CME: Enhancing Recovery After Back Surgery

CME: Enhancing Recovery After Back Surgery
Author Information (click to view)

Richard L. Skolasky, ScD

Associate Professor, Orthopaedic Surgery and Physical Medicine & Rehabilitation
Director, Spine Outcomes Research Center
Johns Hopkins University

Richard L. Skolasky, ScD, has indicated to Physician’s Weekly that he has no financial conflicts of interest to report.

Figure 1 (click to view)
Target Audience (click to view)

This activity is designed to meet the needs of physicians.

Learning Objectives(click to view)

Upon completion of the educational activity, participants should be able to:

 

  • Discuss the findings of a study that examined the effect of using a phone counseling intervention that addresses participation in rehabilitation programs after back surgery.

Method of Participation(click to view)

Statements of credit will be awarded based on the participant reviewing monograph, correctly answer 2 out of 3 questions on the post test, completing and submitting an activity evaluation.  A statement of credit will be available upon completion of an online evaluation/claimed credit form at www.akhcme.com/pwMar3.  You must participate in the entire activity to receive credit.  If you have questions about this CME/CE activity, please contact AKH Inc. at dcotterman@akhcme.com.

Credit Available(click to view)

AKH

CME Credit Provided by AKH Inc., Advancing Knowledge in Healthcare

Physicians
This activity has been planned and implemented in accordance with the Essential Areas and policies of the Accreditation Council for Continuing Medical Education (ACCME) through the joint providership of AKH Inc., Advancing Knowledge in Healthcare and Physician’s Weekly’s.  AKH Inc., Advancing Knowledge in Healthcare is accredited by the ACCME to provide continuing medical education for physicians.

 

AKH Inc., Advancing Knowledge in Healthcare designates this enduring activity for a maximum of 0.5 AMA PRA Category 1 Credit(s)™.  Physicians should claim only the credit commensurate with the extent of their participation in the activity.

Commercial Support(click to view)

There is no commercial support for this activity.

Disclosures(click to view)

It is the policy of AKH Inc. to ensure independence, balance, objectivity, scientific rigor, and integrity in all of its continuing education activities. The author must disclose to the participants any significant relationships with commercial interests whose products or devices may be mentioned in the activity or with the commercial supporter of this continuing education activity. Identified conflicts of interest are resolved by AKH prior to accreditation of the activity and may include any of or combination of the following: attestation to non-commercial content; notification of independent and certified CME/CE expectations; referral to National Author Initiative training; restriction of topic area or content; restriction to discussion of science only; amendment of content to eliminate discussion of device or technique; use of other author for discussion of recommendations; independent review against criteria ensuring evidence support recommendation; moderator review; and peer review.

Disclosure of Unlabeled Use & Investigational Product(click to view)

This educational activity may include discussion of uses of agents that are investigational and/or unapproved by the FDA. Please refer to the official prescribing information for each product for discussion of approved indications, contraindications, and warnings.

Disclaimer(click to view)

This course is designed solely to provide the healthcare professional with information to assist in his/her practice and professional development and is not to be considered a diagnostic tool to replace professional advice or treatment. The course serves as a general guide to the healthcare professional, and therefore, cannot be considered as giving legal, nursing, medical, or other professional advice in specific cases. AKH Inc. specifically disclaim responsibility for any adverse consequences resulting directly or indirectly from information in the course, for undetected error, or through participant’s misunderstanding of the content.

Faculty & Credentials(click to view)

FACULTY DISCLOSURES

Keith D’Oria, Editorial Director
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
Richard L. Skolasky, ScD
Discloses no financial relationships with pharmaceutical or medical product manufacturers.
AKH and PHYSICIAN WEEKLY’S STAFF/REVIEWERS

Dorothy Caputo, MA, BSN, RN- CE Director of Accreditation
Discloses no financial relationships with pharmaceutical or medical product manufacturers.

AKH planners and reviewers have no relevant financial relationships to disclose.

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Richard L. Skolasky, ScD (click to view)

Richard L. Skolasky, ScD

Associate Professor, Orthopaedic Surgery and Physical Medicine & Rehabilitation
Director, Spine Outcomes Research Center
Johns Hopkins University

Richard L. Skolasky, ScD, has indicated to Physician’s Weekly that he has no financial conflicts of interest to report.

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A short series of phone conversations with trained counselors appears to substantially enhance recovery and reduce pain in patients after they have undergone spinal surgery. The phone calls can reinforce the value of adhering to physical therapy and back-strengthening exercise regimens and are a relatively inexpensive and simple intervention.
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Spinal stenosis ranks among the most common reasons for spinal surgery and is expected to affect more than 60 million Americans by 2025. Although significant strides have been made in surgical techniques for spinal stenosis, patient outcomes associated with these procedures vary greatly.

Research has shown that many patients who undergo back surgery for spinal stenosis do not follow through with physical therapy (PT) or home exercises, and many never even engage in postoperative rehabilitation. Some studies show that up to 40% of back surgery patients continue to experience postoperative pain. This tends to result from loss of muscle tone after years of back pain and reduced spine mobility. Rehabilitation is further complicated by the fact that surgical incisions in back surgery are made deep into the muscle tissue during these operations, which can slow recovery.

“Efforts are needed to understand the drivers behind why patients have good or poor outcomes following back surgery for spinal stenosis,” says Richard L. Skolasky, ScD. “We know that patients play a critical role in their recovery after these procedures through their active engagement in rehabilitation programs. However, it can be challenging for physicians and other healthcare providers to provide support for patients to actively partake in these programs.”

 

A Phone Intervention

In a study published in Physical Medicine and Rehabilitation, Dr. Skolasky and colleagues examined the effect of using a phone counseling intervention that addressed participation in rehabilitation programs after back surgery. The study involved 122 patients aged 46 to 72 who underwent surgery between 2009 and 2012 to correct spinal stenosis. All patients in the study were prescribed home exercise programs or PT to help shorten the recovery period after their surgery.

The intervention group received a series of phone counseling sessions from a spinal surgery counselor who was trained in motivational interviewing. “This interviewing technique engages patients in their care and makes them active participants in their recovery,” Dr. Skolasky says. In previous research, motivational interviewing has been shown to improve diabetes self-care practices and the management of hypertension. It has also been linked to improving safe-sex practices among teens.

The first phone session occurred a few weeks before patients had their surgery and addressed the importance of PT and exercise, the patient’s individualized goals for recovery, and potential barriers that the patients may perceive in getting involved in PT and exercise programs. Two follow-up “booster” phone sessions were then conducted at 6 weeks and 3 months after surgery to see how well the plan was working.

“The phone calls were designed to reinforce the perceived value that PT and back-strengthening exercise regimens play and to support adherence to these programs following surgery,” says Dr. Skolasky. “These calls were intended to increase patient self-awareness on their perceptions about care. The calls also improved the dialogue between counselors and patients, making it a collaborative effort rather than have instruction go only one way.”

 

Powerful Results

When compared with the control group, patients who received the phone counseling intervention were more likely to participate in PT and home exercise. “Intervention patients also experienced less pain and less disability 6 months after their surgery,” Dr. Skolasky says (Table). At 6 months after surgery, 74% of patients receiving the phone counseling intervention had significant improvements on standard measures of physical functioning and self-reported measures of pain, compared with a 41% rate that was observed among those not receiving the calls.

“Our results suggest that a short series of phone conversations with trained counselors can improve patient activation, boost recovery, and reduce postoperative pain after spinal surgery,” says Dr. Skolasky. “The phone intervention is a relatively inexpensive and simple approach to care that appears to help maximize surgical outcomes.”

 

Consider Potential Barriers

Although the phone counseling sessions increased patient engagement rates, about one-third of participants remained resistant to the intervention. Several factors appeared to increase the likelihood of patient disengagement, including:

  • Low self-confidence in the ability to perform exercises.
  • Poor confidence in being able to get to PT sessions.
  • Fear of movement.
  • Concern about pain management.

Dr. Skolasky says these barriers should be kept top of mind when managing patients undergoing back surgery. Addressing these factors early in the course of care should lead to greater improvements in rehabilitation engagement.

 

Important Implications

According to Dr. Skolasky, the intervention used in the study is relatively easy to incorporate into other hospital settings and academic medical centers. “Motivational interview training for counselors took just 6-hours to completed, followed by a booster training program several weeks later,” he says. “Approaches like this could play an important role in improving patient outcomes and reducing healthcare spending.” These efforts are important considering that hospitals are increasingly being evaluated on the quality of care they provide.

Readings & Resources (click to view)

Skolasky RL, Maggard AM, Li D, Riley LH 3rd, Wegener ST. Health behavior change counseling in surgery for degenerative lumbar spinal stenosis. Part I: improvement in rehabilitation engagement and functional outcomes. Arch Phys Med Rehabil. 2015;96:1200-1207. Available at: http://www.archives-pmr.org/article/S0003-9993(15)00257-9/abstract.

Skolasky RL, Maggard AM, Li D, Riley LH 3rd, Wegener ST. Health behavior change counseling in surgery for degenerative lumbar spinal stenosis. Part II: patient activation mediates the effects of health behavior change counseling on rehabilitation engagement. Arch Phys Med Rehabil. 2015;96:1208-1214. Available at: http://www.archives-pmr.org/article/S0003-9993(15)00258-0/abstract.

Skolasky RL, Riley LH 3rd, Maggard AM, Bedi S, Wegener ST. Functional recovery in lumbar spine surgery: a controlled trial of health behavior change counseling to improve outcomes. Contemp Clin Trials. 2013;36:207-217.

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