Abstract
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 HEP (.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.
Keywords
List of abbreviations:
HBCC (health behavior change counseling), HEP (home exercise program), HRERS (Hopkins Rehabilitation Engagement Rating Scale), MCID (minimum clinically important difference), MI (motivational interviewing), ODI (Oswestry Disability Index), PCS (physical component score), PT (physical therapy), SF-12v2 (Medical Outcomes Study 12-Item Short-Form Health Survey, version 2)To read this article in full you will need to make a payment
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Article info
Publication history
Published online: March 28, 2015
Footnotes
The Functional Recovery in Lumbar Spine Surgery Health Behavior Change Counseling intervention trial is supported by the Agency for Healthcare Research and Quality (grant no. 1 R01 HS 017990).
Disclosures: none.
Identification
Copyright
© 2015 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
