title: Behavioral-graded activity compared with usual care after first-time disk surgery: considerations of the design of a randomized clinical trial.
abstract: OBJECTIVE
  To present the design of a trial on the effectiveness of a behavioral-graded activity model.
  
  
  METHODS
  Randomized clinical trial.
  
  
  METHODS
  Patients undergoing first-time lumbar disk surgery who still have low-back pain at the 6-week neurosurgical consultation.
  
  
  METHODS
  A patient-tailored behavioral-graded activity program that is based on operant therapy. The key elements of this program are baseline measurements, goal-setting, and time-contingency. This program is compared with usual care in physiotherapy, which is pain-contingent.
  
  
  METHODS
  Primary measures are the patient's global impression of the effect and their functional status. Secondary measures are kinesiophobia, catastrophizing, pain, main complaint, range of motion, and relapses. The direct and indirect costs will also be assessed. The effect measures are rated before randomization and 3, 6, and 12 months later.
  
  
  CONCLUSIONS
  Several trials have been conducted on the effectiveness of behavioral treatments. Subjects were always patients with chronic low-back pain. In this trial, we apply such a treatment in patients after first-time disk surgery in a primary care setting.
authors.affiliation: Department of Epidemiology, Maastricht University, The Netherlands. Raymond.Ostelo@epid.unimaas.nl
authors.forename: R W
authors.initials: RW
authors.lastname: Ostelo
authors.forename: A J
authors.initials: AJ
authors.lastname: Köke
authors.forename: A J
authors.initials: AJ
authors.lastname: Beurskens
authors.forename: H C
authors.initials: HC
authors.lastname: de Vet
authors.forename: M R
authors.initials: MR
authors.lastname: Kerckhoffs
authors.forename: J W
authors.initials: JW
authors.lastname: Vlaeyen
authors.forename: P M
authors.initials: PM
authors.lastname: Wolters
authors.forename: M W
authors.initials: MW
authors.lastname: Berfelo
authors.forename: P A
authors.initials: PA
authors.lastname: van den Brandt
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D001521:Behavior Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000601:surgery*; D008159:Lumbar Vertebrae; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D010149:Postoperative Pain / Q000523:psychology / Q000534:rehabilitation / Q000628:therapy*; D018579:Patient Selection; D011379:Prognosis; D011897:Random Allocation; D016032:Randomized Controlled Trials as Topic / Q000379:methods*; D012107:Research Design; D012680:Sensitivity and Specificity; D013997:Time Factors; D016896:Treatment Outcome