Health Behavior Change Counseling in Surgery for Degenerative Lumbar Spinal Stenosis. Part I: Improvement in Rehabilitation Engagement and Functional Outcomes

作者：Skolasky Richard L^*; Maggard Anica M; Li David; Riley Lee H III; Wegener Stephen T

来源：Archives of Physical Medicine and Rehabilitation, 2015, 96(7): 1200-1207.

DOI：10.1016/j.apmr.2015.03.009

• Laminectomy
• Motivational interviewing
• Rehabilitation
• Spinal stenosis
• Spine

Objective: To examine whether a brief motivational interviewing [MI]-based health behavior change counseling (HBCC) intervention increased patient participation in physical therapy and/or home exercise programs (HEPs), reduced disability, and improved health status after surgery for degenerative lumbar spinal stenosis.
Design: Prospective clinical trial.
Setting: Academic medical center.
Participants: From December 2009 through August 2012, consecutive patients (N=122) underwent surgery for degenerative lumbar spinal stenosis and, based on enrollment date, were prospectively assigned to a control (n=59) or HBCC intervention (n=63) group in a prospective, lagged-control clinical trial.
Interventions: Brief MI-based HBCC versus attention control.
Main Outcome Measures: Rehabilitation participation (primary); disability and health status (secondary). Therapists assessed engagement in, and patients reported attendance at, postoperative rehabilitation (physical therapy and/or HEP). At 3 and 6 months, disability and health status were assessed (Oswestry Disability Index [ODI] and Medical Outcomes Study 12-Item Short-Form Health Survey, version 2 [SF-12v2]) (significance, P<.05).
Results: Compared with controls, HBCC patients had significantly higher rehabilitation engagement (21.20 +/- 4.56 vs 23.57 +/- 2.71, respectively; P<.001), higher physical therapy (.67 +/-.21 vs .82 +/-.16, respectively; P<.001) and REP (.65 +/-.23 vs .75 +/-.22, respectively; P=.019) attendance, and better functional outcomes at 3 months (difference: ODI, -10.7 +/- 4.4, P=.015; SF-12v2, 6.2 +/- 2.2, P=.004) and 6 months (difference: ODI, -12.7 +/- 4.8, P =.008; SF-12v2, 8.9 +/- 2.4, P<.001). The proportion of the HBCC intervention impact on functional recovery mediated by rehabilitation participation was approximately half at 3 months and one-third at 6 months.
Conclusions: HBCC can improve outcomes after spine surgery through improved rehabilitation participation.

• 出版日期2015-7