title: Early rehabilitation targeting cognition, behavior, and motor function after lumbar fusion: a randomized controlled trial.
abstract: METHODS
  Open label randomized controlled trial with 3-, 6-, 12-month, and 2- to 3-year follow-up.
  
  
  OBJECTIVE
  To investigate the effectiveness of a psychomotor therapy focusing on cognition, behavior, and motor relearning compared with exercise therapy applied during the first 3 months after lumbar fusion.
  
  
  BACKGROUND
  Postoperative management after lumbar fusion commonly focuses on analgesic pain control and activities of daily living. After 3 months, exercise therapy is often implemented. No randomized controlled trial has investigated early rehabilitation techniques conducted during the first 3 months after surgery.
  
  
  METHODS
  The study recruited 107 patients, aged 18 to 65 years, selected for lumbar fusion because of 12 months of symptomatic spinal stenosis, spondylosis, degenerative/isthmic spondylolisthesis, or degenerative disc disease. The exercise therapy group received a home program focusing on pain contingent training of back, abdominal, and leg muscle functional strength and endurance, stretching, and cardiovascular fitness. The psychomotor therapy group received a home program and 3 outpatient sessions focusing on modifying maladaptive pain cognitions, behaviors, and motor control.Rated questionnaires investigating functional disability, pain, health-related quality of life, functional self-efficacy, outcome expectancy, fear of movement/(re)injury, and coping were assessed at 3, 6, 12 months, and 2 to 3 years after surgery.
  
  
  RESULTS
  Follow-up rates were 93% at 12 months and 81% at 2 to 3 years after surgery. Psychomotor therapy improved functional disability, self-efficacy, outcome expectancy, and fear of movement/(re)injury significantly more than exercise therapy at respective follow-up occasions. Similar results occurred for pain coping but group differences were nonsignificant at 2 to 3 years follow-up. Potentially clinical relevant higher reoperation rates occurred after psychomotor therapy but rates were within normal ranges.
  
  
  CONCLUSIONS
  The study shows that postoperative rehabilitation can be safely implemented during the first 3 months after lumbar fusion and should include measures to modify psychological as well as motor functions.
authors.affiliation: Department of Physical Therapy, Karolinska University Hospital, Stockholm, Sweden. allan.abbott@karolinska.se
authors.forename: Allan D
authors.initials: AD
authors.lastname: Abbott
authors.forename: Raija
authors.initials: R
authors.lastname: Tyni-Lenné
authors.forename: Rune
authors.initials: R
authors.lastname: Hedlund
mesh_terms: D000328:Adult; D001521:Behavior Therapy / Q000379:methods / Q000706:statistics & numerical data; D003071:Cognition / Q000502:physiology; D015928:Cognitive Behavioral Therapy / Q000379:methods* / Q000706:statistics & numerical data; D005081:Exercise Therapy / Q000379:methods; D005260:Female; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000523:psychology / Q000534:rehabilitation* / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009048:Motor Skills / Q000502:physiology; D017063:Outcome Assessment, Health Care; D010149:Postoperative Pain / Q000523:psychology / Q000534:rehabilitation*; D011183:Postoperative Complications / Q000517:prevention & control / Q000523:psychology / Q000534:rehabilitation; D011597:Psychomotor Performance / Q000502:physiology*; D012046:Rehabilitation / Q000379:methods* / Q000706:statistics & numerical data; D013130:Spinal Stenosis / Q000523:psychology / Q000534:rehabilitation / Q000601:surgery; D013168:Spondylolisthesis / Q000523:psychology / Q000534:rehabilitation / Q000601:surgery; D055009:Spondylosis / Q000523:psychology / Q000534:rehabilitation* / Q000601:surgery; D013663:Teaching / Q000379:methods; D013997:Time Factors; D016896:Treatment Outcome