Department of Orthopaedics at Sahlgrenska Academy, Institute of the Clinical Sciences, University of Gothenburg, Göteborg, Sweden; and Spine Center Göteborg, Västra Frölunda, Sweden.
Department of Orthopaedics at Sahlgrenska Academy, Institute of the Clinical Sciences, University of Gothenburg; and Department of Orthopaedics, Sahlgrenska University Hospital, Göteborg, Sweden.
Phys Ther. 2019 Aug 1;99(8):1069-1088. doi: 10.1093/ptj/pzz020.
Prehabilitation programs have led to improved postoperative outcomes in several surgical contexts, but there are presently no guidelines for the prehabilitation phase before lumbar fusion surgery.
The objective was to investigate whether a person-centered physical therapy prehabilitation program, based on a cognitive-behavioral approach, is more effective than conventional care in reducing disability and improving functioning after lumbar fusion surgery in patients with degenerative disk disease.
This study was a randomized controlled trial.
The study took place at 2 private spine clinics and 1 university hospital.
We prospectively enrolled 118 patients scheduled for lumbar fusion surgery.
The active intervention used a person-centered perspective and focused on promoting physical activity and targeting psychological risk factors before surgery. The control group received conventional preoperative care.
The primary outcome was the Oswestry Disability Index score. Secondary outcomes were back and leg pain intensity, catastrophizing, kinesiophobia, self-efficacy, anxiety, depression, health-related quality of life, and patient-specific functioning, physical activity, and physical capacity. Data were collected on 6 occasions up to 6 months postoperatively. A linear mixed model was used to analyze the change scores of each outcome.
No statistically significant between-group difference was found on the primary outcome (disability) over time (baseline to 6 months). Among secondary outcome measures, a statistically significant interaction effect ("Group × Time") was seen for the European Quality of Life 5 Dimensions Questionnaire. The largest between-group difference on the European Quality of Life 5 Dimensions Questionnaire index was seen 1 week prior to surgery and favored the active intervention. The largest between-group effect sizes at the 6-month follow-up favored the active intervention, and were seen for physical activity intensity, steps per day, and the One Leg Stand Test. Both groups reached the minimal important change for the primary outcome and, in several secondary outcomes (pain intensity, back and leg; pain catastrophizing; anxiety; health-related quality of life [EQ5D VAS]), already at 8-week follow-up.
The participants' preoperative level of disability was lower than normative values, which suggests selection bias.
Both interventions led to clinically important changes, but it is not clear what kind of prehabilitation program is the most effective.
在多个外科手术环境中，预康复方案已经导致术后结果改善，但目前尚无腰椎融合手术前预康复阶段的指南。
旨在调查基于认知行为方法的以人为本的物理治疗预康复方案是否比常规护理更能降低退行性椎间盘疾病患者腰椎融合手术后的残疾程度和改善功能。
这是一项随机对照试验。
在 2 家私人脊柱诊所和 1 家大学医院进行。
前瞻性纳入了 118 名计划接受腰椎融合手术的患者。
主动干预采用以人为本的观点，重点是在手术前促进体力活动并针对心理危险因素。对照组接受常规术前护理。
主要结果是 Oswestry 残疾指数评分。次要结果是腰背疼痛强度、灾难化、运动恐惧、自我效能、焦虑、抑郁、健康相关生活质量和患者特定功能、体力活动和体力能力。数据在术后 6 个月内采集 6 次。使用线性混合模型分析每个结果的变化分数。
在整个时间内（基线至 6 个月），在主要结局（残疾）上未发现组间存在统计学显著差异。在次要结局测量中，欧洲生活质量五维问卷（EQ-5D）观察到统计学显著的交互效应（“组×时间”）。在手术前 1 周，欧洲生活质量五维问卷指数上的组间差异最大，且主动干预有利。在 6 个月随访时，组间效应最大，且有利于主动干预，表现在体力活动强度、每天步数和单腿站立测试。两组均达到了主要结局的最小重要变化，在多个次要结局（疼痛强度、腰背；疼痛灾难化；焦虑；健康相关生活质量[EQ-5D VAS]）中，在 8 周随访时已达到。
参与者术前残疾程度低于正常值，这表明存在选择偏倚。
两种干预措施都导致了有临床意义的变化，但尚不清楚哪种预康复方案最有效。
