Early rehabilitation targeting cognition, behavior, and motor function after lumbar fusion: a randomized controlled trial

Spine (Phila Pa 1976). 2010 Apr 15;35(8):848-57. doi: 10.1097/BRS.0b013e3181d1049f.


Study design: Open label randomized controlled trial with 3-, 6-, 12-month, and 2- to 3-year follow-up.

Objective: To investigate the effectiveness of a psychomotor therapy focusing on cognition, behavior, and motor relearning compared with exercise therapy applied during the first 3 months after lumbar fusion.

Summary of background data: Postoperative management after lumbar fusion commonly focuses on analgesic pain control and activities of daily living. After 3 months, exercise therapy is often implemented. No randomized controlled trial has investigated early rehabilitation techniques conducted during the first 3 months after surgery.

Methods: The study recruited 107 patients, aged 18 to 65 years, selected for lumbar fusion because of 12 months of symptomatic spinal stenosis, spondylosis, degenerative/isthmic spondylolisthesis, or degenerative disc disease. The exercise therapy group received a home program focusing on pain contingent training of back, abdominal, and leg muscle functional strength and endurance, stretching, and cardiovascular fitness. The psychomotor therapy group received a home program and 3 outpatient sessions focusing on modifying maladaptive pain cognitions, behaviors, and motor control.Rated questionnaires investigating functional disability, pain, health-related quality of life, functional self-efficacy, outcome expectancy, fear of movement/(re)injury, and coping were assessed at 3, 6, 12 months, and 2 to 3 years after surgery.

Results: Follow-up rates were 93% at 12 months and 81% at 2 to 3 years after surgery. Psychomotor therapy improved functional disability, self-efficacy, outcome expectancy, and fear of movement/(re)injury significantly more than exercise therapy at respective follow-up occasions. Similar results occurred for pain coping but group differences were nonsignificant at 2 to 3 years follow-up. Potentially clinical relevant higher reoperation rates occurred after psychomotor therapy but rates were within normal ranges.

Conclusion: The study shows that postoperative rehabilitation can be safely implemented during the first 3 months after lumbar fusion and should include measures to modify psychological as well as motor functions.

Publication types

  • Randomized Controlled Trial
  • Research Support, Non-U.S. Gov't

MeSH terms

  • Adult
  • Behavior Therapy / methods
  • Behavior Therapy / statistics & numerical data
  • Cognition / physiology
  • Cognitive Behavioral Therapy / methods*
  • Cognitive Behavioral Therapy / statistics & numerical data
  • Exercise Therapy / methods
  • Female
  • Humans
  • Intervertebral Disc Displacement / psychology
  • Intervertebral Disc Displacement / rehabilitation*
  • Intervertebral Disc Displacement / surgery
  • Male
  • Middle Aged
  • Motor Skills / physiology
  • Outcome Assessment, Health Care
  • Pain, Postoperative / psychology
  • Pain, Postoperative / rehabilitation*
  • Postoperative Complications / prevention & control
  • Postoperative Complications / psychology
  • Postoperative Complications / rehabilitation
  • Psychomotor Performance / physiology*
  • Rehabilitation / methods*
  • Rehabilitation / statistics & numerical data
  • Spinal Stenosis / psychology
  • Spinal Stenosis / rehabilitation
  • Spinal Stenosis / surgery
  • Spondylolisthesis / psychology
  • Spondylolisthesis / rehabilitation
  • Spondylolisthesis / surgery
  • Spondylosis / psychology
  • Spondylosis / rehabilitation*
  • Spondylosis / surgery
  • Teaching / methods
  • Time Factors
  • Treatment Outcome