(536) A cognitive-behavioral based self-management approach to physical therapy: improving surgical spine outcomes

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The purpose was to determine the efficacy of a cognitive-behavioral based physical therapy (CBPT) intervention in patients having surgery for a lumbar degenerative condition. Out of 249 eligible patients, 132 patients were consented preoperatively and screened for high fear of movement (Tampa Scale for Kinesiophobia > 39) between March 2012 and February 2013. Eighty-six patients, 22 to 81 years, were randomized into either the CBPT intervention group (n=43) or an education group (n=43). Surgical procedures included laminectomy with arthrodesis (71%) and without arthrodesis (29%). Patient assessments occurred preoperatively and at 6 weeks (baseline), 3 months (treatment completion), and 6 months after surgery. Assessors were unaware of the patient treatment condition. Outcomes were pain (Brief Pain Inventory), disability (Oswestry Disability Index), gait speed (4-Meter Walk), and functional mobility (Timed Up and Go). Patients were randomized using a stratified design based on screening TSK scores and type of surgery. Treatment sessions were delivered by a physical therapist. The first session was conducted in-person and the remaining 5 sessions were conducted over the phone. The manual-based CBPT intervention focused on goal-setting, problem-solving, cognitive restructuring strategies, and behavioral self-management. Analyses were intent-to-treat using mixed-effects models that adjusted for the baseline measurement of the outcome variable. No significant group differences were found for patient characteristics and baseline variables. The CBPT group demonstrated larger reductions in disability at 6 months and improvement in gait speed and functional mobility at 3 and 6 months compared to the education group (p < .05). No significant differences in pain were noted. A CBT-based self-management approach has the potential to improve surgical spine outcomes in patients at-risk for poor recovery. The CBPT intervention broadens the availability of effective pain self-management and behavior change strategies by expanding implementation to physical therapists and through a telephone delivery model.