Journal
JOURNAL OF PAIN
Volume 17, Issue 1, Pages 76-89Publisher
CHURCHILL LIVINGSTONE
DOI: 10.1016/j.jpain.2015.09.013
Keywords
Lumbar degenerative disease; cognitive-behavioral therapy; randomized controlled trial; postoperative rehabilitation; lumbar spinal fusion
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Funding
- National Institute of Arthritis and Musculoskeletal and Skin Diseases of the National Institutes of Health [R21AR062880]
- Magistro Family Foundation grant through the Foundation for Physical Therapy
- CTSA award from the National Center for Advancing Translational Sciences [UL1TR000445]
- NATIONAL CENTER FOR ADVANCING TRANSLATIONAL SCIENCES [UL1TR000445] Funding Source: NIH RePORTER
- NATIONAL INSTITUTE OF ARTHRITIS AND MUSCULOSKELETAL AND SKIN DISEASES [R21AR062880] Funding Source: NIH RePORTER
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The purpose of this study was to determine the efficacy of a cognitive-behavioral-based physical therapy (CBPT) program for improving outcomes in patients after lumbar spine surgery. A randomized controlled trial was conducted on 86 adults undergoing a laminectomy with or without arthrodesis for a lumbar degenerative condition. Patients were screened preoperatively for high fear of movement using the Tampa Scale for Kinesiophobia. Randomization to either CBPT or an education program occurred at 6 weeks after surgery. Assessments were completed pretreatment, posttreatment and at 3-month follow-up. The primary outcomes were pain and disability measured by the Brief Pain Inventory and Oswestry Disability Index. Secondary outcomes included general health (SF-12) and performance-based tests (5-Chair Stand, Timed tip and Go, 10-Meter Walk). Multivariable linear regression analyses found that CBPT participants had significantly greater decreases in pain and disability and increases in general health and physical performance compared with the education group at the 3-month follow-up. Results suggest a targeted CBPT program may result in significant and clinically meaningful improvement in postoperative outcomes. CBPT has the potential to be an evidence-based program that clinicians can recommend for patients at risk for poor recovery after spine surgery. Perspective: This study investigated a targeted cognitive-behavioral-based physical therapy program for patients after lumbar spine surgery. Findings lend support to the hypothesis that incorporating cognitive-behavioral strategies into postoperative physical therapy may address psychosocial risk factors and improve pain, disability, general health, and physical performance outcomes. (C) 2016 by the American Pain Society
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