Preoperative neuroscience education for patients undergoing surgery for lumbar radiculopathy

Louw, Adriaan (2013-12)

Thesis (PhD)--Stellenbosch University, 2013.

Thesis

ENGLISH ABSTRACT: Background: On average one in three patients following lumbar surgery (LS) for radiculopathy experience persistent pain and disability following surgery. No perioperative treatments have shown any ability to decrease this persistent pain and disability. In another challenging low back pain (LBP) population, chronic LBP, pain education focusing on the neurobiology and neurophysiology of pain, has shown an ability to reduce reported pain and disability. The purpose of this research study was to develop and test a preoperative neuroscience education program for LS and determine its effect on pain and disability following LS. Research Design and Methods: After a series of studies, a newly designed preoperative neuroscience educational tool (PNET) was developed. Eligible patients scheduled for LS for radiculopathy participated in a multi-center study where they were randomized to either receive usual care (preoperative education), or a combination of usual care plus one session covering the content of the PNET, as delivered by a physiotherapist in a one-on-one verbal session. Prior to LS, and one, three and six months after LS, 67 patients completed a series of self-report outcome measures consisting of LBP and leg pain rating (Numeric Rating Scale), function (Oswestry Disability Index), fear avoidance (Fear Avoidance Beliefs Questionnaire), pain catastrophization (Pain Catastrophization Scale), pain knowledge (Pain Neurophysiology Questionnaire), various beliefs and experiences related to LS (Likert Scale), and post-operative utilization of healthcare (Utilization of Healthcare Questionnaire). Results: At six month follow up there were no statistical difference (p <0.05) between the experimental and control groups in regards to the primary outcome measures of function (p = 0.296), LBP (p = 0.077) and leg pain (p = 0.074). The experimental group scored significantly better on various questions regarding beliefs and experiences having undergone LS, compared to the control group indicating a more positive surgical experience. Analysis of healthcare utilization showed that patients who received the preoperative neuroscience educational program had dramatically less health care utilization (medical tests and treatments) in the six months following LS (p = 0.001), resulting in a 38% savings in healthcare cost. Conclusion: The addition of a preoperative neuroscience educational program to usual care for LS for radiculopathy resulted in a profound behavioral change leading to a more positive surgical experience, decreased healthcare utilization and resultant savings, despite persistent pain and disability.

AFRIKAANSE OPSOMMING: Agtergrond: Gemiddeld een uit elke drie pasiënte ervaar volgehoue pyn en gestremdheid na lumbale chirurgie (LC) vir radikulopatie. Geen peri-operatiewe behandeling het al getoon dat dit die vermoe het om hierdie volgehoue pyn en gestremdheid te verminder nie. In nog 'n uitdagende lae rug pynbevolking, naamlik chroniese lae rugpyn, het pyn-onderrig, wat fokus op die neurobiologie en neurofisiologie van pyn, getoon dat dit kan lei tot verminderde rapportering van pyn en gestremdheid. Die doel van hierdie navorsingstudie was om 'n preoperatiewe neuro-onderrig program vir lumbale chirurgie te ontwikkel en te toets, en die uitwerking daarvan op pyn en gestremdheid na LC te bepaal. Navorsingsontwerp en Metodiek: Na 'n reeks studies is 'n nuwe preoperatiewe neuroonderrig hulpmiddel (PNET) ontwikkel. Geskikte pasiënte wat geskeduleer was vir LC weens radikulopatie, het deelgeneem aan 'n veelvuldige- sentrum studie. Deelnemers is lukraak in een van twee groepe ingedeel om of gewone sorg (preoperatiewe onderrig), of 'n kombinasie van gewone sorg met een sessie wat die inhoud van die PNET gedek het. Laasgenoemde sessie is aangebied deur 'n fisioterapeut in 'n een-tot-een verbale sessie. Voor die LC, en een, drie en ses maande na LC, het 67 pasiënte 'n reeks van selfverslaggewende uitkoms metings voltooi, wat insluit: Lae Rug- en beenpyn gradering („Numeric Pain Rating Scale‟), Funksie („Oswestry Disability Index‟), Vrees-vermyding („Fear Avoidance Beliefs Questionnaire‟), Pyn-katastrofering („Pain Catastrophization Scale‟), Pynkennis („Pain Neurophysiology Questionnaire‟), verskeie oortuigings en ervarings wat verband hou met LC („Likert Scale‟), en postoperatiewe Gesondheidsorg-benutting („Utilization of Healthcare Questionnaire‟). Resultate: Tydens die ses-maande-opvolg was daar geen statistiese verskil (p <0,05) tussen die eksperimentele- en kontrolegroepe met betrekking tot die primêre uitkoms metings van Funksie (p = 0,296), Lae rug Pyn (p = 0.077) en beenpyn (p = 0,074), nie. Die eksperimentele-groep het betekenisvol beter gevaar met verskeie vrae oor oortuiging en ervarings na afloop van LC. Ontleding van gesondheidsorg benutting, het getoon dat pasiënte wie die preoperatiewe neuro-onderrig program ontvang het, dramaties minder Gesondheidsorg (mediese toetse en behandelings) in die ses maande na LC benodig het, (p = 0,001), wat gelei het tot 'n 38% besparing in gesondheidsorgkoste. Gevolgtrekking: Die byvoeging van 'n preoperatiewe neuro-onderrig program, tot die gewone-sorg vir LC weens radikulopatie, het „n noemenswaardige gedragsverandering veroorsaak wat tot n meer positiewe chirurgiese ervaring, verminderde gesondheidsorg benutting en finansiele besparing gelei het, ten spyte van volgehoue pyn en gestremdheid.

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