P69. The influence of cognitive behavioral therapy on lumbar spine surgery outcomes: A systematic review and meta-analysis

Abstract

BACKGROUND CONTEXT As more patients undergo lumbar spine surgery for chronic lower back pain, there is a need for novel interventions for those who do not respond to traditional rehabilitation techniques. Although behavioral and psychosocial interventions have demonstrated efficacy in postoperative rehabilitation, few studies have evaluated their impact on patients’ preoperative expectations and perception of their clinical improvements. PURPOSE This study aims to conduct a systematic review and meta-analysis of current randomized control trials (RCTs) to evaluate the influence of cognitive behavioral therapy (CBT) on patient reported outcomes (PROs) among lumbar spine surgery patients. STUDY DESIGN/SETTING Systematic review and meta-analysis. PATIENT SAMPLE A total of 241 articles screened by two independent reviewers. OUTCOME MEASURES Influence of cognitive behavioral therapy (CBT) on patient reported outcomes (PROs). METHODS Relevant studies for this systematic review were found using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). After consulting a medical library expert, the search was conducted in the following databases: PubMed/MEDLINE, Scopus, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, PsycINFO, and Google Scholar. A total of 366 citations were returned, of which 125 were duplicates, resulting in 241 articles screened by two independent reviewers. No restrictions were placed on the initial search in terms of language, date of publication, geography or age of participants. We ran searches using both controlled vocabulary (ie, MeSH terms) and keywords in the title or abstract fields. Articles were excluded if they did not include lumbar spine surgery, if they were in a language other than English, if they were not RCTs, if they were study protocols, and if they were not full manuscripatients. RESULTS After the 241 articles were screened, 29 full-text studies were assessed for eligibility. Ultimately, 11 studies were appropriate for analysis in the systematic review and meta-analysis. These 11 studies were conducted between 2003-2019 and yielded a total of 1,128 patients who underwent lumbar spine surgery. Seven studies evaluated lumbar fusion patients; three studies assessed patients undergoing lumbar disc surgery; and one study observed patients undergoing laminectomy. Only four of the studies utilized a CBT intervention preoperatively, while ten employed postoperative CBT interventions. Total CBT sessions ranged from three to 18 sessions. The most frequent outcomes observed were disability (82%, Oswestry Disability Index), pain (55%, Visual Analog Scale), quality of life (55%, European quality of life 5 dimensions, 55% Short Form-36), pain catastrophizing (45%, Pain Catastrophizing Scale), and kinesiophobia (45%, Tampa Scale of Kinesiophobia). Of the 11 studies, six had findings supporting CBT as a superior rehabilitation intervention when analyzing improvements in PROs. CONCLUSIONS This study addresses the influence of cognitive behavioral interventions on PROs among patients undergoing lumbar spine surgery. The majority of the reviewed studies observed CBT had better outcomes compared to postoperative rehabilitation control groups. Further research is needed to address appropriate assessments before undergoing CBT and to refine the ideal pre- and postoperative CBT frequencies, durations, and settings. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs. As more patients undergo lumbar spine surgery for chronic lower back pain, there is a need for novel interventions for those who do not respond to traditional rehabilitation techniques. Although behavioral and psychosocial interventions have demonstrated efficacy in postoperative rehabilitation, few studies have evaluated their impact on patients’ preoperative expectations and perception of their clinical improvements. This study aims to conduct a systematic review and meta-analysis of current randomized control trials (RCTs) to evaluate the influence of cognitive behavioral therapy (CBT) on patient reported outcomes (PROs) among lumbar spine surgery patients. Systematic review and meta-analysis. A total of 241 articles screened by two independent reviewers. Influence of cognitive behavioral therapy (CBT) on patient reported outcomes (PROs). Relevant studies for this systematic review were found using the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA). After consulting a medical library expert, the search was conducted in the following databases: PubMed/MEDLINE, Scopus, CINAHL, Cochrane Central Register of Controlled Trials, Cochrane Database of Systematic Reviews, PsycINFO, and Google Scholar. A total of 366 citations were returned, of which 125 were duplicates, resulting in 241 articles screened by two independent reviewers. No restrictions were placed on the initial search in terms of language, date of publication, geography or age of participants. We ran searches using both controlled vocabulary (ie, MeSH terms) and keywords in the title or abstract fields. Articles were excluded if they did not include lumbar spine surgery, if they were in a language other than English, if they were not RCTs, if they were study protocols, and if they were not full manuscripatients. After the 241 articles were screened, 29 full-text studies were assessed for eligibility. Ultimately, 11 studies were appropriate for analysis in the systematic review and meta-analysis. These 11 studies were conducted between 2003-2019 and yielded a total of 1,128 patients who underwent lumbar spine surgery. Seven studies evaluated lumbar fusion patients; three studies assessed patients undergoing lumbar disc surgery; and one study observed patients undergoing laminectomy. Only four of the studies utilized a CBT intervention preoperatively, while ten employed postoperative CBT interventions. Total CBT sessions ranged from three to 18 sessions. The most frequent outcomes observed were disability (82%, Oswestry Disability Index), pain (55%, Visual Analog Scale), quality of life (55%, European quality of life 5 dimensions, 55% Short Form-36), pain catastrophizing (45%, Pain Catastrophizing Scale), and kinesiophobia (45%, Tampa Scale of Kinesiophobia). Of the 11 studies, six had findings supporting CBT as a superior rehabilitation intervention when analyzing improvements in PROs. This study addresses the influence of cognitive behavioral interventions on PROs among patients undergoing lumbar spine surgery. The majority of the reviewed studies observed CBT had better outcomes compared to postoperative rehabilitation control groups. Further research is needed to address appropriate assessments before undergoing CBT and to refine the ideal pre- and postoperative CBT frequencies, durations, and settings.