Cognitive-behavioral-based physical therapy to improve surgical spine outcomes: A case series

Kristin R. Archer, Nicole Motzny, Christine M. Abraham, Donna Yaffe, Caryn L. Seebach, Clinton J. Devin, Dan M. Spengler, Matthew J. McGirt, Oran S. Aaronson, Joseph S. Cheng, Stephen T. Wegener

Research output: Contribution to journalArticlepeer-review

29 Scopus citations


Background and Purpose. Fear of movement is a risk factor for poor postoperative outcomes in patients following spine surgery. The purposes of this case series were: (1) to describe the effects of a cognitive-behavioral-based physical therapy (CBPT) intervention in patients with high fear of movement following lumbar spine surgery and (2) to assess the feasibility of physical therapists delivering cognitive-behavioral techniques over the telephone. Case Description. Eight patients who underwent surgery for a lumbar degenerative condition completed the 6-session CBPT intervention. The intervention included empirically supported behavioral self-management, problem solving, and cognitive restructuring and relaxation strategies and was conducted in person and then weekly over the phone. Patient-reported outcomes of pain and disability were assessed at baseline (6 weeks after surgery), postintervention (3 months after surgery), and at follow-up (6 months after surgery). Performance-based outcomes were tested at baseline and postintervention. The outcome measures were the Brief Pain Inventory, Oswestry Disability Index, 5-Chair Stand Test, and 10-Meter Walk Test. Outcomes. Seven of the patients demonstrated a clinically significant reduction in pain, and all 8 of the patients had a clinically significant reduction in disability at 6-month follow-up. Improvement on the performance-based tests also was noted postintervention, with 5 patients demonstrating clinically meaningful change on the 10-Meter Walk Test. Discussion. The findings suggest that physical therapists can feasibly implement cognitive-behavioral skills over the telephone and may positively affect outcomes after spine surgery. However, a randomized clinical trial is needed to confirm the results of this case series and the efficacy of the CBPT intervention. Clinical implications include broadening the availability of well-accepted cognitive-behavioral strategies by expanding implementation to physical therapists and through a telephone delivery model.

Original languageEnglish (US)
Pages (from-to)1130-1139
Number of pages10
JournalPhysical therapy
Issue number8
StatePublished - Aug 2013

ASJC Scopus subject areas

  • Physical Therapy, Sports Therapy and Rehabilitation


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