A NON-PHARMACOLOGICAL PREHABILITATION PROGRAM BASED ON A COGNITIVE-BEHAVIORAL APPROACH FOR PATIENTS SCHEDULED FOR LUMBAR SURGERY - A ONE YEAR FOLLOW-UP OF A RANDOMIZED CONTROLLED TRIAL
Notice bibliographique
Résumé
INTRODUCTION Approximately 230 million surgical procedures are performed annually worldwide. Surgery is acknowledged as one of the most frequent causes of chronic pain in patients attending pain clinics. Access to adequate pain management is declared a human right by the International Association for the Study of Pain (IASP), but what the non-pharmacological pain management should contain before surgery is not clear. The phase before surgery is suggested to be the ideal time to prepare patients for an optimal outcome from surgery by carrying out prehabilitation. This study investigated whether a person-centered non-pharmacological prehabilitation program based on a cognitive-behavioral approach reduces disability and improves functioning after lumbar fusion surgery more than does conventional care. METHODS Patients scheduled for lumbar fusion surgery were recruited from two private spine clinics and one university hospital in Gothenburg, Sweden. The patients were a subgroup of individuals with CLBP, characterized by the combination of motion elicited (often called mechanical), localized, clinically provocable pain, with corresponding (i.e. the same region) radiologically demonstrated degenerative changes (i.e. disc height reduction and facet arthrosis in varying combination) in one or a few of the lumbar intervertebral segments. The patients were randomized into either an active intervention group or to a control group. The active intervention utilized a person-centered approach over 5 sessions (4.5 hours in total) and focused on promoting physical activity and targeting pain-related fear factors before surgery. The control group received conventional preoperative care. The primary outcome was the Oswestry Disability Index score. Secondary outcomes were back and leg pain intensity, catastrophizing, kinesiophobia, self-efficacy, anxiety, depression, health-related quality of life, and patient-specific functioning, physical activity, and physical capacity. Data were collected on seven occasions up to 1 year postoperatively. A linear mixed model was used to analyze the change scores of each outcome. RESULTS No statistically significant difference between groups was found on the primary outcome (disability) over time (baseline to 1 year). Among secondary outcome measures, a statistically-significant interaction effect (u201cGroup x Timeu201d) was seen for EQ-5D. Minimally important changes over time were found in almost all outcomes in each group separately. Both groups reached a stable plateau of change in primary and secondary outcomes by 8 weeks post-operatively. In the patient specific functioning scale (PSFS) the improvement continued to 1 year. DISCUSSION A prehabilitation program leads to clinically important changes in pain variables (pain intensity and fear-avoidance variables), and does not lead to any negative side effects. The principles of non-pharmacological pain management needs to be incorporated in surgical context, such as before surgery in a prehabilitation program. Trial registration: Current Controlled Trials ISRCTN17115599.
Récupéré en direct depuis OpenAlex et désinversé. Les résumés ne sont pas conservés dans cette base de données : les index inversés représentent 8,6 Go des 9,3 Go de texte de la base, et le serveur dispose de 13 Go libres.
Comment cette classification a été obtenuedéplier
Prédiction machine sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Le volet Gemma est une étiquette directe du modèle pour chaque travail de la base, lue sur la notice réduite au titre. Le volet Codex est un classifieur appris des 10 348 étiquettes directes de Codex et calibré sur les taux pondérés de l'échantillon; les champs sans appui suffisant ne portent aucun appel Codex. Le mode candidate est l'union des deux volets; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont pas des étiquettes humaines.
Scores du classifieur distillé par catégorie (deux têtes)
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,003 | 0,003 |
| Méta-épidémiologie (sens strict) | 0,001 | 0,001 |
| Méta-épidémiologie (sens large) | 0,005 | 0,003 |
| Bibliométrie | 0,001 | 0,001 |
| Études des sciences et des technologies | 0,001 | 0,001 |
| Communication savante | 0,001 | 0,001 |
| Science ouverte | 0,001 | 0,001 |
| Intégrité de la recherche | 0,003 | 0,002 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,005 | 0,001 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule source (Gemma direct ou Codex distillé), pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».