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| Author/Association: | Abbott AD, Tyni-Lenne R, Hedlund R |
| Title: | Early rehabilitation targeting cognition, behavior, and motor function after lumbar fusion: a randomized controlled trial [with consumer summary] |
| Source: | Spine 2010 Apr 15;35(8):848-857 |
| Method: | clinical trial |
| Method Score: | 7/10 [Eligibility criteria: Yes; Random allocation: Yes; Concealed allocation: Yes; Baseline comparability: Yes; Blind subjects: No; Blind therapists: No; Blind assessors: No; Adequate follow-up: Yes; Intention-to-treat analysis: Yes; Between-group comparisons: Yes; Point estimates and variability: Yes. Note: Eligibility criteria item does not contribute to total score] *This score has been confirmed* |
| Consumer Summary: | KEY POINTS: This is the first randomized controlled trial to investigate the effectiveness of rehabilitation interventions performed during the first 3 months after lumbar fusion. Psychomotor therapy combines cognitive behavioural and motor relearning strategies to modify maladaptive pain cognitions, behavior, and motor control while exercise therapy encompasses physical training focusing on muscular strength, endurance, and cardiovascular fitness. Psychomotor therapy improves functional disability, self-efficacy, outcome expectancy, and reduces fear of movement/(re)injury significantly more than exercise therapy in short and long term lumbar fusion outcome. Psychomotor therapy improves return to work levels and reduces levels of long-term sickness leave and health care use in lumbar fusion patients significantly more than exercise therapy. |
| Abstract: | STUDY DESIGN: Open label randomized controlled trial with 3-, 6-, 12-month, and 2- to 3-year follow-up. OBJECTIVE: To investigate the effectiveness of a psychomotor therapy focusing on cognition, behavior, and motor relearning compared with exercise therapy applied during the first 3 months after lumbar fusion. SUMMARY OF BACKGROUND DATA: Postoperative management after lumbar fusion commonly focuses on analgesic pain control and activities of daily living. After 3 months, exercise therapy is often implemented. No randomized controlled trial has investigated early rehabilitation techniques conducted during the first 3 months after surgery. METHODS: The study recruited 107 patients, aged 18 to 65 years, selected for lumbar fusion because of 12 months of symptomatic spinal stenosis, spondylosis, degenerative/isthmic spondylolisthesis, or degenerative disc disease. The exercise therapy group received a home program focusing on pain contingent training of back, abdominal, and leg muscle functional strength and endurance, stretching, and cardiovascular fitness. The psychomotor therapy group received a home program and 3 outpatient sessions focusing on modifying maladaptive pain cognitions, behaviors, and motor control. Rated questionnaires investigating functional disability, pain, health-related quality of life, functional self-efficacy, outcome expectancy, fear of movement/(re)injury, and coping were assessed at 3, 6, 12 months, and 2 to 3 years after surgery. RESULTS: Follow-up rates were 93% at 12 months and 81% at 2 to 3 years after surgery. Psychomotor therapy improved functional disability, self-efficacy, outcome expectancy, and fear of movement/(re)injury significantly more than exercise therapy at respective follow-up occasions. Similar results occurred for pain coping but group differences were nonsignificant at 2 to 3 years follow-up. Potentially clinical relevant higher reoperation rates occurred after psychomotor therapy but rates were within normal ranges. CONCLUSION: The study shows that postoperative rehabilitation can be safely implemented during the first 3 months after lumbar fusion and should include measures to modify psychological as well as motor functions. For more information on this journal, please visit http://www.lww.com. Full text (sometimes free) may be available at these link(s):  help |
