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Objective. Changing Behavior through Physical Therapy (CBPT), a cognitive-behavioral-based program, has been shown to improve outcomes after lumbar spine surgery in patients with a high psychosocial risk profile; however, little is known about potential mechanisms associated with CBPT treatment effects. The purpose of this study was to explore potential mediators underlying CBPT efficacy after spine surgery. Methods. In this secondary analysis, 86 participants were enrolled in a randomized trial comparing a postoperative CBPT (n = 43) and education program (n = 43). Participants completed validated questionnaires at 6 weeks (baseline) and 3 and 6 months following surgery for back pain (Brief Pain Inventory), disability (Oswestry Disability Index), physical health (12-Item Short-Form Health Survey), fear of movement (Tampa Scale for Kinesiophobia), pain catastrophizing (Pain Catastrophizing Scale), and pain self-efficacy (Pain Self-Efficacy Questionnaire). Parallel multiple mediation analyses using Statistical Package for the Social Sciences (SPSS) were conducted to examine whether 3- and 6-month changes in fear of movement, pain catastrophizing, and pain self-efficacy mediate treatment outcome effects at 6 months. Results. Six-month changes, but not 3-month changes, in fear of movement and pain self-efficacy mediated postoperative outcomes at 6 months. Specifically, changes in fear of movement mediated the effects of CBPT treatment on disability (indirect effect = -2.0 [95% CI = -4.3 to 0.3]), whereas changes in pain self-efficacy mediated the effects of CBPT treatment on physical health (indirect effect = 3.5 [95% CI = 1.2 to 6.1]). Conclusions. This study advances evidence on potential mechanisms underlying cognitive-behavioral strategies. Future work with larger samples is needed to establish whether these factors are a definitive causal mechanism. Impact. Fear of movement and pain self-efficacy may be important mechanisms to consider when developing and testing psychologically informed physical therapy programs., Chronic daily pain affects over 40 million individuals in the United States, with approximately 10.6 million people reporting high-impact pain that results in significant activity limitation or participation restriction. (1) [...]

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., The United States has the highest rate of lumbar spine surgery in the world, with rates increasing more than 200% in the last decade. (1) Medicare spends more than $1 [...]

EXPRESS STOP Rehabilitation candidates: Patients who have acute low-back pain and do not respond to conservative care after 2-4 months should begin rehabilitation to prevent deconditioning and chronic pain syndromes. [...]

A minority of back patients account for the majority of complications and costs; tough cases require discretion, imagination, and timing. EXPRESS STOP The initial interview: Obtain detailed employment and recreational [...]

The lumbar discs serve as cushions between the vertebrae, the bony units of the spine, in the lumbar area or lower back. A herniated, or slipped, lumbar disc involves a rupture of the fibrocartilage surrounding the disc. Herniation causes compression of the spinal nerve roots with severe pain, and can also lead to nerve damage. Although lumbar discectomy (surgical removal of the disc) is frequently performed for a herniated lumbar disc, it is difficult to predict which patients will benefit from this surgery. The generally accepted clinical criteria for this surgery include some factors that are subjective, such as level of pain. The authors chose objective criteria that were potentially useful in selecting which patients should have discectomy. The criteria fell into four categories: neurological indices, signs of sciatic nerve tension, personality factors, and diagnostic imaging results. These criteria were measured in 84 patients who then underwent lumbar disc surgery. The preoperative scores of the patients were correlated with the findings at surgery to test the usefulness of the various criteria. The higher the score, the more likely it was that the patient would have a good result from the discectomy. The three patients with the lowest scores were the only patients who were found not to have herniation of the disc at the time of surgery. Previous studies have shown that patients with sciatica (inflammation of the sciatic nerve of the lower back and leg) who are inappropriately selected for this surgery may develop chronic low-back pain. The best predictor of the findings during surgery was the imaging studies such as myelogram and computed tomography, and the best predictor of outcome of the treatment was the psychological score. Use of objective scoring reduced the number of patients who were taken into surgery but were found not to need it, and also improved patient outcome. (Consumer Summary produced by Reliance Medical Information, Inc.)