Functional recovery in lumbar spine surgery: a controlled trial of health behavior change counseling to improve outcomes

Abstract

In 2001, the Institute of Medicine issued a challenge to the American health care system to improve the quality of care by focusing on six major areas: safety, effectiveness, patient-centeredness, timeliness, efficiency, and equity. The patient-centered model of care directly addresses important limits of surgical care of the lumbar spine, i.e., the lack of effective methods for increasing patient participation and engagement in post-operative follow-up. Recent evidence indicates that post-surgical outcomes are better among those with higher patient activation. We therefore developed an intervention based on the principles of motivational interviewing to increase patient activation: the Functional Recovery in Lumbar Spine Surgery Health Behavior Change Counseling (HBCC) intervention. The HBCC was designed to maximize post-operative engagement and participation in physical therapy and home exercise, to improve functional recovery, and to decrease pain in individuals undergoing elective lumbar spine surgery. From December 2009 through October 2012, 120 participants were recruited and divided into two groups: those receiving (intervention group, 60) and not receiving (control group, 60) the HBCC intervention. The current manuscript provides a detailed description of the theoretical framework and study design of the HBCC and describes the implementation of this health behavior intervention in a university-based spine service. The HBCC provides a model for conducting health behavioral research in a real-world setting.

Keywords: FRiLSS; Functional Recovery in Lumbar Spine Surgery; HBCC; HEP; Health Behavior Change Counseling; Lumbar spine; MI; Motivational interviewing; ODI; Oswestry Disability Index; PAM; PT; Patient activation; Physical therapy; Rehabilitation; SD; Spine surgery; home exercise programs; motivational interviewing; patient activation measures; physical therapy; standard deviation..

Fig. 1.

Development and maintenance of patient activation. Copyright 2013 The Johns Hopkins University. Used with permission.

Fig. 2.

Schematic of control (standard care) and intervention (Health Behavior Change Counseling) groups. PT = physical therapy. HEP = home exercise program. Copyright 2013 The Johns Hopkins University. Used with permission. MI = motivational interviewing. PE = patient education. Solid line = in person. Dotted line = via telephone.