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Early rehabilitation targeting cognition, behaviour and motor function after lumbar fusion: A randomized controlled trial
Department of Physical Therapy, Karolinska University Hospital; Department of Clinical Science, Intervention and Technology, Division of Orthopaedics, Karolinska Institute, Stockholm, Sweden.ORCID iD: 0000-0002-4318-9216
Department of Physical Therapy, Karolinska University Hospital, Stockholm, Sweden.
Department for Orthopaedics, Institute for Clinical Sciences, Sahlgrenska University Hospital, Gothenburg, Sweden.
2010 (English)In: Spine, ISSN 0362-2436, E-ISSN 1528-1159, Vol. 35, no 8, 848-857 p.Article in journal (Refereed) Published
Abstract [en]

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.

Place, publisher, year, edition, pages
Lippincott Williams & Wilkins, 2010. Vol. 35, no 8, 848-857 p.
Keyword [en]
randomised controlled trial, spinal fusion, chronic low back pain, rehabilitation, physiotherapy, motor control, cognitive-behavioural therapy, exercise therapy
National Category
Clinical Medicine
Identifiers
URN: urn:nbn:se:liu:diva-113849DOI: 10.1097/BRS.0b013e3181d1049fISI: 000276834000002PubMedID: 20354468Scopus ID: 2-s2.0-77951937925OAI: oai:DiVA.org:liu-113849DiVA: diva2:785139
Available from: 2015-02-02 Created: 2015-02-02 Last updated: 2017-12-05Bibliographically approved

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Abbott, Allan

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