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The main goal of the proposed study is to examine the effectiveness of a cognitive-behavioral based physical therapy (CBPT) intervention on pain and disability in a cohort of individuals treated by lumbar spine surgery for degenerative conditions. The investigators overarching hypothesis is that such an intervention will have a measurable impact on postoperative pain, disability and physical and psychosocial functioning in persons treated by lumbar spine surgery who are at-risk for poor outcomes.
The spine surgery rate in the United States is the highest in the world and up to 40% of patients report residual chronic pain and restrictions in functional activity. Studies suggest that cognitive-behavioral factors, such as fear of movement and subsequent avoidance behavior and low self-efficacy, may explain some of the variability in outcomes after spine surgery. Rehabilitation after spine surgery has traditionally focused on exercise programs to reduce physical complaints, but the literature recommends broadening the scope of physical therapy to include cognitive-behavioral components in order to address patients' fear of physical activity. Specific aims of the study are to: 1) demonstrate the feasibility of training physical therapists in cognitive-behavioral techniques; 2) determine physical therapist and patient satisfaction with cognitive-behavioral education and exercises; and 3) examine the effectiveness of a CBPT intervention in reducing pain and disability and improving quality of life. A two group (control-standard physical therapy treatment vs. CBPT intervention) randomized controlled clinical trial design will be conducted at two outpatient physical rehabilitation centers. The study will recruit 70 subjects treated by lumbar spine surgery and screened for high fear-avoidance beliefs. All participants will be treated by therapists 2 times a week for 5 weeks and followed for 6 months after discharge from therapy. CBPT, focusing on decreasing fear-avoidance and improving self-efficacy, has the potential to improve pain, disability and quality of life after lumbar spine surgery.
Allocation: Randomized, Control: Placebo Control, Endpoint Classification: Efficacy Study, Intervention Model: Factorial Assignment, Masking: Double Blind (Subject, Investigator, Outcomes Assessor), Primary Purpose: Treatment
CBPT, Physical Therapy
Vanderbilt Orthopaedic Institute
Active, not recruiting
Published on BioPortfolio: 2014-08-27T03:13:22-0400
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Observational prospective study.
To compare the effectiveness of a comprehensive non-surgical training program to a self-directed approach in improving walking ability in lumbar spinal stenosis.
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Therapeutic modalities frequently used in PHYSICAL THERAPY (SPECIALTY) by physical therapists or physiotherapists to promote, maintain, or restore the physical and physiological well-being of an individual.
Persons trained in PHYSICAL THERAPY SPECIALTY to make use of PHYSICAL THERAPY MODALITIES to prevent, correct, and alleviate movement dysfunction.
The auxiliary health profession by which PHYSICAL THERAPISTS make use of PHYSICAL THERAPY MODALITIES to prevent, correct, and alleviate movement dysfunction of anatomic or physiological origin.
Narrowing of the spinal canal.
The auxiliary health profession which makes use of PHYSICAL THERAPY MODALITIES to prevent, correct, and alleviate movement dysfunction of anatomic or physiologic origin.
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