Preoperative cognitive-behavioural intervention improves in-hospital mobilisation and analgesic use for lumbar spinal fusion patients

被引:42
作者
Rolving, Nanna [1 ,2 ]
Nielsen, Claus Vinther [3 ,4 ]
Christensen, Finn Bjarke [5 ]
Holm, Randi [6 ]
Bunger, Cody Eric [7 ]
Oestergaard, Lisa Gregersen [1 ,8 ,9 ]
机构
[1] Reg Hosp Silkeborg, Ctr Diagnost, Falkevej 1-3, DK-8600 Silkeborg, Denmark
[2] Reg Hosp Silkeborg, Silkeborg, Denmark
[3] Aarhus Univ, Sch Publ Hlth, Dept Social Med & Rehabil, Aarhus, Denmark
[4] Cent Denmark Reg, Publ Hlth & Qual Improvement, Aarhus, Denmark
[5] Aarhus Univ Hosp, Dept Clin Med, DK-8000 Aarhus, Denmark
[6] Reg Hosp Silkeborg, Elect Surg Ctr, Silkeborg, Denmark
[7] Aarhus Univ Hosp, Dept Orthopaed Surg, DK-8000 Aarhus, Denmark
[8] Aarhus Univ Hosp, Ctr Res Rehabil, DK-8000 Aarhus, Denmark
[9] Aarhus Univ, Dept Publ Hlth, Aarhus, Denmark
关键词
Lumbar spinal fusion; Low back pain; Cognitive-behavioural therapy; Acute postsurgical pain; Mobility; Randomised controlled trial;
D O I
10.1186/s12891-016-1078-8
中图分类号
R826.8 [整形外科学]; R782.2 [口腔颌面部整形外科学]; R726.2 [小儿整形外科学]; R62 [整形外科学(修复外科学)];
学科分类号
摘要
Background: Catastrophic thinking and fear-avoidance belief are negatively influencing severe acute pain following surgery causing delayed ambulation and discharge. We aimed to examine if a preoperative intervention of cognitive-behavioural therapy (CBT) could influence the early postsurgical outcome following lumbar spinal fusion surgery (LSF). Methods: Ninety patients undergoing LSF due to degenerative spinal disorders were randomly allocated to either the CBT group or the control group. Both groups received surgery and postoperative rehabilitation. In addition, the CBT group received a preoperative intervention focussed on pain coping using a CBT approach. Primary outcome was back pain during the first week (0-10 scale). Secondary outcomes were mobility, analgesic consumption, and length of hospitalisation. Data were retrieved using self-report questionnaires, assessments made by physical therapists and from medical records. Results: No difference between the groups' self-reported back pain (p = 0.76) was detected. Independent mobility was reached by a significantly larger number of patients in the CBT group than the control group during the first three postoperative days. Analgesic consumption tended to be lower in the CBT group, whereas length of hospitalisation was unaffected by the CBT intervention. Conclusion: Participation in a preoperative CBT intervention appeared to facilitate mobility in the acute postoperative phase, despite equally high levels of self-reported acute postsurgical pain in the two groups, and a slightly lower intake of rescue analgesics in the CBT group. This may reflect an overall improved ability to cope with pain following participation in the preoperative CBT intervention.
引用
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页数:7
相关论文
共 20 条
[1]  
Abbott AD, 2010, SPINE
[2]  
Anonymous Washington State Agency Medical Directors Group, 2014, WEB BAS OP DOS CALC
[3]  
Ferreira-Valente MA, 2011, PAIN VALIDITY 4 PAIN
[4]  
Foss NB, 2006, CLIN REHABIL
[5]  
Hjermstad MJ, 2011, J PAIN SYMPTOM MANAG
[6]  
Ip HYV, 2009, ANESTHESIOLOGY
[7]  
Jones I, 2014, SURG UK CHRONIC PAIN
[8]  
Katz J, 2009, EXPERT REV NEUROTHER
[9]  
Kehlet H, 2006, LANGENBECKS ARCH SUR
[10]  
Monticone M, 2014, EUR SPINE J