title: Cognitive-behavioral-based physical therapy to improve surgical spine outcomes: a case series.
abstract: OBJECTIVE
  Fear of movement is a risk factor for poor postoperative outcomes in patients following spine surgery. The purposes of this case series were: (1) to describe the effects of a cognitive-behavioral-based physical therapy (CBPT) intervention in patients with high fear of movement following lumbar spine surgery and (2) to assess the feasibility of physical therapists delivering cognitive-behavioral techniques over the telephone.
  
  
  METHODS
  Eight patients who underwent surgery for a lumbar degenerative condition completed the 6-session CBPT intervention. The intervention included empirically supported behavioral self-management, problem solving, and cognitive restructuring and relaxation strategies and was conducted in person and then weekly over the phone. Patient-reported outcomes of pain and disability were assessed at baseline (6 weeks after surgery), postintervention (3 months after surgery), and at follow-up (6 months after surgery). Performance-based outcomes were tested at baseline and postintervention. The outcome measures were the Brief Pain Inventory, Oswestry Disability Index, 5-Chair Stand Test, and 10-Meter Walk Test.
  
  
  RESULTS
  Seven of the patients demonstrated a clinically significant reduction in pain, and all 8 of the patients had a clinically significant reduction in disability at 6-month follow-up. Improvement on the performance-based tests also was noted postintervention, with 5 patients demonstrating clinically meaningful change on the 10-Meter Walk Test.
  
  
  CONCLUSIONS
  The findings suggest that physical therapists can feasibly implement cognitive-behavioral skills over the telephone and may positively affect outcomes after spine surgery. However, a randomized clinical trial is needed to confirm the results of this case series and the efficacy of the CBPT intervention. Clinical implications include broadening the availability of well-accepted cognitive-behavioral strategies by expanding implementation to physical therapists and through a telephone delivery model.
authors.affiliation: Department of Orthopaedic Surgery & Rehabilitation, School of Medicine, Vanderbilt University, Medical Center East-South Tower, Suite 4200, Nashville, TN 37232, USA. kristin.archer@vanderbilt.edu
authors.forename: Kristin R
authors.initials: KR
authors.lastname: Archer
authors.forename: Nicole
authors.initials: N
authors.lastname: Motzny
authors.forename: Christine M
authors.initials: CM
authors.lastname: Abraham
authors.forename: Donna
authors.initials: D
authors.lastname: Yaffe
authors.forename: Caryn L
authors.initials: CL
authors.lastname: Seebach
authors.forename: Clinton J
authors.initials: CJ
authors.lastname: Devin
authors.forename: Dan M
authors.initials: DM
authors.lastname: Spengler
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: McGirt
authors.forename: Oran S
authors.initials: OS
authors.lastname: Aaronson
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Cheng
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Wegener
mesh_terms: D000328:Adult; D000368:Aged; D015928:Cognitive Behavioral Therapy; D004185:Disability Evaluation; D005239:Fear; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D026741:Physical Therapy Modalities; D011788:Quality of Life; D015203:Reproducibility of Results; D012307:Risk Factors; D013122:Spinal Diseases / Q000523:psychology* / Q000534:rehabilitation* / Q000601:surgery*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome