Cognitive-behavioural therapy vs. control for pain reduction after lumbar spinal fusion .
OrthoEvidence Journal (OE Journal) - ACE Report
OE Journal. 2017;5(2):34 BMC Musculoskelet Disord. 2016 May 20;17(1):21790 patients with degenerative spinal disorders undergoing lumbar spinal fusion were randomized to receive either cognitive-behavioural therapy or standard treatment. The objective of this study was to determine whether or not cognitive-behavioural therapy (CBT) has the ability to affect early postoperative outcomes such as back pain, mobility, analgesic consumption, and hospital stay duration. Findings indicated no significant differences between groups for improvement in postoperative back pain, analgesic consumption, and length of hospitalization. However, mobility was significantly improved in the CBT group compared to the control group by postoperative day 3.
Was the allocation sequence adequately generated?
Was allocation adequately concealed?
Blinding Treatment Providers: Was knowledge of the allocated interventions adequately prevented?
Blinding Outcome Assessors: Was knowledge of the allocated interventions adequately prevented?
Blinding Patients: Was knowledge of the allocated interventions adequately prevented?
Was loss to follow-up (missing outcome data) infrequent?
Are reports of the study free of suggestion of selective outcome reporting?
Were outcomes objective, patient-important and assessed in a manner to limit bias (ie. duplicate assessors, Independent assessors)?
Was the sample size sufficiently large to assure a balance of prognosis and sufficiently large number of outcome events?
Was investigator expertise/experience with both treatment and control techniques likely the same (ie.were criteria for surgeon participation/expertise provided)?
Ja = 1
Ungewiss = 0.5
Nicht relevant = 0
Nein = 0
Die Bewertung der Berichtskriterien bewertet die Transparenz, mit der die Autoren die methodischen und studienspezifischen Merkmale der Studie in der Veröffentlichung angeben. Die Bewertung ist in fünf Kategorien unterteilt, die im Folgenden vorgestellt werden.
3/4
Randomization
2/4
Outcome Measurements
4/4
Inclusion / Exclusion
4/4
Therapy Description
3/4
Statistics
Detsky AS, Naylor CD, O'Rourke K, McGeer AJ, L'Abbé KA. J Clin Epidemiol. 1992;45:255-65
Der Fragilitätsindex ist ein Instrument, das bei der Interpretation signifikanter Ergebnisse hilft und ein Maß für die Stärke eines Ergebnisses liefert. Der Fragilitätsindex gibt die Anzahl der aufeinanderfolgenden Ereignisse an, die zu einem dichotomen Ergebnis hinzugefügt werden müssen, damit das Ergebnis nicht mehr signifikant ist. Eine kleine Zahl steht für ein schwächeres Ergebnis und eine große Zahl für ein stärkeres Ergebnis.
Warum wurde diese Studie jetzt benötigt?
Psychological factors such as fear-avoidance belief and catastrophic thinking are believed to limit postoperative recovery and heighten pain. Cognitive-behavioural therapy (CBT) has been suggested to combat these negative thoughts. Previous trials have found inconclusive results of CBT on pain after lumbar spinal fusion due to the administration of the therapy postoperatively. Therefore, the present study attempts to study the effects of CBT on pain after lumbar spinal fusion when administered preoperatively.
Was war die wichtigste Forschungsfrage?
In the treatment of patients undergoing lumbar spinal fusion surgery, does the addition of cognitive-behavioural therapy to standard treatment prior to the operative procedure reduce the intensity of back pain within the first postoperative week?
- No significant differences were reported for back pain severity between the CBT group and the Control group (Median: 5.6 [1.7-10.0] vs. 5.3 [1.1-7.7]; p=0.74)
- Significantly more patients in the CBT group were able to walk on day 3 compared to the Control group (43 [73%] vs. 15 [48%]; p=0.02); ability to walk was also significantly greater in the CBT group on day 2 (p<0.05), but comparable to the Control group on day 1
- Significantly more patients in the CBT group were able to rise and sit from a chair, and get in and out of bed on day 3 compared to the Control group (both 58 [98%] vs. 26 [84%]; p=0.017); however, both groups were comparable on postoperative days 1 and 2 (p>0.05)
- Analgesic use of morphine equivalents was similar between the CBT group and the Control group (Median: 142.5 vs. 196.8; p=0.23)
- Hospitalization duration was similar between CBT and Control groups (Median: 5 [3-9] vs. 4 [3-10]; p=0.46)
Was sollte ich mir besonders merken?
In the treatment of lumbar spinal fusion, cognitive-behavioural therapy (CBT) did not significantly improve back pain severity compared to standard treatment. Mobility in terms of walking, rising and sitting from a chair, and getting in and out of bed were all significantly improved in the CBT group compared to the Control group by the third postoperative day.
Wie wird sich dies auf die Behandlung meiner Patienten auswirken?
The results of this study suggest that CBT may not be effective for improving postoperative back pain compared to standard treatment in patients undergoing lumbar spine fusion, but may be effective for improved postoperative mobility. Further research is necessary to determine a treatment that is able to better manage postoperative back pain in patients with degenerative spinal disorders.
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