Telephone Counseling: Less Pain, More Mobility After Spine Surgery

New research has found that patients who spend time on phone counseling sessions improve their engagement in physical therapy and improve outcomes among patients recovering from lumbar spine surgery.

The study, “Telephone-Based Intervention to Improve Rehabilitation Engagement After Spinal Stenosis Surgery: A Prospective Lagged Controlled Trial,” was published in the January 8, 2018 edition of The Journal of Bone and Joint Surgery.

Richard L. Skolasky, Jr., Sc.D., with the Departments of Orthopaedic Surgery and Physical Medicine and Rehabilitation at The Johns Hopkins University School of Medicine in Baltimore, Maryland, told OTW, “Experience and research has shown that recovery after lumbar spine surgery is highly variable—with up to 40% of patients experiencing continued pain and functional limitations and nearly 20% requiring reoperation.”

“We had previously demonstrated that a patient’s level of activation influenced how engaged they were in their post-operative physical therapy. We were interested in seeing if a brief telephone-based intervention could increase activation, support engagement in physical therapy, and improve post-operative health outcomes among patients recovering from lumbar spine surgery.”

“We had shown in earlier papers that we were able to increase activation and support engagement in physical therapy and home exercise. These improvements in health behavior lead to early improvements in health outcomes (pain, disability, and physical function) when compared to patients who did not receive the intervention. The focus of the current paper was whether these improvements were evident 2-3 years after surgery.”

The authors wrote, “In this study, 122 patients with lumbar spinal stenosis undergoing a decompression surgical procedure from December 2009 through August 2012 were enrolled. Participants were assigned, according to enrollment date, to health behavior change counseling or usual care.”

Dr. Skolasky commented to OTW, “We were able to document one-year improvements in health outcomes (pain, disability, and physical health) among patients who received our intervention compared to controls. These early improvements were driven by the early changes in health behavior that lead to increased engagement in physical therapy and home exercise.”

“As we had expected, the improvements in the intervention group were attenuated by 2 and 3 years after surgery. Our intervention was designed to increase engagement in the post-operative period (~12 weeks) and not to increase physical activity, etc. in the longer period of recovery.”

“While both groups end at similar outcomes by 2-3 years after surgery, the early improvements in health among patients in our intervention group should not be discounted. These patients are spending significantly less time in pain and with physical limitations. This may allow them to return to work or usual activities sooner and to experience an improved quality of life compared to their peers who did not receive our intervention.”

“The early post-operative period is an important time when patients should be encouraged to be fully engaged in their physical therapy and home exercise. This encouragement, in our study, took the form of identifying goals for recovery and determining barriers and solutions for engagement by using the principles and practices of motivational interviewing.”