Cognitive-behavioral-based physical therapy for patients with chronic pain undergoing lumbar spine surgery: a randomized controlled trial

Archer, Kristin R.; Devin, Clinton J.; Vanston, Susan W.; Koyama, Tatsuki; Phillips, Sharon E.; George, Steven Z.; McGirt, Matthew J.; Spengler, Dan M.; Aaronson, Oran S.; Cheng, Joseph S.; Wegener, Stephen T.

doi:10.1016/j.jpain.2015.09.013

Cited by 219Musculoskeletal pain and rehabilitationSpine and Intervertebral Disc PathologyPain Management and Treatment

Cognitive-behavioral-based physical therapy for patients with chronic pain undergoing lumbar spine surgery: a randomized controlled trial

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Archer, Kristin R., Devin, Clinton J., Vanston, Susan W., Koyama, Tatsuki, Phillips, Sharon E., George, Steven Z., McGirt, Matthew J., Spengler, Dan M. +3 more·2016·The Journal of Pain

DOI 10.1016/j.jpain.2015.09.013PMC PMC4709178

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Abstract

Unlabelled The purpose of this study was to determine the efficacy of a cognitive-behavioral-based physical therapy (CBPT) program for improving outcomes in patients after lumbar spine surgery. A randomized controlled trial was conducted on 86 adults undergoing a laminectomy with or without arthrodesis for a lumbar degenerative condition. Patients were screened preoperatively for high fear of movement using the Tampa Scale for Kinesiophobia. Randomization to either CBPT or an education program occurred at 6 weeks after surgery. Assessments were completed pretreatment, posttreatment and at 3-month follow-up. The primary outcomes were pain and disability measured by the Brief Pain Inventory and Oswestry Disability Index. Secondary outcomes included general health (SF-12) and performance-based tests (5-Chair Stand, Timed Up and Go, 10-Meter Walk). Multivariable linear regression analyses found that CBPT participants had significantly greater decreases in pain and disability and increases in general health and physical performance compared with the education group at the 3-month follow-up. Results suggest a targeted CBPT program may result in significant and clinically meaningful improvement in postoperative outcomes. CBPT has the potential to be an evidence-based program that clinicians can recommend for patients at risk for poor recovery after spine surgery.Perspective This study investigated a targeted cognitive-behavioral-based physical therapy program for patients after lumbar spine surgery. Findings lend support to the hypothesis that incorporating cognitive-behavioral strategies into postoperative physical therapy may address psychosocial risk factors and improve pain, disability, general health, and physical performance outcomes.

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Participants were recruited through a stratified purposeful sampling approach from a cohort of 80 adults enrolled in a randomized controlled trial evaluating CBPT versus education after elective lumbar spine surgery.
“Participants were recruited through a stratified purposeful sampling approach from a cohort of 80 adults enrolled in a randomized controlled trial evaluating the efficacy of a cognitive-behavioral-based physical therapy (CBPT) program compared to education in patients following elective lumbar spine surgery (NCT01131611).20”
From A Conceptual Model for Spine Surgery Recovery: A Qualitative Study of Patients’ Expectations, Experiences, and Satisfaction (2023) · cites this paper as [20]
The Methods (Trial Design) identify this as the randomized trial comparing CBPT with Education after lumbar spine surgery, and give the cited trial registration number. The paper does not describe stratified purposeful sampling from a cohort of 80 adults; its Results report 102 enrolled and 86 randomized. The Methods (Sample Size and Power) describe 80 as a planned sample size, not the enrolled cohort. (LLM, conf=0.88)
Experimental — accuracy not yet measured
MSK providers have addressed the mental factors that influence pain using three primary frameworks: the fear-avoidance model, pain neuroscience education and cognitive behavioural therapy (CBT).
“Musculoskeletal (MSK) providers have addressed the mental factors that influence pain using three primary frameworks: the fear-avoidance model, pain neuroscience education and cognitive behavioural therapy (CBT) (Archer et al., 2016;Chimenti et al., 2018;Leeuw et al., 2007;Moseley & Vlaeyen, 2015;Stearns et al., 2021).”
From Beyond yellow flags: The Big‐Five personality traits and psychologically informed musculoskeletal rehabilitation. (2023) · cites this paper as Archer et al., 2016
The Introduction and Methods (page not provided) describe physical therapists using cognitive-behavioral strategies to address fear of movement and other psychosocial factors in patients undergoing lumbar spine surgery. The paper therefore supports CBT as one approach used by MSK providers, but it does not identify pain neuroscience education or establish that the three named approaches are the primary frameworks. (LLM, conf=0.86)
Experimental — accuracy not yet measured
Behavioral interventions such as cognitive behavioral therapy and sleep interventions can simultaneously improve symptoms related to mental health and chronic pain.
“Fortunately, behavioral interventions such as cognitive behavioral therapy and sleep interventions can simultaneously improve symptoms related to mental health and chronic pain [6-9].”
From Behavioral Mechanisms That Mediate Mental and Physical Health Improvements in People With Chronic Pain Who Receive a Digital Health Intervention: Prospective Cohort Pilot Study (2023) · cites this paper as [6]
Archer et al. (2016) have used a combined CBT along with physical therapy to effectively decrease the fear of movement and improve pain self-efficacy in lowback patients.
“Archer et al. (2016) have used a combined CBT along with physical therapy to effectively decrease the fear of movement and improve pain self-efficacy in lowback patients.”
From Beyond yellow flags: The Big‐Five personality traits and psychologically informed musculoskeletal rehabilitation. (2023) · cites this paper as Archer et al. (2016)

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Authors: Archer, K. R., Devin, C. J., Vanston, S. W., Koyama, T., Phillips, S. E., George, S. Z., McGirt, M. J., Spengler, D. M., Aaronson, O. S., Cheng, J. S., & Wegener, S. T.
Affiliations: Vanderbilt University Medical Center (US)
University of Florida Health (US)
Carolina Neurosurgery and Spine Associates (US)
Johns Hopkins University (US)
Corresponding author: Archer, Kristin R.
ORCID: Archer, Kristin R.
Devin, Clinton J.
Koyama, Tatsuki
Phillips, Sharon E.
George, Steven Z.
Spengler, Dan M.
Cheng, Joseph S.
Wegener, Stephen T.
Venue: The Journal of Pain
Publisher: Elsevier BV
Published: 2016-01
Volume: 17
Issue: 1
Pages: 76-89
ISSN: 1526-5900 (ISSN-L)
DOI: 10.1016/j.jpain.2015.09.013
PMC: PMC4709178
OpenAlex: W2176763793
Cited by: 219
References: 93
Citations by year: 2026: 18 · 2025: 28 · 2024: 20 · 2023: 31 · 2022: 18 · 2021: 29 · 2020: 29 · 2019: 17 · 2018: 13 · 2017: 10 · 2016: 6
FWCI: 6.96
Type: journal article
Language: en
Update notices: erratum (2017-04-01)
Open access: bronze
doi.org
Licence: www.elsevier.com/tdm/userlicense/1.0/ (tdm)
www.elsevier.com/open-access/userlicense/1.0/ (vor, 2810 d)
Locations: Journal of Pain (publishedVersion)
PubMed (publishedVersion)
Europe PMC (PubMed Central) (acceptedVersion)
PubMed Central (acceptedVersion)
Funders: National Institutes of Health (R21AR062880)
Magistro Family Foundation
National Center for Advancing Translational Sciences (UL1TR000445)
Topics: Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
Health Sciences › Medicine › Pathology and Forensic Medicine › Spine and Intervertebral Disc Pathology
Health Sciences › Medicine › Anesthesiology and Pain Medicine › Pain Management and Treatment
Keywords: cognitive behavioral therapy, postoperative physiotherapy, lumbar spine surgery, chronic low back pain, kinesiophobia, lumbar degenerative disease, laminectomy, spinal fusion, postoperative pain, disability, physical performance, psychosocial risk factors, patient education
MeSH terms: Activities of Daily Living, Adult, Aged, Female, Health Education, Humans, Lumbar Vertebrae, Male, Middle Aged, Postoperative Pain, Spinal Diseases, Cognitive Behavioral Therapy, Physical Therapy Modalities, Chronic Pain

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Cognitive-behavioral-based physical therapy for patients with chronic pain undergoing lumbar spine surgery: a randomized controlled trial

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