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.
RCT Entities:
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.
Authors: Kristin R Archer; Clinton J Devin; Susan W Vanston; Tatsuki Koyama; Sharon E Phillips; Shannon L Mathis; Steven Z George; Matthew J McGirt; Dan M Spengler; Oran S Aaronson; Joseph S Cheng; Stephen T Wegener Journal: J Pain Date: 2015-10-23 Impact factor: 5.820
Authors: Rogelio A Coronado; Steven Z George; Clinton J Devin; Stephen T Wegener; Kristin R Archer Journal: Arch Phys Med Rehabil Date: 2015-06-20 Impact factor: 3.966
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Authors: Kristin R Archer; Nicole Motzny; Christine M Abraham; Donna Yaffe; Caryn L Seebach; Clinton J Devin; Dan M Spengler; Matthew J McGirt; Oran S Aaronson; Joseph S Cheng; Stephen T Wegener Journal: Phys Ther Date: 2013-04-18
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Authors: Outi Ilves; Arja Häkkinen; Joost Dekker; Liisa Pekkanen; Kirsi Piitulainen; Salme Järvenpää; Ilkka Marttinen; Kimmo Vihtonen; Marko H Neva Journal: Eur Spine J Date: 2016-09-29 Impact factor: 3.134