A Person-Centered Prehabilitation Program Based on Cognitive-Behavioral Physical Therapy for Patients Scheduled for Lumbar Fusion Surgery: A Randomized Controlled Trial.
Journal
Physical therapy
ISSN: 1538-6724
Titre abrégé: Phys Ther
Pays: United States
ID NLM: 0022623
Informations de publication
Date de publication:
01 08 2019
01 08 2019
Historique:
received:
12
08
2018
accepted:
24
01
2019
pubmed:
6
4
2019
medline:
28
12
2019
entrez:
6
4
2019
Statut:
ppublish
Résumé
Prehabilitation programs have led to improved postoperative outcomes in several surgical contexts, but there are presently no guidelines for the prehabilitation phase before lumbar fusion surgery. The objective was to investigate whether a person-centered physical therapy prehabilitation program, based on a cognitive-behavioral approach, is more effective than conventional care in reducing disability and improving functioning after lumbar fusion surgery in patients with degenerative disk disease. This study was a randomized controlled trial. The study took place at 2 private spine clinics and 1 university hospital. We prospectively enrolled 118 patients scheduled for lumbar fusion surgery. The active intervention used a person-centered perspective and focused on promoting physical activity and targeting psychological risk factors before surgery. The control group received conventional preoperative care. The primary outcome was the Oswestry Disability Index score. Secondary outcomes were back and leg pain intensity, catastrophizing, kinesiophobia, self-efficacy, anxiety, depression, health-related quality of life, and patient-specific functioning, physical activity, and physical capacity. Data were collected on 6 occasions up to 6 months postoperatively. A linear mixed model was used to analyze the change scores of each outcome. No statistically significant between-group difference was found on the primary outcome (disability) over time (baseline to 6 months). Among secondary outcome measures, a statistically significant interaction effect ("Group × Time") was seen for the European Quality of Life 5 Dimensions Questionnaire. The largest between-group difference on the European Quality of Life 5 Dimensions Questionnaire index was seen 1 week prior to surgery and favored the active intervention. The largest between-group effect sizes at the 6-month follow-up favored the active intervention, and were seen for physical activity intensity, steps per day, and the One Leg Stand Test. Both groups reached the minimal important change for the primary outcome and, in several secondary outcomes (pain intensity, back and leg; pain catastrophizing; anxiety; health-related quality of life [EQ5D VAS]), already at 8-week follow-up. The participants' preoperative level of disability was lower than normative values, which suggests selection bias. Both interventions led to clinically important changes, but it is not clear what kind of prehabilitation program is the most effective.
Sections du résumé
BACKGROUND
Prehabilitation programs have led to improved postoperative outcomes in several surgical contexts, but there are presently no guidelines for the prehabilitation phase before lumbar fusion surgery.
OBJECTIVE
The objective was to investigate whether a person-centered physical therapy prehabilitation program, based on a cognitive-behavioral approach, is more effective than conventional care in reducing disability and improving functioning after lumbar fusion surgery in patients with degenerative disk disease.
DESIGN
This study was a randomized controlled trial.
SETTING
The study took place at 2 private spine clinics and 1 university hospital.
PATIENTS
We prospectively enrolled 118 patients scheduled for lumbar fusion surgery.
INTERVENTION
The active intervention used a person-centered perspective and focused on promoting physical activity and targeting psychological risk factors before surgery. The control group received conventional preoperative care.
MEASUREMENTS
The primary outcome was the Oswestry Disability Index score. Secondary outcomes were back and leg pain intensity, catastrophizing, kinesiophobia, self-efficacy, anxiety, depression, health-related quality of life, and patient-specific functioning, physical activity, and physical capacity. Data were collected on 6 occasions up to 6 months postoperatively. A linear mixed model was used to analyze the change scores of each outcome.
RESULTS
No statistically significant between-group difference was found on the primary outcome (disability) over time (baseline to 6 months). Among secondary outcome measures, a statistically significant interaction effect ("Group × Time") was seen for the European Quality of Life 5 Dimensions Questionnaire. The largest between-group difference on the European Quality of Life 5 Dimensions Questionnaire index was seen 1 week prior to surgery and favored the active intervention. The largest between-group effect sizes at the 6-month follow-up favored the active intervention, and were seen for physical activity intensity, steps per day, and the One Leg Stand Test. Both groups reached the minimal important change for the primary outcome and, in several secondary outcomes (pain intensity, back and leg; pain catastrophizing; anxiety; health-related quality of life [EQ5D VAS]), already at 8-week follow-up.
LIMITATIONS
The participants' preoperative level of disability was lower than normative values, which suggests selection bias.
CONCLUSIONS
Both interventions led to clinically important changes, but it is not clear what kind of prehabilitation program is the most effective.
Identifiants
pubmed: 30951604
pii: 5352997
doi: 10.1093/ptj/pzz020
pmc: PMC6665875
doi:
Banques de données
ISRCTN
['ISRCTN17115599']
Types de publication
Journal Article
Randomized Controlled Trial
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
1069-1088Informations de copyright
© American Physical Therapy Association 2019.
Références
Arch Gen Psychiatry. 2004 Mar;61(3):310-7
pubmed: 14993119
World J Surg. 2013 Apr;37(4):711-20
pubmed: 23292047
Phys Ther. 2019 Feb 1;99(2):127-130
pubmed: 30508203
Physiotherapy. 2018 Jun;104(2):194-202
pubmed: 28935227
BMC Musculoskelet Disord. 2016 Aug 18;17(1):349
pubmed: 27538757
Spine (Phila Pa 1976). 2010 Dec 15;35(26):E1559-63
pubmed: 20634779
Clin J Pain. 2014 Mar;30(3):183-90
pubmed: 23552561
J Adv Nurs. 2007 Apr;58(2):116-25
pubmed: 17445014
Neurosurgery. 2017 Mar 1;80(3):380-385
pubmed: 27352275
Eur J Prev Cardiol. 2018 Mar;25(4):404-417
pubmed: 29338307
Cochrane Database Syst Rev. 2014 Sep 02;(9):CD000963
pubmed: 25180773
Eur Spine J. 2007 Jun;16(6):777-86
pubmed: 17103229
J Evid Based Med. 2018 Feb;11(1):12-19
pubmed: 29356437
Spine (Phila Pa 1976). 2015 May 1;40(9):593-600
pubmed: 25705964
Spine (Phila Pa 1976). 2014 Aug 15;39(18):1449-57
pubmed: 24875964
Eur Spine J. 2006 Jan;15 Suppl 1:S93-108
pubmed: 16320033
Qual Life Res. 2015 Jul;24(7):1775-84
pubmed: 25555837
Med Sci Sports Exerc. 2008 Jan;40(1):181-8
pubmed: 18091006
Control Clin Trials. 2000 Oct;21(5 Suppl):195S-9S
pubmed: 11018575
Appl Physiol Nutr Metab. 2015 Sep;40(9):966-9
pubmed: 26300015
J Pain. 2003 Sep;4(7):407-14
pubmed: 14622683
Clin Rehabil. 2010 Feb;24(2):137-48
pubmed: 20103575
Phys Ther. 2018 May 1;98(5):398-407
pubmed: 29669084
Pain. 1983 Sep;17(1):45-56
pubmed: 6226917
Qual Life Res. 2015 Feb;24(2):391-8
pubmed: 25064207
Physiotherapy. 2015 Jun;101(2):111-8
pubmed: 25287631
JBI Database System Rev Implement Rep. 2015 Jan;13(1):146-87
pubmed: 26447015
Spine (Phila Pa 1976). 2013 Oct 1;38(21):1799-811
pubmed: 23846502
Physiotherapy. 2014 Sep;100(3):196-207
pubmed: 24439570
Spine (Phila Pa 1976). 1998 Nov 15;23(22):2412-21
pubmed: 9836355
Eur Spine J. 2011 Oct;20(10):1626-34
pubmed: 21311916
Eur J Phys Rehabil Med. 2017 Jun;53(3):351-358
pubmed: 27827516
J Cancer Surviv. 2018 Feb;12(1):64-73
pubmed: 28900822
Spine (Phila Pa 1976). 2000 Nov 15;25(22):2940-52; discussion 2952
pubmed: 11074683
Eur J Pain. 2007 Oct;11(7):711-8
pubmed: 17218132
Spine J. 2013 May;13(5):501-6
pubmed: 23422730
Acta Psychiatr Scand. 1983 Jun;67(6):361-70
pubmed: 6880820
J Adv Nurs. 2009 Aug;65(8):1626-35
pubmed: 19493145
Eur Spine J. 2014 Jan;23(1):87-95
pubmed: 23836299
Spine (Phila Pa 1976). 2017 Sep 1;42(17):1302-1310
pubmed: 28832440
J Visc Surg. 2016 Apr;153(2):109-12
pubmed: 26851994
Eur Spine J. 2010 Sep;19(9):1484-94
pubmed: 20397032
Clin Rehabil. 2011 Feb;25(2):99-111
pubmed: 21059667
Physiotherapy. 1980 Aug;66(8):271-3
pubmed: 6450426
Phys Ther. 2006 Jan;86(1):8-18
pubmed: 16386058
Spine (Phila Pa 1976). 2010 Apr 15;35(8):848-57
pubmed: 20354468
Int J Surg. 2012;10(1):28-55
pubmed: 22036893
Spine (Phila Pa 1976). 2018 May 15;43(10):713-719
pubmed: 28885297
BMC Musculoskelet Disord. 2013 Apr 26;14:148
pubmed: 23622053
Spine J. 2018 Aug;18(8):1347-1355
pubmed: 29253630
Int J Behav Nutr Phys Act. 2011 Jul 28;8:79
pubmed: 21798015
BMC Med Phys. 2013 Nov 26;13(1):5
pubmed: 24279826
Orthop Nurs. 2002 Sep-Oct;21(5):43-51; quiz 52-4
pubmed: 12432699
Neurosurg Focus. 2018 Jan;44(1):E2
pubmed: 29290132
Pain. 1995 Sep;62(3):363-72
pubmed: 8657437
Med Sci Sports Exerc. 2011 Feb;43(2):357-64
pubmed: 20581716
Clin Rehabil. 2006 Nov;20(11):989-97
pubmed: 17065542
Spine J. 2005 Jan-Feb;5(1):71-8
pubmed: 15653087
Eur Heart J. 2012 May;33(9):1112-9
pubmed: 21926072
Acta Anaesthesiol Scand. 2019 Feb;63(2):259-266
pubmed: 30132784
Int J Surg. 2014;12(2):134-40
pubmed: 24325942
Lancet. 2018 Jun 9;391(10137):2384-2388
pubmed: 29573871
Health Psychol. 2004 Sep;23(5):443-51
pubmed: 15367063
Am J Epidemiol. 2010 May 15;171(10):1055-64
pubmed: 20406758
J Pain. 2016 Jan;17(1):76-89
pubmed: 26476267
Eur Spine J. 2003 Feb;12(1):12-20
pubmed: 12592542
Psychol Bull. 1992 Jul;112(1):155-9
pubmed: 19565683
BMJ Open. 2014 Feb 04;4(2):e003821
pubmed: 24496696
Physiother Theory Pract. 2014 Feb;30(2):131-7
pubmed: 24083621