title: Health behavior change counseling in surgery for degenerative lumbar spinal stenosis. Part I: improvement in rehabilitation engagement and functional outcomes.
abstract: OBJECTIVE
  To examine whether a brief motivational interviewing [MI]-based health behavior change counseling (HBCC) intervention increased patient participation in physical therapy and/or home exercise programs (HEPs), reduced disability, and improved health status after surgery for degenerative lumbar spinal stenosis.
  
  
  METHODS
  Prospective clinical trial.
  
  
  METHODS
  Academic medical center.
  
  
  METHODS
  From December 2009 through August 2012, consecutive patients (N=122) underwent surgery for degenerative lumbar spinal stenosis and, based on enrollment date, were prospectively assigned to a control (n=59) or HBCC intervention (n=63) group in a prospective, lagged-control clinical trial.
  
  
  METHODS
  Brief MI-based HBCC versus attention control.
  
  
  METHODS
  Rehabilitation participation (primary); disability and health status (secondary). Therapists assessed engagement in, and patients reported attendance at, postoperative rehabilitation (physical therapy and/or HEP). At 3 and 6 months, disability and health status were assessed (Oswestry Disability Index [ODI] and Medical Outcomes Study 12-Item Short-Form Health Survey, version 2 [SF-12v2]) (significance, P<.05).
  
  
  RESULTS
  Compared with controls, HBCC patients had significantly higher rehabilitation engagement (21.20±4.56 vs 23.57±2.71, respectively; P<.001), higher physical therapy (.67±.21 vs .82±.16, respectively; P<.001) and HEP (.65±.23 vs .75±.22, respectively; P=.019) attendance, and better functional outcomes at 3 months (difference: ODI, -10.7±4.4, P=.015; SF-12v2, 6.2±2.2, P=.004) and 6 months (difference: ODI, -12.7±4.8, P=.008; SF-12v2, 8.9±2.4, P<.001). The proportion of the HBCC intervention impact on functional recovery mediated by rehabilitation participation was approximately half at 3 months and one-third at 6 months.
  
  
  CONCLUSIONS
  HBCC can improve outcomes after spine surgery through improved rehabilitation participation.
authors.affiliation: Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD. Electronic address: editorialservices@jhmi.edu.
authors.forename: Richard L
authors.initials: RL
authors.lastname: Skolasky
authors.affiliation: Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Anica M
authors.initials: AM
authors.lastname: Maggard
authors.affiliation: Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: David
authors.initials: D
authors.lastname: Li
authors.affiliation: Department of Orthopaedic Surgery, The Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Lee H
authors.initials: LH
authors.lastname: Riley
authors.affiliation: Department of Physical Medicine and Rehabilitation, The Johns Hopkins University School of Medicine, Baltimore, MD.
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Wegener
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000368:Aged; D004185:Disability Evaluation; D015444:Exercise; D005260:Female; D015438:Health Behavior; D006304:Health Status; D006801:Humans; D008159:Lumbar Vertebrae; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D062405:Motivational Interviewing / Q000379:methods*; D010358:Patient Participation / Q000379:methods*; D026741:Physical Therapy Modalities; D011446:Prospective Studies; D020127:Recovery of Function; D012959:Socioeconomic Factors; D013130:Spinal Stenosis / Q000534:rehabilitation* / Q000601:surgery*
keywords: Laminectomy; Motivational interviewing; Rehabilitation; Spinal stenosis; Spine
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