Department of Physical Therapy, Karolinska University Hospital, Stockholm, Sweden.
Spine (Phila Pa 1976). 2010 Apr 15;35(8):848-57. doi: 10.1097/BRS.0b013e3181d1049f.
Open label randomized controlled trial with 3-, 6-, 12-month, and 2- to 3-year follow-up.
To investigate the effectiveness of a psychomotor therapy focusing on cognition, behavior, and motor relearning compared with exercise therapy applied during the first 3 months after lumbar fusion.
Postoperative management after lumbar fusion commonly focuses on analgesic pain control and activities of daily living. After 3 months, exercise therapy is often implemented. No randomized controlled trial has investigated early rehabilitation techniques conducted during the first 3 months after surgery.
The study recruited 107 patients, aged 18 to 65 years, selected for lumbar fusion because of 12 months of symptomatic spinal stenosis, spondylosis, degenerative/isthmic spondylolisthesis, or degenerative disc disease. The exercise therapy group received a home program focusing on pain contingent training of back, abdominal, and leg muscle functional strength and endurance, stretching, and cardiovascular fitness. The psychomotor therapy group received a home program and 3 outpatient sessions focusing on modifying maladaptive pain cognitions, behaviors, and motor control.Rated questionnaires investigating functional disability, pain, health-related quality of life, functional self-efficacy, outcome expectancy, fear of movement/(re)injury, and coping were assessed at 3, 6, 12 months, and 2 to 3 years after surgery.
Follow-up rates were 93% at 12 months and 81% at 2 to 3 years after surgery. Psychomotor therapy improved functional disability, self-efficacy, outcome expectancy, and fear of movement/(re)injury significantly more than exercise therapy at respective follow-up occasions. Similar results occurred for pain coping but group differences were nonsignificant at 2 to 3 years follow-up. Potentially clinical relevant higher reoperation rates occurred after psychomotor therapy but rates were within normal ranges.
The study shows that postoperative rehabilitation can be safely implemented during the first 3 months after lumbar fusion and should include measures to modify psychological as well as motor functions.
开放标签随机对照试验，随访 3、6、12 个月及 2 至 3 年。
调查一种侧重于认知、行为和运动再学习的精神运动疗法与术后前 3 个月应用的运动疗法相比的有效性。
腰椎融合术后的术后管理通常侧重于镇痛止痛控制和日常生活活动。3 个月后，常实施运动疗法。没有随机对照试验调查过术后前 3 个月进行的早期康复技术。
该研究招募了 107 名年龄在 18 至 65 岁之间的患者，因 12 个月的症状性椎管狭窄症、颈椎病、退行性/峡部裂性腰椎滑脱症或退行性椎间盘疾病而选择接受腰椎融合术。运动疗法组接受家庭方案，侧重于背部、腹部和腿部肌肉功能力量和耐力、伸展运动和心血管健康的疼痛相关训练。精神运动疗法组接受家庭方案和 3 次门诊治疗，侧重于改变适应性疼痛认知、行为和运动控制。在术后 3、6、12 个月和 2 至 3 年后，使用评估功能障碍、疼痛、健康相关生活质量、功能自我效能、结果预期、运动恐惧/(再)受伤和应对的评定问卷进行评估。
术后 12 个月的随访率为 93%，2 至 3 年后的随访率为 81%。在各自的随访期间，精神运动疗法比运动疗法显著改善了功能障碍、自我效能、结果预期和运动恐惧/(再)受伤，而在 2 至 3 年后的随访中，疼痛应对的结果相似，但组间差异无统计学意义。精神运动疗法后可能出现临床相关的更高的再手术率，但这些比率在正常范围内。
该研究表明，腰椎融合术后的康复可以在术后前 3 个月内安全进行，并且应该包括改善心理和运动功能的措施。
