (SBT) for muscular endurance. The number of therapeutic sessions required to achieve similar clinical and functional outcomes was recorded and compared between groups. RESULTS - Experimental group performed significantly less treatments than control group (6.1 ±0.8 vs 9.8 ±1.9, P<0.001). However, both groups had similar outcomes in NRS and ODI-I (all, P=<0.02), and a significant effect of time interaction existed for PBT and SBT immediately after the intervention (all, P<0.001), DISCUSSION – This study showed that the performance of supervised graded exercises with education in a home exercise program in fewer treatment sessions is as effective as control group in more sessions, indicating that SPL may be responsive to a series of 5-8 treatment sessions delivered over a period of 6-8 weeks. Comparison of the clinical outcomes between groups revealed a similar attainment of physical performance level at discharge, measured with lumbar endurance (SBT and PBT). Similar rates of pain and disability were also found at the end of treatment. CONCLUSIONS - In the treatment of symptoms on grade I SPL, 5-8 sessions of physical therapy are as effective as 9-12 sessions. Our study adds some information to assist physical therapists in clinical decision making on the number of expected treatment sessions for people presenting for treatment of SPL.