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Early rehabilitation targeting cognition, behavior, and motor function after lumbar fusion. A randomized controlled trial
Spine (2010)
  • Allan D. Abbott
  • Raija Tyni-Lenne´
  • Rune Hedlund
Abstract

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.

Keywords
  • randomised controlled trial,
  • spinal fusion,
  • chronic low back pain,
  • rehabilitation,
  • physiotherapy,
  • motor control,
  • cognitive-behavioural therapy,
  • exercise therapy
Disciplines
Publication Date
April 1, 2010
Publisher Statement
Citation only.

Abbott, A. D., Tyni-Lenné, R., & Hedlund, R. (2010). Early rehabilitation targeting cognition, behavior, and motor function after lumbar fusion. A randomized controlled trial. Spine, 35(8), 848-857.

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© Copyright Lippincott Williams & Wilkins, Inc., 2010
Citation Information
Allan D. Abbott, Raija Tyni-Lenne´ and Rune Hedlund. "Early rehabilitation targeting cognition, behavior, and motor function after lumbar fusion. A randomized controlled trial" Spine Vol. 35 Iss. 8 (2010)
Available at: http://works.bepress.com/allan_abbott/1/