INTRODUCTION:

Pre-operative anxiety, depression and kinesiophobia are associated with poorer post-operative recovery. Previous research has related mood disorders and kinesiophobia with increased disability, pain and reduced functional capacity in patients undergoing spine surgery. Current rehabilitation practices concentrate on physical recovery, neglecting to consider the dynamic interaction between biological, psychological and socio-environmental factors. Thus, the purpose of this study is to determine the short-term efficacy of biopsychosocial rehabilitation, compared to physiotherapy alone, in spinal fusion and laminectomy patients with symptoms of anxiety, depression and kinesiophobia pre-operatively.

METHODS:

A randomized controlled trial was conducted in 44 adults aged 33 to 79 years (55.9±12.3y) undergoing spinal fusion or laminectomy surgery, and with heightened anxiety (62.8%), depression (46.5%) or kinesiophobia (87.9%) pre-operatively. Experimental intervention group one (CBPT) received a behaviour change intervention (weekly, for the first six weeks after surgery), consisting of cognitive-behavioural strategies in addition to the standard physiotherapy regime (n= 14). Intervention group two (CC) received a care coordination intervention (weekly, for the first six weeks after surgery) in addition to the standard physiotherapy regime (n= 15). The control group (CON) received a physiotherapy intervention as part of standard post-operative spine care (n= 14). This is the first RCT to compare a structured cognitive-behavioural intervention aimed at reducing underlying unhelpful thought patterns and promoting a return to activity, against a social intervention intended to reduce participant solitude and doubt within the acute post-operative phase through discussion and reassurance about recovery. Baseline (pre-op) and 6-weeks following surgery, all participants completed the Oswestry Disability Index (ODI, primary outcome), Visual Analogue Scale (VAS, primary outcome), 30-Sit to Stand (30-STS) and Timed Up-and-Go (TUG).

RESULTS:

Short-term (6-week) outcomes indicate there were no significant changes in ODI and VAS scores between groups, and at selected time points (all p>0.05). Similarly, no significant changes were seen in functional outcomes between any of the three groups (all p>0.05).

DISCUSSION:

Prior studies have suggested anxiety, depression and kinesiophobia hinder post-operative recovery. This study anticipated poorer outcomes in this population and consequently, included patients’ contingent on their pre-operative anxiety, depression or kinesiophobia score. This stratification of patients has failed to generate any statistical significance differences at short-term follow-up and questions the role of biopsychosocial interventions in the acute post-operative period. Data collection is ongoing to achieve a larger sample size (n=117) and follow-up is currently underway to understand the longer-term role of biopsychosocial interventions in at-risk populations.