Physical Medicine and Rehabilitation, Department of Medical Sciences and Public Health, University of Cagliari.
Neurorehabilitation Unit, Department of Neuroscience and Rehabilitation, G. Brotzu Hospital, Cagliari, Italy.
Disabil Rehabil. 2022 Jul;44(14):3422-3429. doi: 10.1080/09638288.2020.1863480. Epub 2020 Dec 27.
To evaluate the effect of multimodal exercises integrated with cognitive-behavioural therapy on disability, pain, and quality of life in patients suffering from failed back surgery syndrome (FBSS), and to appraise its extent in the long term.
By means of a parallel-group superiority-controlled trial, 150 outpatients were randomly assigned to a 10-week individual-based multimodal programme of task-oriented exercises integrated with cognitive-behavioural therapy (experimental group, 75 patients) or individual-based general physiotherapy (control group, 75 patients). Before treatment, 10 weeks later (post-treatment), and 12 months after the end of treatment, the Oswestry Disability Index (primary outcome), the Tampa Scale for Kinesiophobia, the Pain Catastrophising Scale, a pain intensity numerical rating scale and the Short-Form Health Survey were evaluated. Linear mixed model analysis for repeated measures was carried out for each outcome measure.
Significant group ( < 0.001), time ( < 0.001), and time-by-group interaction ( < 0.001) effects were found for all outcome measures. Concerning disability, between-group differences (95% confidential interval) in favour of the experimental group of -9 (-10.7; -7.3) after training and of -13.2 (-14.7; -11.7) at follow-up were found. Also, kinesiophobia, catastrophising and pain showed significant between-group differences of 9, 12.5 and 1.7 points, respectively.
The multimodal intervention proposed was superior to general physiotherapy in reducing disability, kinesiophobia, catastrophising, and enhancing the quality of life of patients with FBSS. The effects were reinforced one year after the programme ended.IMPLICATIONS FOR REHABILITATIONMultimodal exercises integrated with cognitive-behavioural therapy induced significant improvements in disability, pain, kinesiophobia, catastrophising, and quality of life of subjects with Failed Back Surgery Syndrome.A well-integrated rehabilitative team which contributes towards reaching intervention goals is advised.Physiotherapists should adopt task-oriented exercises to promote an earlier return to common activities of disabled patients.Psychologists should explain how to modify useless beliefs and support adequate behaviours, in order to produce constructive attitudes towards perceived disability.
评估将多模式运动与认知行为疗法相结合对失败性腰椎手术后综合征（FBSS）患者的残疾、疼痛和生活质量的影响，并评估其在长期内的效果。
通过一项平行组优势对照试验，将 150 名门诊患者随机分配至 10 周的个体化基于任务导向运动与认知行为疗法的多模式方案（实验组，75 名患者）或个体化基于常规物理治疗的多模式方案（对照组，75 名患者）。在治疗前、治疗 10 周后（治疗后）以及治疗结束后 12 个月时，使用 Oswestry 残疾指数（主要结局指标）、坦帕运动恐惧量表、疼痛灾难化量表、疼痛强度数字评分量表和简明健康量表进行评估。对每个结局指标进行重复测量的线性混合模型分析。
所有结局指标均显示出显著的组间（ < 0.001）、时间（ < 0.001）和时间-组间交互作用（ < 0.001）效应。关于残疾，实验组在训练后和随访时分别表现出优于对照组的 9 分（95%置信区间：-10.7；-7.3）和 13.2 分（95%置信区间：-14.7；-11.7）的组间差异。此外，运动恐惧、灾难化和疼痛分别表现出 9、12.5 和 1.7 个点的显著组间差异。
与常规物理治疗相比，多模式干预方案在降低 FBSS 患者的残疾、运动恐惧、灾难化和提高生活质量方面更具优势。这种效果在方案结束一年后仍得到增强。
多模式运动与认知行为疗法相结合可显著改善失败性腰椎手术后综合征患者的残疾、疼痛、运动恐惧、灾难化和生活质量。建议建立一个综合的康复团队，以促进达到干预目标。物理治疗师应采用任务导向的运动，以促进残疾患者尽早恢复日常活动。心理学家应解释如何改变无用的信念并提供支持，以培养对感知残疾的建设性态度。
