BACKGROUND: Prehabilitation programs have led to improved postoperative outcomes in several surgical contexts, but there are presently no guidelines for the prehabilitation phase before lumbar fusion surgery. OBJECTIVE: The objective was to investigate whether a person-centered physiotherapeutic prehabilitation program, based on a cognitive-behavioral approach, reduces disability and improves functioning after lumbar fusion surgery more than conventional care does in patients with degenerative disc disease. DESIGN: This study was a randomized controlled trial. SETTING: The study took place at 2 private spine clinics and 1 university hospital. PATIENTS: We prospectively enrolled 118 patients scheduled for lumbar fusion surgery. INTERVENTION: The active intervention utilized a person-centered perspective and focused on promoting physical activity and targeting psychological risk factors before surgery. The control group received conventional preoperative care. MEASUREMENTS: The primary outcome was the Oswestry Disability Index score. Secondary outcomes were back and leg pain intensity, catastrophizing, kinesiophobia, self-efficacy, anxiety, depression, health-related quality of life, and patient-specific functioning, physical activity, and physical capacity. Data were collected on 6 occasions up to 6 months postoperatively. A linear mixed model was used to analyze the change scores of each outcome. RESULTS: No statistically-significant between-group difference was found on the primary outcome (disability) over time (baseline to 6 months). Among secondary outcome measures, a statistically-significant interaction effect ("group x time") was seen for the European Quality of Life 5 Dimensions Questionnaire (EQ-5D index). The largest between-group difference on EQ-5D index was seen 1 week prior to surgery and was in favor of the active intervention. The largest between-group effect sizes at the 6 months follow-up were in favor of the active intervention, and were seen for physical activity intensity, steps per day, and the one-leg stand test. Both groups reached the minimal important change for the primary outcome, and many of the secondary outcomes already at 8 weeks follow-up. LIMITATIONS: The patients' preoperative level of disability was lower than normative values, which suggests selection bias. CONCLUSIONS: Both interventions led to clinically important changes, but it is not clear what kind of prehabilitation program is the most effective.

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