Dataset Information

Cognitive-behavioral-based physical therapy to improve surgical spine outcomes: a case series.

ABSTRACT:

Background and purpose

Fear of movement is a risk factor for poor postoperative outcomes in patients following spine surgery. The purposes of this case series were: (1) to describe the effects of a cognitive-behavioral-based physical therapy (CBPT) intervention in patients with high fear of movement following lumbar spine surgery and (2) to assess the feasibility of physical therapists delivering cognitive-behavioral techniques over the telephone.

Case description

Eight patients who underwent surgery for a lumbar degenerative condition completed the 6-session CBPT intervention. The intervention included empirically supported behavioral self-management, problem solving, and cognitive restructuring and relaxation strategies and was conducted in person and then weekly over the phone. Patient-reported outcomes of pain and disability were assessed at baseline (6 weeks after surgery), postintervention (3 months after surgery), and at follow-up (6 months after surgery). Performance-based outcomes were tested at baseline and postintervention. The outcome measures were the Brief Pain Inventory, Oswestry Disability Index, 5-Chair Stand Test, and 10-Meter Walk Test.

Outcomes

Seven of the patients demonstrated a clinically significant reduction in pain, and all 8 of the patients had a clinically significant reduction in disability at 6-month follow-up. Improvement on the performance-based tests also was noted postintervention, with 5 patients demonstrating clinically meaningful change on the 10-Meter Walk Test.

Discussion

The findings suggest that physical therapists can feasibly implement cognitive-behavioral skills over the telephone and may positively affect outcomes after spine surgery. However, a randomized clinical trial is needed to confirm the results of this case series and the efficacy of the CBPT intervention. Clinical implications include broadening the availability of well-accepted cognitive-behavioral strategies by expanding implementation to physical therapists and through a telephone delivery model.

SUBMITTER: Archer KR

PROVIDER: S-EPMC3732232 | biostudies-literature | 2013 Aug

REPOSITORIES: biostudies-literature

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Publications

Cognitive-behavioral-based physical therapy to improve surgical spine outcomes: a case series.

Archer Kristin R KR Motzny Nicole N Abraham Christine M CM Yaffe Donna D Seebach Caryn L CL Devin Clinton J CJ Spengler Dan M DM McGirt Matthew J MJ Aaronson Oran S OS Cheng Joseph S JS Wegener Stephen T ST

Physical therapy 20130418 8

<h4>Background and purpose</h4>Fear of movement is a risk factor for poor postoperative outcomes in patients following spine surgery. The purposes of this case series were: (1) to describe the effects of a cognitive-behavioral-based physical therapy (CBPT) intervention in patients with high fear of movement following lumbar spine surgery and (2) to assess the feasibility of physical therapists delivering cognitive-behavioral techniques over the telephone.<h4>Case description</h4>Eight patients w ...[more]

PMID: 23599351

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Project description:ObjectiveChanging Behavior through Physical Therapy (CBPT), a cognitive-behavioral-based program, has been shown to improve outcomes after lumbar spine surgery in patients with a high psychosocial risk profile; however, little is known about potential mechanisms associated with CBPT treatment effects. The purpose of this study was to explore potential mediators underlying CBPT efficacy after spine surgery.MethodsIn this secondary analysis, 86 participants were enrolled in a randomized trial comparing a postoperative CBPT (n = 43) and education program (n = 43). Participants completed validated questionnaires at 6 weeks (baseline) and 3 and 6 months following surgery for back pain (Brief Pain Inventory), disability (Oswestry Disability Index), physical health (12-Item Short-Form Health Survey), fear of movement (Tampa Scale for Kinesiophobia), pain catastrophizing (Pain Catastrophizing Scale), and pain self-efficacy (Pain Self-Efficacy Questionnaire). Parallel multiple mediation analyses using Statistical Package for the Social Sciences (SPSS) were conducted to examine whether 3- and 6-month changes in fear of movement, pain catastrophizing, and pain self-efficacy mediate treatment outcome effects at 6 months.ResultsSix-month changes, but not 3-month changes, in fear of movement and pain self-efficacy mediated postoperative outcomes at 6 months. Specifically, changes in fear of movement mediated the effects of CBPT treatment on disability (indirect effect = -2.0 [95% CI = -4.3 to 0.3]), whereas changes in pain self-efficacy mediated the effects of CBPT treatment on physical health (indirect effect = 3.5 [95% CI = 1.2 to 6.1]).ConclusionsThis study advances evidence on potential mechanisms underlying cognitive-behavioral strategies. Future work with larger samples is needed to establish whether these factors are a definitive causal mechanism.ImpactFear of movement and pain self-efficacy may be important mechanisms to consider when developing and testing psychologically informed physical therapy programs.

Project description:IntroductionA common approach to personalizing psychological interventions is the allocation of treatment modules to individual patients based on cut-off scores on questionnaires, which are mostly based on group studies. However, this way, intraindividual variation and temporal dynamics are not taken into account. Automated individual time series analyses are a possible solution, since these can identify the factors influencing the targeted symptom in a specific individual, and associated modules can be allocated accordingly. The aim of this study was to illustrate how automated individual time series analyses can be applied to personalize cognitive behavioral therapy for cancer-related fatigue in cancer survivors and how this procedure differs from allocating modules based on questionnaires.MethodsThis study was a case report series (n = 3). Patients completed ecological momentary assessments at the start of therapy, and after three treatment modules (approximately 14 weeks). Assessments were analyzed with AutoVAR, an R package that automates the process of finding optimal vector autoregressive models. The results informed the treatment plan.ResultsThree cases were described. From the ecological momentary assessments and automated time series analyses three individual treatment plans were constructed, in which the most important predictor for cancer-related fatigue was treated first. For two patients, this led to the treatment ending after the follow-up ecological momentary assessments. One patient continued treatment until six months, the standard treatment time in regular treatment. All three treatment plans differed from the treatment plans informed by questionnaire scores.DiscussionThis study is one of the first to apply time series analyses in systematically personalizing psychological treatment. An important strength of this approach is that it can be used for every modular cognitive behavioral intervention where each treatment module addresses specific maintaining factors. Whether or not personalized CBT is more efficacious than standard, non-personalized CBT remains to be determined in controlled studies comparing it to usual care.

Dataset Information

Cognitive-behavioral-based physical therapy to improve surgical spine outcomes: a case series.

Background and purpose

Case description

Outcomes

Discussion

Publications

Cognitive-behavioral-based physical therapy to improve surgical spine outcomes: a case series.

Similar Datasets

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