Thursday, September 27, 2018 1:05 PM–2:05 PM Understanding Anxiety and Depression when Performing Spine Surgery: 123. Is a physical therapist-delivered cognitive-behavioral intervention effective for improving surgical spine outcomes?

BACKGROUND CONTEXT Studies have found that patient psychosocial characteristics are strongly related to surgical spine outcomes. Limited evidence exists on the potential benefit of physical therapist-delivered cognitive-behavioral therapy (CBT) treatments for patients following lumbar spine surgery. PURPOSE The purpose was to compare which of two treatments delivered by telephone – a CBT-based physical therapy program (CBPT) or an education program – are more effective for improving patient-centered outcomes after lumbar spine surgery. STUDY DESIGN/SETTING Randomized controlled clinical trial at two medical centers (NCT02184143). PATIENT SAMPLE A total of 248 patients undergoing surgery for a lumbar degenerative condition (spinal stenosis, spondylosis with or without myelopathy and degenerative spondylolisthesis) using laminectomy with or without arthrodesis were randomized into CBPT (n=124) or an attention-control education group (n=124). OUTCOME MEASURES Patient-reported outcomes were disability (Oswestry Disability Index [ODI]), pain intensity (Brief Pain Inventory), and physical and mental health (SF-12). Observed physical activity was assessed using accelerometers. Health care utilization was also recorded. METHODS Patient assessments occurred preoperatively and at 6 weeks (baseline) and 6 and 12 months after surgery. Assessors and patients were unaware of the treatment condition. Patients were randomized at baseline using a stratified design based on age and type of surgery. Six treatment sessions were delivered by a physical therapist over the telephone. The CBPT intervention focused on walking and functional goal setting, relaxation techniques, symptom management through problem solving, and replacing negative thoughts about activity with positive ones. Analyses were intent-to-treat using multivariable regression models that adjusted for the outcome at baseline, age, study site, depressive symptoms, and type of surgical procedure. Missing data were handled with multiple imputation. The level of significance was set at α=0.05. RESULTS Follow-up rate at 12 months was 93% and 88% for patient-reported outcomes and physical activity, respectively. CBPT participants were 69% less likely to have a rehospitalization compared to education participants between 6 weeks and 12 months after surgery (p=.02). Statistically significant differences across groups were also noted for disability and physical health, but only for those completing all six sessions of the CBPT treatment. CBPT participants had an ODI score 4.3-points lower [95%CI, −8.5 to −0.03] and a SF-12 physical health score 3.2-points higher [95%CI, 0.16 to 6.3] than the education group at 12 months (p CONCLUSIONS Results from a multicenter trial found that a physical therapist-delivered cognitive-behavioral intervention reduced the odds of rehospitalization and improved disability and physical health in patients who completed the 6-session program. Older adults were more likely to benefit from the CBPT treatment in terms of increased physical activity. Telephone delivery appears to be an effective platform for incorporating CBT-based strategies into rehabilitation. Future work is needed to determine how to implement the CBPT approach in a typical clinic setting. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.