Management of catastrophising and kinesiophobia improves rehabilitation after fusion for lumbar spondylolisthesis and stenosis. A randomised controlled trial

Abstract

The rehabilitation programme, including the management of catastrophising and kinesiophobia, was superior to the exercise programme in reducing disability, dysfunctional thoughts, and pain, and enhancing the quality of life of patients after lumbar fusion for degenerative spondylolisthesis and/or LSS. The effects lasted for at least 1 year after the intervention ended.

Quality of life and disability: can they be improved by active postoperative rehabilitation after spinal fusion surgery in patients with spondylolisthesis? A randomised controlled trial with 12-month follow-up

“…The future challenge will be to identify these patients in an earlier postoperative phase to offer them more individual rehabilitation interventions, while most of the LSF patients could possibly recover with subtler interventions. In previously published RCTs, the mean ODI scores showed severe disability (over 40) at baseline [10,12], while in this study, the mean disability levels were moderate in the EG and minimal in the UCG at baseline. In the study by Abbott et al [10], the baseline measurement was actually performed preoperatively when the patient's clinical status was worse than three months postoperatively, which was the time point used as a baseline of present study.…”

“…The In this study, all dimensions of the HRQoL, except the Role Physical dimension, were higher at baseline compared to the baseline in the study by Monticone et al in 2014 [12]. In that study, there were significant differences between the two treatment groups in the changes in all HRQoL dimensions of the SF-36, meaning that the 4-week cognitive-behavioural therapy (CBT) with exercise training was more effective than the 4-week exercise training alone, when implemented within the first five postoperative weeks [12]. The later timing of the intervention in the present study may explain the smaller changes, as the surgery and early postoperative care already improved outcomes before the 12-month intervention started.…”

“…Thus far, a limited number of randomised controlled trials (RCTs) have been published and the evidence of exercise therapy in restoring the spinal functioning and improving disability or HRQoL after fusion surgery is weak [10][11][12][13][14][15][16]. The commencement time and structure of the rehabilitation programs in previous RCT's varies [10][11][12][13][14]17].…”

“…The commencement time and structure of the rehabilitation programs in previous RCT's varies [10][11][12][13][14]17]. Most trials were implemented close to time of surgery, starting preoperatively [13,14], during hospital stay or soon after discharge [10,12].…”

“…Most trials were implemented close to time of surgery, starting preoperatively [13,14], during hospital stay or soon after discharge [10,12]. The two trials, which have been measuring disability and health related quality of life, indicate that combination of exercises and cognitive-behavioral therapy is more effective than exercises alone, when implemented within first postoperative months [10,12]. Because the existing evidence concerning exercise rehabilitation after LSF is limited and controversial, there is no consensus on the contents of effective rehabilitation program after LSF.…”