TY - JOUR
T1 - Health Behavior Change Counseling in Surgery for Degenerative Lumbar Spinal Stenosis. Part I
T2 - Improvement in Rehabilitation Engagement and Functional Outcomes
AU - Skolasky, Richard L.
AU - Maggard, Anica M.
AU - Li, David
AU - Riley, Lee H.
AU - Wegener, Stephen T.
N1 - Publisher Copyright:
© 2015 American Congress of Rehabilitation Medicine.
PY - 2015/7/1
Y1 - 2015/7/1
N2 - Abstract Objective To examine whether a brief motivational interviewing [MI]-based health behavior change counseling (HBCC) intervention increased patient participation in physical therapy and/or home exercise programs (HEPs), reduced disability, and improved health status after surgery for degenerative lumbar spinal stenosis. Design Prospective clinical trial. Setting Academic medical center. Participants From December 2009 through August 2012, consecutive patients (N=122) underwent surgery for degenerative lumbar spinal stenosis and, based on enrollment date, were prospectively assigned to a control (n=59) or HBCC intervention (n=63) group in a prospective, lagged-control clinical trial. Interventions Brief MI-based HBCC versus attention control. Main Outcome Measures Rehabilitation participation (primary); disability and health status (secondary). Therapists assessed engagement in, and patients reported attendance at, postoperative rehabilitation (physical therapy and/or HEP). At 3 and 6 months, disability and health status were assessed (Oswestry Disability Index [ODI] and Medical Outcomes Study 12-Item Short-Form Health Survey, version 2 [SF-12v2]) (significance, P<.05). Results Compared with controls, HBCC patients had significantly higher rehabilitation engagement (21.20±4.56 vs 23.57±2.71, respectively; P<.001), higher physical therapy (.67±.21 vs.82±.16, respectively; P<.001) and HEP (.65±.23 vs.75±.22, respectively; P=.019) attendance, and better functional outcomes at 3 months (difference: ODI, -10.7±4.4, P=.015; SF-12v2, 6.2±2.2, P=.004) and 6 months (difference: ODI, -12.7±4.8, P=.008; SF-12v2, 8.9±2.4, P<.001). The proportion of the HBCC intervention impact on functional recovery mediated by rehabilitation participation was approximately half at 3 months and one-third at 6 months. Conclusions HBCC can improve outcomes after spine surgery through improved rehabilitation participation.
AB - Abstract Objective To examine whether a brief motivational interviewing [MI]-based health behavior change counseling (HBCC) intervention increased patient participation in physical therapy and/or home exercise programs (HEPs), reduced disability, and improved health status after surgery for degenerative lumbar spinal stenosis. Design Prospective clinical trial. Setting Academic medical center. Participants From December 2009 through August 2012, consecutive patients (N=122) underwent surgery for degenerative lumbar spinal stenosis and, based on enrollment date, were prospectively assigned to a control (n=59) or HBCC intervention (n=63) group in a prospective, lagged-control clinical trial. Interventions Brief MI-based HBCC versus attention control. Main Outcome Measures Rehabilitation participation (primary); disability and health status (secondary). Therapists assessed engagement in, and patients reported attendance at, postoperative rehabilitation (physical therapy and/or HEP). At 3 and 6 months, disability and health status were assessed (Oswestry Disability Index [ODI] and Medical Outcomes Study 12-Item Short-Form Health Survey, version 2 [SF-12v2]) (significance, P<.05). Results Compared with controls, HBCC patients had significantly higher rehabilitation engagement (21.20±4.56 vs 23.57±2.71, respectively; P<.001), higher physical therapy (.67±.21 vs.82±.16, respectively; P<.001) and HEP (.65±.23 vs.75±.22, respectively; P=.019) attendance, and better functional outcomes at 3 months (difference: ODI, -10.7±4.4, P=.015; SF-12v2, 6.2±2.2, P=.004) and 6 months (difference: ODI, -12.7±4.8, P=.008; SF-12v2, 8.9±2.4, P<.001). The proportion of the HBCC intervention impact on functional recovery mediated by rehabilitation participation was approximately half at 3 months and one-third at 6 months. Conclusions HBCC can improve outcomes after spine surgery through improved rehabilitation participation.
KW - Laminectomy
KW - Motivational interviewing
KW - Rehabilitation
KW - Spinal stenosis
KW - Spine
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U2 - 10.1016/j.apmr.2015.03.009
DO - 10.1016/j.apmr.2015.03.009
M3 - Article
C2 - 25827657
AN - SCOPUS:84937515905
SN - 0003-9993
VL - 96
SP - 1200
EP - 1207
JO - Archives of physical medicine and rehabilitation
JF - Archives of physical medicine and rehabilitation
IS - 7
M1 - 56145
ER -