Three-year follow-up of a randomized controlled trial comparing preoperative neuroscience education for patients undergoing surgery for lumbar radiculopathy
Open accessAbstract
BACKGROUND: Results from a previous multicenter randomized controlled trial (RCT) on preoperative pain neuroscience education (PNE) for lumbar radiculopathy found no significant difference in patient reported outcomes between groups. However, patients who received PNE viewed their surgical experience more favorably and utilized significantly less healthcare compared to those that did not. The purpose is to determine if the reduction in healthcare costs from 1-year would be continued at 3-year following surgery, and to explore differences (if any) in patient reported outcomes. Study design-analysis of 3-year follow-up data from RCT on preoperative PNE for lumbar radiculopathy. METHODS: Participating patients from the previous RCT were contacted for 3-year follow-up. Of the 67 patients who commenced in the study, there were 61 who completed 1-year follow-up. Data packets were sent to these 61 patients to examine post-operative utilization of healthcare (Utilization of Healthcare Questionnaire); LBP [numeric rating scale (NRS)]; leg pain (NRS); function (Oswestry disability index); and beliefs and experiences related to LS (10 item survey with Likert responses). RESULTS: At 3-year follow-up, 50 patients (29 females) responded, with 22 patients in the experimental group (EG) and 28 in the control group (CG). Cumulative medical expenses were 37% lower for the EG, with those patients spending less on X-rays and visits to their family physician, physical therapist, and massage therapist. There were no differences in patient reported outcomes between groups. Patients who received PNE continued to view their surgical experience more favorably compared to those that did not. CONCLUSIONS: Adding a single PNE session prior to surgery for lumbar radiculopathy results in significant healthcare savings over 3 years. Educating such patients about normal responses to lumbar surgery (LS) in a neuroscience framework may result in lasting behavior changes following surgery.
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Integrity signals
Registry
Cites
Statistics
Claims the paper makes
The claims and statistics of this paper haven’t been checked yet.
Run the check — free, no account needed. It reads the open-access text and checks the sources it cites.
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
This form of pain education was developed in Australia and has been adapted in numerous Western countries, demonstrating mixed results for effectiveness for managing LBP.
“This form of pain education (widely known as ‘Explain Pain’ or ‘Pain Neuroscience Education’)15–24 was developed in Australia and has been adapted in numerous Western countries, demonstrating mixed results for effectiveness for managing LBP.15 17 21 23–25”
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
The self-check needs the paper’s full text.
Cites
CONSORT 2010 Statement: updated guidelines for reporting parallel group randomised trials
the CONSORT Group, Schulz, K. F., Altman, D. G., & Moher, D. (2010) · BMC Medicine · doi:10.1186/1741-7015-8-18 · Cited by 13,371 · see citing works
The Transtheoretical Model of Health Behavior Change.
Prochaska, J. O., & Velicer, W. F. (1997) · American Journal of Health Promotion · doi:10.4278/0890-1171-12.1.38 · Cited by 7,782 · see citing works
Central sensitization: a generator of pain hypersensitivity by central neural plasticity
Latremoliere, A., & Woolf, C. J. (2009) · The Journal of Pain · doi:10.1016/j.jpain.2009.06.012 · Cited by 3,913 · see citing works
CONSORT 2010 statement: updated guidelines for reporting parallel group randomised trials
Schulz, K. F., Altman, D. G., Moher, D., & for the CONSORT Group (2010) · PLoS Medicine · doi:10.1371/journal.pmed.1000251 · Cited by 2,296 · see citing works
Ostelo, R. W. J. G., Deyo, R. A., Stratford, P., Waddell, G., Croft, P., Von Korff, M., Bouter, L. M., & de Vet, H. C. (2008) · Spine · doi:10.1097/brs.0b013e31815e3a10 · Cited by 2,009 · see citing works
Pain as a global public health priority
Goldberg, D. S., & McGee, S. J. (2011) · BMC Public Health · doi:10.1186/1471-2458-11-770 · Cited by 1,471 · see citing works
Outcome Measures for Low Back Pain Research: A Proposal for Standardized Use
Deyo, R. A., Battie, M., Beurskens, A. J. H. M., Bombardier, C., Croft, P., Koes, B., Malmivaara, A., Roland, M., Von Korff, M., & Waddell, G. (1998) · Spine · doi:10.1097/00007632-199809150-00018 · Cited by 1,229 · see citing works
From the gate to the neuromatrix
Melzack, R. (1999) · Pain · doi:10.1016/s0304-3959(99)00145-1 · Cited by 1,170 · see citing works
Chronic pain in Australia: a prevalence study.
Blyth, F. M., March, L. M., Brnabic, A. J. M., Jorm, L. R., Williamson, M., & Cousins, M. J. (2001) · Pain · doi:10.1016/s0304-3959(00)00355-9 · Cited by 1,096 · see citing works
Fritz, J. M., & Irrgang, J. J. (2001) · Physical Therapy · doi:10.1093/ptj/81.2.776 · Cited by 1,048 · see citing works
Pain and the Neuromatrix in the Brain
Melzack, R. (2001) · Journal of Dental Education · doi:10.1002/j.0022-0337.2001.65.12.tb03497.x · Cited by 897 · see citing works
A 10-year follow-up of the outcome of lumbar microdiscectomy.
Findlay, G. F., Hall, B. I., Musa, B. S., Oliveira, M. D., & Fear, S. C. (1981) · PubMed · doi:10.1097/00007632-199805150-00019 · Cited by 797 · see citing works
Overtreating chronic back pain: time to back off?
Deyo, R. A., Mirza, S. K., Turner, J. A., & Martin, B. I. (2009) · The Journal of the American Board of Family Medicine · doi:10.3122/jabfm.2009.01.080102 · Cited by 796 · see citing works
Cleland, J. A., Childs, J. D., & Whitman, J. M. (2008) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2007.08.126 · Cited by 750 · see citing works
International Journal of Health Sciences
(2017) · doi:10.21744/ijhs · Cited by 729 · see citing works
Louw, A., Diener, I., Butler, D. S., & Puentedura, E. J. (2011) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2011.07.198 · Cited by 686 · see citing works
Self-citationA Randomized Controlled Trial of Intensive Neurophysiology Education in Chronic Low Back Pain
Moseley, G. L., Nicholas, M. K., & Hodges, P. W. (2004) · The Clinical Journal of Pain · doi:10.1097/00002508-200409000-00007 · Cited by 537 · cited 1× · see citing works
“Various randomized controlled trials (RCT) and a systematic review have shown that PNE has a positive effect on pain, disability, pain catastrophization, and physical movement for patients with chronic low back pain (CLBP), extending to 1-year outcomes (22-26).”
BackgroundCombined physiotherapy and education is efficacious for chronic low back pain
Moseley, L. (2002) · Australian Journal of Physiotherapy · doi:10.1016/s0004-9514(14)60169-0 · Cited by 472 · see citing works
Long-Term Outcomes of Standard Discectomy for Lumbar Disc Herniation
Yorimitsu, E., Chiba, K., Toyama, Y., & Hirabayashi, K. (2001) · Spine · doi:10.1097/00007632-200103150-00019 · Cited by 429 · see citing works
Moseley, G. L. (2003) · European Journal of Pain · doi:10.1016/s1090-3801(03)00063-6 · Cited by 402 · see citing works
A pain neuromatrix approach to patients with chronic pain
Moseley, G. L. (2003) · Manual Therapy · doi:10.1016/s1356-689x(03)00051-1 · Cited by 343 · see citing works
Seven- to 20-Year Outcome of Lumbar Discectomy
Loupasis, G. A., Stamos, K., Katonis, P. G., Sapkas, G. S., Korres, D. S., & Hartofilakidis, G. C. (1999) · Spine · doi:10.1097/00007632-199911150-00005 · Cited by 269 · see citing works
Nijs, J., Roussel, N. A., van Wilgen, C. P., Köke, A. J. A., & Smeets, R. (2012) · Manual Therapy · doi:10.1016/j.math.2012.11.001 · Cited by 247 · see citing works
Rehabilitation after lumbar disc surgery
Oosterhuis, T., Costa, L. O. P., Maher, C. G., de Vet, H. C. W., van Tulder, M. W., & Ostelo, R. (2014) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd003007.pub3 · Cited by 226 · see citing works
The challenge of rising health care costs – a view from the Congressional Budget Office
Orszag, P. R., & Ellis, P. (2007) · New England Journal of Medicine · doi:10.1056/nejmp078190 · Cited by 224 · see citing works
Preoperative Pain Neuroscience Education for Lumbar Radiculopathy
Louw, A., Diener, I., Landers, M. R., & Puentedura, E. J. (2014) · Spine · doi:10.1097/brs.0000000000000444 · Cited by 202 · see citing works
Self-citationMoseley, G. L. (2003) · Journal of Manual & Manipulative Therapy · doi:10.1179/106698103790826383 · Cited by 178 · see citing works
Patientsʼ Expectations and Satisfaction in Lumbar Spine Surgery
Toyone, T., Tanaka, T., Kato, D., Kaneyama, R., & Otsuka, M. (2005) · Spine · doi:10.1097/01.brs.0000187876.14304.15 · Cited by 164 · see citing works
Early Rehabilitation Targeting Cognition, Behavior, and Motor Function After Lumbar Fusion
Abbott, A. D., Tyni‐Lenné, R., & Hedlund, R. (2010) · Spine · doi:10.1097/brs.0b013e3181d1049f · Cited by 160 · see citing works
Rönnberg, K., Lind, B., Zoëga, B., Halldin, K., Gellerstedt, M., & Brisby, H. (2007) · Spine · doi:10.1097/01.brs.0000251876.98496.52 · Cited by 158 · see citing works
Do Patient Expectations of Spinal Surgery Relate to Functional Outcome?
Yee, A. J. M., Adjei, N., Do, J., Ford, M. H., & Finkelstein, J. A. (2008) · Clinical Orthopaedics and Related Research · doi:10.1007/s11999-008-0194-7 · Cited by 149 · see citing works
Moseley, G. L. (2005) · Australian Journal of Physiotherapy · doi:10.1016/s0004-9514(05)70053-2 · Cited by 142 · see citing works
Reoperations After Lumbar Disc Surgery
Keskimäki, I. (2000) · Spine · doi:10.1097/00007632-200006150-00008 · Cited by 139 · see citing works
Central sensitization: uncovering the relation between pain and plasticity.
Woolf, C. J. (2007) · Anesthesiology · doi:10.1097/01.anes.0000264769.87038.55 · Cited by 117 · see citing works
Can Exercise Therapy Improve the Outcome of Microdiscectomy?
Dolan, P., Greenfield, K., Nelson, R. J., & Nelson, I. W. (2000) · Spine · doi:10.1097/00007632-200006150-00011 · Cited by 107 · see citing works
Greene, D. L., Appel, A., Reinert, S. E., & Palumbo, M. A. (2005) · Spine · doi:10.1097/01.brs.0000157754.98023.cd · Cited by 101 · see citing works
Behavioral Graded Activity Following First-Time Lumbar Disc Surgery
Ostelo, R., de Vet, H. C. W., Vlaeyen, J. W. S., Kerckhoffs, M. R., Berfelo, W. M., Wolters, P. M. J. C., & van den Brandt, P. A. (2003) · Spine · doi:10.1097/01.brs.0000083317.62258.e6 · Cited by 88 · see citing works
HÄKKINEN, A. H., Kautiainen, H., Järvenpää, S. K., et al. (2006) · European Spine Journal · doi:10.1007/s00586-006-0187-8 · Cited by 84 · see citing works
Explanatory and Diagnostic Labels and Perceived Prognosis in Chronic Low Back Pain
Sloan, T. J., & Walsh, D. A. (2010) · Spine · doi:10.1097/brs.0b013e3181e089a9 · Cited by 82 · see citing works
The impact of preoperative education on postoperative pain. Part 2
Oshodi, T. O. (2007) · British Journal of Nursing · doi:10.12968/bjon.2007.16.13.24244 · Cited by 70 · see citing works
McGregor, A. H., Doré, C. J., Morris, T. P., Stephen Morris, A., & Jamrozik, K. D. (2011) · Spine · doi:10.1097/brs.0b013e318214e3e6 · Cited by 67 · see citing works
Louw, A., Butler, D. S., Diener, I., & Puentedura, E. J. (2013) · American Journal of Physical Medicine & Rehabilitation · doi:10.1097/phm.0b013e3182876aa4 · Cited by 63 · see citing works
Self-citationNational audit of post-operative management in spinal surgery
McGregor, A. H., Dicken, B., & Jamrozik, K. (2006) · BMC Musculoskeletal Disorders · doi:10.1186/1471-2474-7-47 · Cited by 59 · see citing works
The impact of preoperative education on postoperative pain. Part 1
Oshodi, T. O. (2007) · British Journal of Nursing · doi:10.12968/bjon.2007.16.12.23719 · Cited by 55 · see citing works
Louw, A., Diener, I., & Puentedura, E. J. (2015) · The International Journal of Spine Surgery · doi:10.14444/2011 · Cited by 48 · see citing works
Self-citationPreoperative therapeutic neuroscience education for lumbar radiculopathy: A single-case fMRI report
Louw, A., Puentedura, E. J., Diener, I., & Peoples, R. R. (2015) · Physiotherapy Theory and Practice · doi:10.3109/09593985.2015.1038374 · Cited by 45 · see citing works
Self-citationPreoperative education for lumbar surgery for radiculopathy
Louw, A., Louw, Q. A., & Crous, L. C. (2009) · South African Journal of Physiotherapy · doi:10.4102/sajp.v65i2.244 · Cited by 32 · see citing works
Self-citationRehabilitation after lumbar disc surgery
Ostelo, R., Costa, L. O. P., Maher, C. G., et al. (2008) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd003007.pub2 · Cited by 32 · see citing works
Preoperative education for lumbar radiculopathy: A survey of US spine surgeons
Louw, A., Butler, D. S., Diener, I., & Puentedura, E. J. (2012) · The International Journal of Spine Surgery · doi:10.1016/j.ijsp.2012.03.001 · Cited by 27 · see citing works
Self-citationStrategies to Promote Deep Learning in Clinical Nursing Courses
Wittmann‐Price, R. A., & Godshall, M. (2009) · Nurse Educator · doi:10.1097/nne.0b013e3181b2b576 · Cited by 23 · see citing works
Function After Spinal Treatment, Exercise, and Rehabilitation
Morris, S., Morris, T. P., McGregor, A. H., et al. (2011) · Spine · doi:10.1097/brs.0b013e31821cba1f · Cited by 23 · see citing works
Chronic pain in Australia: a prevalence study
(2001) · Journal of Osteopathic Medicine · doi:10.1016/s1443-8461(01)80066-6 · Cited by 23 · see citing works
Keskimako, Seitsalo, Osterman, et al. (2000) · Cited by 18 · see citing works
Crabtree, J. L., Royeen, C. B., & Mu, K. (2001) · PubMed · Cited by 12 · see citing works
Comparison of Terminology in Patient Education Booklets for Lumbar Surgery
Louw, A., Diener, I., & Puentedura, E. J. (2014) · International Journal of Health Sciences (IJHS) · doi:10.15640/ijhs.v2n3a5 · Cited by 10 · see citing works
Self-citation
Flagged first, then by citations
Research works printed but not linked: 5
- © OSS Press Ltd. All rights reserved. J Spine Surg 2016;2(4):289-298 jss.osspress.com
- Moseley GL. Reconceptualising pain acording to modern pain sciences. Phys Ther Rev 2007;12:169-78.
- Prochaska JO, Velicer WF. Behavior Change: The transtheoretical model of health behaviour change. American Journal of Health Promotion 1998;12:38-48.
- © OSS Press Ltd. All rights reserved. J Spine Surg 2016;2(4):289-298
- jss.osspress.com Cite this article as: Louw A, Diener I, Landers MR, Zimney K, Puentedura EJ. Three-year follow-up of a randomized controlled trial comparing preoperative neuroscience education for patients undergoing surgery for lumbar radiculopathy. J Spine Surg 2016;2(4):289-298. doi: 10.21037/jss.2016.12.04
Cited by
Sorted by citations
Watson, J. A., Ryan, C. G., Cooper, L., Ellington, D., Whittle, R., Lavender, M., Dixon, J., Atkinson, G., Cooper, K., & Martin, D. J. (2019) · The Journal of Pain · doi:10.1016/j.jpain.2019.02.011 · Cited by 428 · see citing works
Nijs, J., Wijma, A. J., Willaert, W., Huysmans, E., Mintken, P., Smeets, R., Goossens, M., van Wilgen, C. P., Van Bogaert, W., Louw, A., et al. (2020) · Physical Therapy · doi:10.1093/ptj/pzaa021 · Cited by 97 · see citing works
Self-citationSharma, S., Jensen, M. P., Moseley, G. L., & Abbott, J. H. (2019) · BMJ Open · doi:10.1136/bmjopen-2018-026874 · Cited by 61 · see citing works
- Authors
- Louw, A., Diener, I., Landers, M. R., Zimney, K., & Puentedura, E. J.
- Affiliations
- Stellenbosch University (ZA)
- University of Nevada, Las Vegas (US)
- Corresponding author
- Puentedura, Emilio J.
- Venue
- Journal of Spine Surgery
- Publisher
- AME Publishing Company
- Published
- 2016-12
- Volume
- 2
- Issue
- 4
- Pages
- 289-298
- ISSN
- 2414-4630 (ISSN-L)
- 2414-469X
- PMC
- PMC5233858
- OpenAlex
- W2568564197
- Cited by
- 59
- References
- 55
- Citations by year
- 2026: 4 · 2025: 5 · 2024: 9 · 2023: 5 · 2022: 6 · 2021: 7 · 2020: 7 · 2019: 10 · 2018: 4 · 2017: 1 · 2016: 1
- FWCI
- 4.32
- Type
- journal article
- Language
- en
- Open access
- diamond
- doi.org
- Licence
- cc-by-nc-nd
- Locations
- Journal of Spine Surgery (publishedVersion, cc-by-nc-nd)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- 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
- pain neuroscience education, lumbar radiculopathy, lumbar spine surgery, health care costs, health care utilization, patient-reported outcomes, low back pain, leg pain, disability, long-term follow-up, patient education
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
