School of Psychology, Aston University, Aston Triangle, Birmingham, UK.
Adelante Centre of Expertise in Rehabilitation and Audiology, Hoensbroek, The Netherlands.
Eur J Pain. 2022 Sep;26(8):1790-1799. doi: 10.1002/ejp.2004. Epub 2022 Jul 18.
To investigate whether early changes in fear of movement (kinesiophobia), self-efficacy and catastrophizing were mediators of the relationship between allocation to the pre-habilitation intervention and later changes in health outcomes.
The original pre-habilitation trial (PREPARE, ISRCTN17115599) recruited 118 participants awaiting lumbar fusion surgery, half of whom received a prehabilitation intervention designed based on the modified fear-avoidance model and half of whom received usual care. Mediation analysis was performed to test each mediator separately. Analysis was performed on each outcome of interest separately (Oswestry disability index, patient-specific function, EQ general health and moderate/vigorous physical activity). Mediation analysis was carried out using PROCESS. Beta coefficients and bootstrapped 95% CIs were used to interpret the results.
None of the potential mediators was found to mediate the relationship between allocation to the intervention and 3-month scores on any of the health outcomes tested.
Screening patients for higher levels of catastrophizing and fear avoidance and lower levels of self-efficacy could help ensure only the patients who are most likely to benefit from the intervention are included.
Prehabilitation interventions for spinal fusion surgery have been found to improve health outcomes for patients. Theory-based interventions that target key mechanisms are more effective at improving outcomes than non-theory-based interventions. While no mediating effects were found for this particular intervention, the analysis suggests that the underlying theoretical model and treatment targets are appropriate and could drive improvement if more strongly targeted.
探讨运动恐惧（运动恐惧）、自我效能感和灾难化的早期变化是否是分配到预康复干预与健康结果后期变化之间关系的中介因素。
原始预康复试验（PREPARE，ISRCTN65421367）招募了 118 名等待腰椎融合手术的参与者，其中一半接受了基于改良恐惧回避模型设计的预康复干预，另一半接受了常规护理。进行中介分析以分别测试每个中介变量。分别对每个感兴趣的结果（Oswestry 残疾指数、患者特定功能、EQ 一般健康和中度/剧烈体力活动）进行分析。使用 PROCESS 进行中介分析。使用贝塔系数和引导的 95%置信区间来解释结果。
在测试的任何健康结果中，没有一个潜在的中介变量被发现可以调节分配给干预措施与 3 个月得分之间的关系。
对灾难化和回避恐惧程度较高、自我效能感较低的患者进行筛查，可以帮助确保只有最有可能从干预中受益的患者被纳入。
脊柱融合手术的预康复干预已被发现可改善患者的健康结果。针对关键机制的基于理论的干预措施比非基于理论的干预措施更有效地改善结果。虽然对于该特定干预措施未发现中介作用，但分析表明，潜在的理论模型和治疗目标是合适的，如果更有针对性，可能会推动改善。
