Article

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.
CI - Copyright (c) 2015 American Congress of Rehabilitation Medicine. All rights
reserved.

Langue : ANGLAIS