Patient-Centered Goals After Lumbar Spine Surgery: A Secondary Analysis of Cognitive-Behavioral–Based Physical Therapy Outcomes From a Randomized Controlled Trial

Abstract

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 on the basis of goals met as expected (GAS t score of ≥50) or goals not met as expected (GAS t score of <50). Six- and 12-month outcomes included disability (Oswestry Disability Index), physical and mental health (12-Item Short-Form Health Survey [SF-12]), 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.

Rehabilitation after cervical and lumbar spine surgery

“… No differences were found among the groups regarding lumbar ROM. Coronado et al ( 54 ) SART II 112 Examine the association between goal attainment and patient-reported outcomes in patients who engaged in a 6-session, telephone-based, CBPT intervention after spine surgery. 12 months GAS; ODI; 12-item short-form health survey; PROM information system; pain numeric rating scale.…”

“…Patients with these degenerative pathologies develop high levels of functional limitation, fear of movement and pain catastrophizing ( 5 , 15 , 45 ). In that way, studies have shown the effectiveness and importance of using exercise rehabilitation protocols combined with cognitive-behavioral therapy and patient goal attainment-based therapy, showing significant improvements in disability, back and leg pain, fear avoidance behavior, mental health and quality of life ( 1 , 2 , 5 , 13 , 15 , 45 , 54 ).…”

“…The scientific evidence is insufficient to recommend specific rehabilitation protocols cognitive-behavioral physical therapy programs should start immediately after surgery, with psychological intervention with personal goal attainment, patient education and gradual mobilization. Formal spine exercise rehabilitation should then begin at 2–3 months postoperatively, with soft-tissue mobilization, neural mobilization, joint mobilization and with more evidence support: back endurance, stretching, motor control and strengthening exercises ( 2 , 54 ). These rehabilitation programs seem to be well tolerated and safe for the patients ( 13 ).…”