Does a Preoperative Cognitive-behavioral Intervention affect disability, pain behavior, pain and return to work the first year after Lumbar Spinal Fusion Surgery?

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Study Design. A randomized clinical trial including 90 patients.Objective. To examine the effect of a preoperative cognitive-behavioural intervention (CBT) for patients undergoing lumbar spinal fusion surgery (LSF)Summary of Background Data. Few published studies have looked at the potential of rehabilitation to improve outcomes following LSF. Rehabilitation programmes using CBT are recommended. Further, initiating interventions preoperatively seems beneficial, but only limited data exists in the field of spine surgery.Methods. Patients with degenerative disc disease or spondylolisthesis undergoing LSF were randomized to usual care (control group) or preoperative CBT and usual care (CBT group). Primary outcome was change in Oswestry Disability Index (ODI) from baseline to 1-year follow-up. Secondary outcomes were catastrophizing, fear-avoidance belief, work status and back and leg pain.Results. At 1-year follow-up there was no statistically significant difference between the CBT group and the control group in ODI score (P = 0.082). However, the CBT group had achieved a significant reduction of -15 points (-26;-4) already at 3 months (between group difference P = 0.003) and this reduction was maintained throughout the year. There were no differences between groups at 1-year follow-up with regards to any of the secondary outcomes.Conclusions. Participating in a preoperative CBT intervention in addition to usual care did not produce better outcomes at 1-year follow-up for patients undergoing LSF. Although the reduction in disability was achieved much faster in the CBT group, resulting in a significant difference between groups already three months after surgery, it did not translate into a faster return to work. Our findings support the need for further research into the use of targeted rehabilitation interventions among patients with elevated levels of catastrophizing and fear avoidance beliefs.

Original languageEnglish
JournalSpine
Volume40
Issue9
Pages (from-to)593-600
Number of pages8
ISSN0362-2436
DOIs
Publication statusPublished - 1 May 2015

    Research areas

  • cognitive-behavioral therapy, lumbar spinal fusion, rehabilitation, preoperative, randomized study

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