腰椎术后以患者为中心的目标：一项基于认知行为的物理治疗随机对照试验的二次分析。
Patient-Centered Goals After Lumbar Spine Surgery: A Secondary Analysis of Cognitive-Behavioral-Based Physical Therapy Outcomes From a Randomized Controlled Trial.
机构信息
Department of Orthopedic Surgery, Center for Musculoskeletal Research, Department of Physical Medicine and Rehabilitation, Osher Center for Integrative Health, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
Department of Orthopedic Surgery, Vanderbilt Institute for Clinical and Translational Research, Vanderbilt University Medical Center, Nashville, Tennessee, USA.
出版信息
Phys Ther. 2022 Sep 4;102(9). doi: 10.1093/ptj/pzac091.
OBJECTIVE
The purpose of this study was to examine the association between goal attainment and patient-reported outcomes in patients who engaged in a 6-session, telephone-based, cognitive-behavioral-based physical therapy (CBPT) intervention after spine surgery.
METHODS
In this secondary analysis of a randomized trial, data from 112 participants (mean age = 63.3 [SD = 11.2] years; 57 [51%] women) who attended at least 2 CBPT sessions (median = 6 [range = 2-6]) were examined. At each session, participants set weekly goals and used goal attainment scaling (GAS) to report goal attainment from the previous session. The number and type of goals and percentage of goals met were tracked. An individual GAS t score was computed across sessions. Participants were categorized based on goals met as expected (GAS t score ≥ 50) or goals not met as expected (GAS t score < 50). Six- and 12-month outcomes included disability (Oswestry Disability Index), physical and mental health (12-Item Short-Form Health Survey), physical function (Patient-Reported Outcomes Measurement Information System), pain interference (Patient-Reported Outcomes Measurement Information System), and back and leg pain intensity (numeric rating scale). Outcome differences over time between groups were examined with mixed-effects regression.
RESULTS
Participants set a median of 3 goals (range = 1-6) at each session. The most common goal categories were recreational/physical activity (36%), adopting a CBPT strategy (28%), exercising (11%), and performing activities of daily living (11%). Forty-eight participants (43%) met their goals as expected. Participants who met their goals as expected had greater physical function improvement at 6 months (estimate = 3.7; 95% CI = 1.0 to 6.5) and 12 months (estimate = 2.8; 95% CI = 0.04 to 5.6). No other outcome differences were noted.
CONCLUSIONS
Goal attainment within a CBPT program was associated with 6- and 12-month improvements in postoperative physical functioning.
IMPACT
This study highlights goal attainment as an important rehabilitation component related to physical function recovery after spine surgery.
目的
本研究旨在探讨参与 6 次电话为基础的认知行为物理治疗（CBPT）干预的脊柱手术后患者的目标达成与患者报告结局之间的关联。
方法
这是一项随机试验的二次分析，共纳入 112 名参与者（平均年龄 63.3 [11.2] 岁；57 [51%] 名女性）的数据，他们至少参加了 2 次 CBPT 治疗（中位数 6 [范围 2-6]）。在每次治疗中，参与者都会设定每周的目标，并使用目标达成评分（GAS）报告上一次治疗中的目标达成情况。记录目标的数量和类型以及目标达成的百分比。根据整个治疗过程中的 GAS t 评分，对参与者进行分类，分为目标达成（GAS t 评分≥50）和目标未达成（GAS t 评分<50）。6 个月和 12 个月的结果包括残疾（Oswestry 残疾指数）、身体和心理健康（12 项简短健康调查）、身体功能（患者报告结局测量信息系统）、疼痛干扰（患者报告结局测量信息系统）、腰背和腿部疼痛强度（数字评分量表）。使用混合效应回归分析比较两组间随时间的变化。
结果
参与者每次治疗设定的目标中位数为 3 个（范围 1-6）。最常见的目标类别为娱乐/体育活动（36%）、采用 CBPT 策略（28%）、锻炼（11%）和日常生活活动（11%）。48 名参与者（43%）达成了预期目标。达到预期目标的参与者在 6 个月（估计值=3.7；95%CI=1.0 至 6.5）和 12 个月（估计值=2.8；95%CI=0.04 至 5.6）时身体功能改善更大。没有观察到其他结局差异。
结论
CBPT 方案中的目标达成与术后身体功能的 6 个月和 12 个月改善相关。
影响
本研究强调了目标达成作为脊柱手术后身体功能恢复相关的重要康复组成部分。
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