Cognitive-Behavioral–Based Physical Therapy to Improve Surgical Spine Outcomes: A Case Series

• Published in: Physical therapy Vol. 93; no. 8; pp. 1130 - 1139
• Main Authors: Archer, Kristin R, Motzny, Nicole, Abraham, Christine M, Yaffe, Donna, Seebach, Caryn L, Devin, Clinton J, Spengler, Dan M, McGirt, Matthew J, Aaronson, Oran S, Cheng, Joseph S, Wegener, Stephen T
• Format: Journal Article
• Language: English
• Published: United States American Physical Therapy Association 01.08.2013; Oxford University Press
• Subjects: Adult; Aged; Back surgery; Case Reports; Clinical trials; Cognitive Therapy; Cognitive-behavioral therapy; Cognitive-behavioural therapy; Disability Evaluation; Fear; Female; Health care; Humans; Lumbar Vertebrae - surgery; Male; Methods; Middle Aged; Pain; Pain Measurement; Physical therapy; Physical Therapy Modalities; Postoperative care; Quality of Life; Reproducibility of Results; Risk Factors; Spinal Diseases - psychology; Spinal Diseases - rehabilitation; Spinal Diseases - surgery; Spinal surgery; Spine; Surgery; Surveys and Questionnaires; Therapeutics, Physiological; Treatment Outcome; United States > US
• ISSN: 0031-9023; 1538-6724
• DOI: 10.2522/ptj.20120426

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. 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. 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. 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.