Health Behavior Change Counseling in Surgery for Degenerative Lumbar Spinal Stenosis. Part I: Improvement in Rehabilitation Engagement and Functional Outcomes

ObjectiveTo examine whether a brief motivational interviewing [MI]–based health behavior change counseling (HBCC) intervention increased patient participation in physical therapy and/or home exercise programs (HEPs), reduced disability, and improved health status after surgery for degenerative lumbar spinal stenosis.DesignProspective clinical trial.SettingAcademic medical center.ParticipantsFrom December 2009 through August 2012, consecutive patients (N=122) underwent surgery for degenerative lumbar spinal stenosis and, based on enrollment date, were prospectively assigned to a control (n=59) or HBCC intervention (n=63) group in a prospective, lagged-control clinical trial.InterventionsBrief MI-based HBCC versus attention control.Main Outcome MeasuresRehabilitation participation (primary); disability and health status (secondary). Therapists assessed engagement in, and patients reported attendance at, postoperative rehabilitation (physical therapy and/or HEP). At 3 and 6 months, disability and health status were assessed (Oswestry Disability Index [ODI] and Medical Outcomes Study 12-Item Short-Form Health Survey, version 2 [SF-12v2]) (significance, P<.05).ResultsCompared with controls, HBCC patients had significantly higher rehabilitation engagement (21.20±4.56 vs 23.57±2.71, respectively; P<.001), higher physical therapy (.67±.21 vs .82±.16, respectively; P<.001) and HEP (.65±.23 vs .75±.22, respectively; P=.019) attendance, and better functional outcomes at 3 months (difference: ODI, −10.7±4.4, P=.015; SF-12v2, 6.2±2.2, P=.004) and 6 months (difference: ODI, −12.7±4.8, P=.008; SF-12v2, 8.9±2.4, P<.001). The proportion of the HBCC intervention impact on functional recovery mediated by rehabilitation participation was approximately half at 3 months and one-third at 6 months.ConclusionsHBCC can improve outcomes after spine surgery through improved rehabilitation participation.