Abstract
BackgroundFollowing lumbar fusion surgery, a successful outcome is empirically linked to effective rehabilitation. While rehabilitation is typically postoperative, the phase before surgery – termed prehabilitation – is reportedly an ideal time to prepare the patient. There are presently no guidelines for prehabilitation before lumbar fusion surgery. Physical activity has well-known health benefits, and staying physically active despite pain is a major principle in non-pharmacological chronic low back pain treatment. Psychological factors such as fear of movement, pain catastrophizing and low self-efficacy are known to be barriers to staying active. No studies have investigated prehabilitation protocols that promote physical activity and target psychological risk factors before lumbar fusion surgery. The aim of our proposed randomised controlled trial is to investigate whether patients who undergo lumbar fusion surgery for degenerative disc disease experience better functioning with a physiotherapeutic prehabilitation program (PREPARE) based on a cognitive behavioural approach compared to conventional care.Methods/DesignWe will recruit 110 patients between 18–70 years of age with degenerative disc disease who are waiting for lumbar fusion surgery. These patients will be randomly assigned to receive either PREPARE or conventional care. PREPARE uses a person-centred perspective and focuses on promoting physical activity and targeting psychological risk factors before surgery. The primary outcome will be disability measured using the Oswestry Disability Index 2.0. Secondary outcomes will include functioning (patient-reported and performance-based), physical activity (accelerometer), health-related quality of life, back and leg pain intensity, pain catastrophizing, kinesiophobia, self-efficacy, depression, anxiety, satisfaction with treatment results and health economic factors. Data will be collected at baseline (preoperatively) after the intervention (preoperatively), 3 and 8 weeks, 3, 6, 12, 24 and 60 months postoperatively.DiscussionWe hypothesise that the focus on promoting physical activity and targeting psychological risk factors before surgery will decrease disability and help the patients to be more active despite pain both before and after surgery. We will use a combination of outcome measures both patient-reported and performance-based, as well as accelerometer data. This will provide a more comprehensive picture of the patient’s functioning than just patient-reported outcomes alone.Trial registrationCurrent Controlled Trials ISCRTN17115599, Retrospectively Registered 18 May 2015.
Highlights
Following lumbar fusion surgery, a successful outcome is empirically linked to effective rehabilitation
We hypothesise that the focus on promoting physical activity and targeting psychological risk factors before surgery will decrease disability and help the patients to be more active despite pain both before and after surgery
Patients who receive PREPARE – a physiotherapeutic person-centred prehabilitation program based on a cognitive behavioural approach – before spinal fusion surgery will experience decreased disability levels, improved functioning, increased physical activity level, better health-related quality of life, decreased leg and back pain intensity, less pain catastrophizing, less pain-related fear, increased self-efficacy to exercise and less depressed mood after surgery compared to patients who receive conventional care
Summary
The overall aim of our trial is to investigate whether patients experience improved post-operative functioning if they receive a pre-surgical physiotherapeutic prehabilitation program based on a cognitive behavioural approach, as compared to conventional care. At the time that the present trial was designed, no prior investigation had examined a prehabilitation program with a cognitive behavioural approach To this date, two studies have been published within the field [26, 30]. It means that we have set up person-centred treatment sessions on a one-to-one basis This is in line with the trial from Nielsen et al in which the healthcare professional met the patient on an individual basis before surgery. In PREPARE we combine cognitive behavioural techniques with physical activity goal setting which we argue is a major strength that will further help the patients to be more active despite pain both before and after surgery. It is expected that data regarding the intervention effects and the economic analyses will be available at the end of 2017
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Free) 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
