Cognitive-Behavioral–Based Physical Therapy to Improve Surgical Spine Outcomes: A Case Series

Archer, Kristin R.; Motzny, Nicole; Abraham, Christine M.; Yaffe, Donna M.; Seebach, Caryn; Devin, Clinton J.; Spengler, Dan M.; McGirt, Matthew J.; Aaronson, Oran S.; Cheng, Joseph; Wegener, Stephen T.

doi:10.2522/ptj.20120426

Cited by 39 publications

(31 citation statements)

References 30 publications

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“…Once identified, these psychological distress factors can be mitigated with cognitive behavioral therapy prior to surgery. Implementation of cognitive behavioral therapy could result in a lower level of pain experienced by depressed individuals suffering from cervical deformity, as has already been seen in patients who have undergone lumbar discectomy 5 and cervical spine surgery.…”

Section: Figmentioning

confidence: 86%

Despite worse baseline status depressed patients achieved outcomes similar to those in nondepressed patients after surgery for cervical deformity

Poorman

Passias

Horn

et al. 2017

Neurosurgical Focus

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OBJECTIVEDepression and anxiety have been demonstrated to have negative impacts on outcomes after spine surgery. In patients with cervical deformity (CD), the psychological and physiological burdens of the disease may overlap without clear boundaries. While surgery has a proven record of bringing about significant pain relief and decreased disability, the impact of depression and anxiety on recovery from cervical deformity corrective surgery has not been previously reported on in the literature. The purpose of the present study was to determine the effect of depression and anxiety on patients’ recovery from and improvement after CD surgery.METHODSThe authors conducted a retrospective review of a prospective, multicenter CD database. Patients with a history of clinical depression, in addition to those with current self-reported anxiety or depression, were defined as depressed (D group). The D group was compared with nondepressed patients (ND group) with a similar baseline deformity determined by propensity score matching of the cervical sagittal vertical axis (cSVA). Baseline demographic, comorbidity, clinical, and radiographic data were compared among patients using t-tests. Improvement of symptoms was recorded at 3 months, 6 months, and 1 year postoperatively. All health-related quality of life (HRQOL) scores collected at these follow-up time points were compared using t-tests.RESULTSSixty-six patients were matched for baseline radiographic parameters: 33 with a history of depression and/or current depression, and 33 without. Depressed patients had similar age, sex, race, and radiographic alignment: cSVA, T-1 slope minus C2–7 lordosis, SVA, and T-1 pelvic angle (p > 0.05). Compared with nondepressed individuals, depressed patients had a higher incidence of osteoporosis (21.2% vs 3.2%, p = 0.028), rheumatoid arthritis (18.2% vs 3.2%, p = 0.012), and connective tissue disorders (18.2% vs 3.2%, p = 0.012). At baseline, the D group had greater neck pain (7.9 of 10 vs 6.6 on a Numeric Rating Scale [NRS], p = 0.015), lower mean EQ-5D scores (68.9 vs 74.7, p < 0.001), but similar Neck Disability Index (NDI) scores (57.5 vs 49.9, p = 0.063) and myelopathy scores (13.4 vs 13.9, p = 0.546). Surgeries performed in either group were similar in terms of number of levels fused, osteotomies performed, and correction achieved (baseline to 3-month measurements) (p < 0.05). At 3 months, EQ-5D scores remained lower in the D group (74.0 vs 78.2, p = 0.044), and NDI scores were similar (48.5 vs 39.0, p = 0.053). However, neck pain improved in the D group (NRS score of 5.0 vs 4.3, p = 0.331), and modified Japanese Orthopaedic Association (mJOA) scores remained similar (14.2 vs 15.0, p = 0.211). At 6 months and 1 year, all HRQOL scores were similar between the 2 cohorts. One-year measurements were as follows: NDI 39.7 vs 40.7 (p = 0.878), NRS neck pain score of 4.1 vs 5.0 (p = 0.326), EQ-5D score of 77.1 vs 78.2 (p = 0.646), and mJOA score of 14.0 vs 14.2 (p = 0.835). Anxiety/depression levels reported on the EQ-5D scale were significantly higher in the depressed cohort at baseline, 3 months, and 6 months (all p < 0.05), but were similar between groups at 1 year postoperatively (1.72 vs 1.53, p = 0.416).CONCLUSIONSClinical depression was observed in many of the study patients with CD. After matching for baseline deformity, depression symptomology resulted in worse baseline EQ-5D and pain scores. Despite these baseline differences, both cohorts achieved similar results in all HRQOL assessments 6 months and 1 year postoperatively, demonstrating no clinical impact of depression on recovery up until 1 year after CD surgery. Thus, a history of depression does not appear to have an impact on recovery from CD surgery.

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Section: Figmentioning

confidence: 86%

Despite worse baseline status depressed patients achieved outcomes similar to those in nondepressed patients after surgery for cervical deformity

Poorman

Passias

Horn

et al. 2017

Neurosurgical Focus

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“…In particular, our findings contribute to research on the importance of pain catastrophizing and depressive symptoms to persistent postsurgical pain and physical disability. Cognitive and behavioral strategies that target pain catastrophizing and psychological distress have proven effective for chronic and surgical pain populations and may be beneficial for trauma survivors [4,9,26,32,55,59,64]. More specifically, cognitive-restructuring strategies such as identifying automatic negative thoughts, constructing realistic alternative responses, and acquiring positive coping selfstatements may be beneficial for pain catastrophizing, whereas relaxation such as breathing and progressive muscle relaxation and mindfulness training can be useful techniques to address depression [24].…”

Section: Methodsmentioning

confidence: 99%

Psychosocial Factors Predict Pain and Physical Health After Lower Extremity Trauma

Archer

Abraham

Obremskey

2015

Clinical Orthopaedics &Amp; Related Research

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Background There has been increasing evidence to support the importance of psychosocial factors to poor outcomes after trauma. However, little is known about the contribution of pain catastrophizing and fear of movement to persistent pain and disability. Questions/purposes Therefore, we aimed to determine whether (1) high pain catastrophizing scores are independently associated with pain intensity or pain interference; (2) high fear of movement scores are independently associated with decreased physical health; and (3) depressive symptoms are independently associated with pain intensity, pain interference, or physical health at 1 year after accounting for patient characteristics of age and education. Methods Of 207 eligible patients, we prospectively enrolled 134 patients admitted to a Level I trauma center for surgical treatment of a fracture to the lower extremity. Sixty percent of patients (80 of 134) had an isolated lower extremity injury and the remainder sustained additional minor injury to the head/spine, abdomen/thorax, or upper extremity. Pain catastrophizing was measured with the Pain Catastrophizing Scale, fear of movement with the Tampa Scale for Kinesiophobia, and depressive symptoms with the Patient Health Questionnaire. Pain and physical health outcomes were assessed with the Brief Pain Inventory and the SF-12, respectively. Assessments were completed at 4 weeks and 1 year after hospitalization. Multiple variable hierarchical linear regression analyses were used to address study hypotheses. One hundred ten patients (82%)

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“…The interventions included various forms of cognitive behavioral therapy (CBT) including acceptance and commitment therapy (ACT), provision of self-help materials, Lorig's arthritis self-management program, reality therapy, and exercise and strength training programs. Six studies 19,[28][29][30]32,36 used the telephone as the sole or primary means of treatment delivery, meaning telephone session were of a similar length as typical in-person treatment sessions. Another 4 15,27,31,35 trials provided treatment through self-help materials or in-person treatment supplemented with periodic telephone contact that emphasized goal setting or action planning.…”

Section: Telephonementioning

confidence: 99%

A Systematic Review of Technology-assisted Self-Management Interventions for Chronic Pain

Heapy

Higgins

Cervone

et al. 2015

The Clinical Journal of Pain

118

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Future trials should focus on direct comparisons of technology-assisted interventions with in-person treatment and head to head comparisons of different technology-assisted modalities. Additional areas of focus include quantifying the cost of technology-assisted interventions, examining the effect of treatment "dose" on outcomes, and establishing guidelines for developing treatments for the technology-assisted environment.

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Cognitive-Behavioral–Based Physical Therapy to Improve Surgical Spine Outcomes: A Case Series

Cited by 39 publications

References 30 publications

Despite worse baseline status depressed patients achieved outcomes similar to those in nondepressed patients after surgery for cervical deformity

Despite worse baseline status depressed patients achieved outcomes similar to those in nondepressed patients after surgery for cervical deformity

Psychosocial Factors Predict Pain and Physical Health After Lower Extremity Trauma

A Systematic Review of Technology-assisted Self-Management Interventions for Chronic Pain

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