title: Cognitive-Behavioral-Based Physical Therapy for Patients With Chronic Pain Undergoing Lumbar Spine Surgery: A Randomized Controlled Trial.
abstract: The purpose of this study was to determine the efficacy of a cognitive-behavioral-based physical therapy (CBPT) program for improving outcomes in patients after lumbar spine surgery. A randomized controlled trial was conducted on 86 adults undergoing a laminectomy with or without arthrodesis for a lumbar degenerative condition. Patients were screened preoperatively for high fear of movement using the Tampa Scale for Kinesiophobia. Randomization to either CBPT or an education program occurred at 6 weeks after surgery. Assessments were completed pretreatment, posttreatment and at 3-month follow-up. The primary outcomes were pain and disability measured by the Brief Pain Inventory and Oswestry Disability Index. Secondary outcomes included general health (SF-12) and performance-based tests (5-Chair Stand, Timed Up and Go, 10-Meter Walk). Multivariable linear regression analyses found that CBPT participants had significantly greater decreases in pain and disability and increases in general health and physical performance compared with the education group at the 3-month follow-up. Results suggest a targeted CBPT program may result in significant and clinically meaningful improvement in postoperative outcomes. CBPT has the potential to be an evidence-based program that clinicians can recommend for patients at risk for poor recovery after spine surgery.
  
  
  
  This study investigated a targeted cognitive-behavioral-based physical therapy program for patients after lumbar spine surgery. Findings lend support to the hypothesis that incorporating cognitive-behavioral strategies into postoperative physical therapy may address psychosocial risk factors and improve pain, disability, general health, and physical performance outcomes.
authors.affiliation: Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee; Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, Nashville, Tennessee. Electronic address: kristin.archer@vanderbilt.edu.
authors.forename: Kristin R
authors.initials: KR
authors.lastname: Archer
authors.affiliation: Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Clinton J
authors.initials: CJ
authors.lastname: Devin
authors.affiliation: Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Susan W
authors.initials: SW
authors.lastname: Vanston
authors.affiliation: Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Tatsuki
authors.initials: T
authors.lastname: Koyama
authors.affiliation: Department of Biostatistics, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Sharon E
authors.initials: SE
authors.lastname: Phillips
authors.forename: Shannon L
authors.initials: SL
authors.lastname: Mathis
authors.affiliation: Department of Physical Therapy, University of Florida, Gainesville, Florida.
authors.forename: Steven Z
authors.initials: SZ
authors.lastname: George
authors.affiliation: Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina.
authors.forename: Matthew J
authors.initials: MJ
authors.lastname: McGirt
authors.affiliation: Department of Orthopaedic Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Dan M
authors.initials: DM
authors.lastname: Spengler
authors.affiliation: Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Oran S
authors.initials: OS
authors.lastname: Aaronson
authors.affiliation: Department of Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee.
authors.forename: Joseph S
authors.initials: JS
authors.lastname: Cheng
authors.affiliation: Department of Physical Medicine and Rehabilitation, Johns Hopkins Medicine, Baltimore, Maryland.
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Wegener
mesh_terms: D000203:Activities of Daily Living / Q000523:psychology; D000328:Adult; D000368:Aged; D059350:Chronic Pain / Q000209:etiology / Q000523:psychology / Q000628:therapy*; D015928:Cognitive Behavioral Therapy / Q000379:methods*; D005260:Female; D006266:Health Education; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010149:Postoperative Pain / Q000209:etiology / Q000523:psychology / Q000628:therapy*; D026741:Physical Therapy Modalities; D013122:Spinal Diseases / Q000601:surgery*
keywords: Lumbar degenerative disease; cognitive-behavioral therapy; lumbar spinal fusion; postoperative rehabilitation; randomized controlled trial