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Coronado R1, Henry A1, Pennings J1, Haug C1, Vanston S1, Skolasky R2, Riley L2, Neuman B2, Cheng J3, Aaronson O4, Devin C1,5, Wegener S6, Archer K1,7
1Vanderbilt University Medical Center, Orthopaedic Surgery, Nashville, United States, 2Johns Hopkins University, Orthopaedic Surgery, Baltimore, United States, 3University of Cincinnati College of Medicine, Cincinnati, United States, 4Saint Thomas Hospital, Nashville, United States, 5Orthopaedics of Steamboat Springs, Steamboat Springs, United States, 6Johns Hopkins University, Physical Medicine and Rehabilitation, Baltimore, United States, 7Vanderbilt University Medical Center, Physical Medicine and Rehabilitation, Nashville, United States
Background: Cognitive-behavioral-based physical therapy (CBPT) approaches have been developed to target risk factors for improved outcomes. Individual responses to CBPT may be impacted by baseline psychological status such as resilience.
Purpose: The purpose of this study was to explore the prognostic and moderating influence of resilience, self-efficacy, and fear of movement on 12-month physical function, pain, social support and physical activity after lumbar spine surgery.
Methods: This is an exploratory analysis from a randomized trial comparing a postoperative CBPT (n = 124) and education program (n = 124) in 248 patients (mean (SD) age = 62.2 (11.9) years; 51% female) who underwent spine surgery for a degenerative lumbar condition. The primary results of the trial showed no difference in 12-month outcomes in intent-to-treat analyses, but did show superiority of CBPT in an intervention completers only analysis. Participants completed validated questionnaires at 6 weeks (baseline) and 12 months after surgery for physical function (PROMIS Physical Function), pain interference (PROMIS Pain Interference), back pain intensity (Numeric Rating Scale), social health (PROMIS Ability to Participate in Social Roles and Activities), and physical activity (Acceleromoter step counts). Psychological factors measured at baseline were resilience (Brief Resilience Scale), self-efficacy (Pain Self-Efficacy Questionnaire), and fear of movement (Tampa Scale of Kinesiophobia). Separate multivariable regressions were conducted for each outcome and psychological factor using all patient data. Separate moderated regressions tested the interaction between psychological factor and intervention using data from intervention completers only (n = 179). Covariates in analyses included age, sex, study site, fusion status, and baseline outcome score. Semi-partial correlations were examined.
Results: In multivariable models, resilience was associated with all 12-month outcomes (range or r = -0.16 to -0.14 and 0.12 to 0.23, p 0.05). Self-efficacy was associated with 12-month physical function (r = 0.17, p = 0.002), pain interference (r = -0.14, p = 0.01), back pain intensity (r = -0.12, p = 0.03), and social health (r = 0.17, p = 0.003). Fear of movement was associated with 12-month back pain intensity (r = 0.12, p = 0.03) and social health (r = -0.14, p = 0.01). None of the psychological factors moderated the effect of CBPT on 12-month outcomes (p > 0.05).
Conclusion(s): Early postoperative resilience, self-efficacy, and fear of movement are important prognostic factors for pain-related outcomes after lumbar spine surgery.
Implications: Along with fear of movement, positive psychological factors such as resilience and self-efficacy are key determinants of postoperative outcomes in patients with degenerative spine conditions. Further work is needed for developing intervention strategies for enhancing resilience.
Keywords: Postoperative rehabilitation, cognitive therapy, psychosocial
Funding acknowledgements: This study was funded by a grant from the Patient-Centered Outcomes Research Institute (PCORI) and Foundation for Physical Therapy
Purpose: The purpose of this study was to explore the prognostic and moderating influence of resilience, self-efficacy, and fear of movement on 12-month physical function, pain, social support and physical activity after lumbar spine surgery.
Methods: This is an exploratory analysis from a randomized trial comparing a postoperative CBPT (n = 124) and education program (n = 124) in 248 patients (mean (SD) age = 62.2 (11.9) years; 51% female) who underwent spine surgery for a degenerative lumbar condition. The primary results of the trial showed no difference in 12-month outcomes in intent-to-treat analyses, but did show superiority of CBPT in an intervention completers only analysis. Participants completed validated questionnaires at 6 weeks (baseline) and 12 months after surgery for physical function (PROMIS Physical Function), pain interference (PROMIS Pain Interference), back pain intensity (Numeric Rating Scale), social health (PROMIS Ability to Participate in Social Roles and Activities), and physical activity (Acceleromoter step counts). Psychological factors measured at baseline were resilience (Brief Resilience Scale), self-efficacy (Pain Self-Efficacy Questionnaire), and fear of movement (Tampa Scale of Kinesiophobia). Separate multivariable regressions were conducted for each outcome and psychological factor using all patient data. Separate moderated regressions tested the interaction between psychological factor and intervention using data from intervention completers only (n = 179). Covariates in analyses included age, sex, study site, fusion status, and baseline outcome score. Semi-partial correlations were examined.
Results: In multivariable models, resilience was associated with all 12-month outcomes (range or r = -0.16 to -0.14 and 0.12 to 0.23, p 0.05). Self-efficacy was associated with 12-month physical function (r = 0.17, p = 0.002), pain interference (r = -0.14, p = 0.01), back pain intensity (r = -0.12, p = 0.03), and social health (r = 0.17, p = 0.003). Fear of movement was associated with 12-month back pain intensity (r = 0.12, p = 0.03) and social health (r = -0.14, p = 0.01). None of the psychological factors moderated the effect of CBPT on 12-month outcomes (p > 0.05).
Conclusion(s): Early postoperative resilience, self-efficacy, and fear of movement are important prognostic factors for pain-related outcomes after lumbar spine surgery.
Implications: Along with fear of movement, positive psychological factors such as resilience and self-efficacy are key determinants of postoperative outcomes in patients with degenerative spine conditions. Further work is needed for developing intervention strategies for enhancing resilience.
Keywords: Postoperative rehabilitation, cognitive therapy, psychosocial
Funding acknowledgements: This study was funded by a grant from the Patient-Centered Outcomes Research Institute (PCORI) and Foundation for Physical Therapy
Topic: Musculoskeletal: spine; Pain & pain management; Mental health
Ethics approval required: Yes
Institution: Vanderbilt University Medical Center
Ethics committee: Institutional Review Board
Ethics number: 140057
All authors, affiliations and abstracts have been published as submitted.
