title: Management of catastrophising and kinesiophobia improves rehabilitation after fusion for lumbar spondylolisthesis and stenosis. A randomised controlled trial.
abstract: OBJECTIVE
  To evaluate the effect of a rehabilitation programme including the management of catastrophising and kinesiophobia on disability, dysfunctional thoughts, pain, and the quality of life in patients after lumbar fusion for degenerative spondylolisthesis and/or lumbar spinal stenosis.
  
  
  METHODS
  This was a parallel-group, randomised, superiority-controlled study in which 130 patients were randomly assigned to a programme consisting of exercises and cognitive-behavioural therapy (experimental group, 65 subjects) or exercises alone (control group, 65 subjects). Before treatment (T1), 4 weeks later (post-treatment analysis, T2) and 12 months after the end of treatment (follow-up, T3), all the patients completed a booklet containing the Oswestry Disability Index (ODI, primary outcome), the Tampa Scale for Kinesiophobia, the Pain Catastrophising Scale, a pain Numerical Rating Scale, and the Short-Form Health Survey. A linear mixed model for repeated measures was used for each outcome measure.
  
  
  RESULTS
  The ODI linear mixed model revealed significant main effects of group (F(1,122.8) = 95.78, p < 0.001) and time (F(2,120.1) = 432.02, p < 0.001) in favour of the experimental group. There was a significant group × time interaction effect (F(2,120.1) = 20.37, p < 0.001). The analyses of all of the secondary outcome measures revealed a significant effect of time, group and interaction in favour of the experimental group.
  
  
  CONCLUSIONS
  The rehabilitation programme, including the management of catastrophising and kinesiophobia, was superior to the exercise programme in reducing disability, dysfunctional thoughts, and pain, and enhancing the quality of life of patients after lumbar fusion for degenerative spondylolisthesis and/or LSS. The effects lasted for at least 1 year after the intervention ended.
authors.affiliation: Physical Medicine and Rehabilitation Unit, Scientific Institute of Lissone (Milan), Institute of Care and Research (IRCCS), Salvatore Maugeri Foundation IRCCS, Via Monsignor Bernasconi, 16, Lissone, 20851, Milan, Italy, marco.monticone@fsm.it.
authors.forename: Marco
authors.initials: M
authors.lastname: Monticone
authors.forename: Simona
authors.initials: S
authors.lastname: Ferrante
authors.forename: Marco
authors.initials: M
authors.lastname: Teli
authors.forename: Barbara
authors.initials: B
authors.lastname: Rocca
authors.forename: Calogero
authors.initials: C
authors.lastname: Foti
authors.forename: Alessio
authors.initials: A
authors.lastname: Lovi
authors.forename: Marco
authors.initials: M
authors.lastname: Brayda Bruno
mesh_terms: D000328:Adult; D058443:Catastrophization / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D006233:Persons with Disabilities; D019468:Disease Management; D005081:Exercise Therapy / Q000379:methods*; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009068:Movement / Q000502:physiology; D017063:Outcome Assessment, Health Care; D010147:Pain Measurement; D010698:Phobic Disorders / Q000628:therapy*; D011788:Quality of Life; D013130:Spinal Stenosis / Q000523:psychology / Q000534:rehabilitation* / Q000601:surgery; D013168:Spondylolisthesis / Q000523:psychology / Q000534:rehabilitation* / Q000601:surgery; D016896:Treatment Outcome