A Person‐Centred Prehabilitation Program based on Cognitive Behavioural Physical Therapy for patients scheduled for Lumbar Fusion surgery: A mediation analysis to assess fear of movement (kinesiophobia), self‐efficacy and catastrophizing as mediators of health outcomes

Abstract

Objective: To investigate whether early changes in fear of movement (kinesiophobia), self-efficacy and catastrophizing were mediators of the relationship between allocation to the pre-habilitation intervention and later changes in health outcomes. Methods:The original pre-habilitation trial (PREPARE, ISRCTN17115599) recruited 118 participants awaiting lumbar fusion surgery, half of whom received a prehabilitation intervention designed based on the modified fear-avoidance model and half of whom received usual care. Mediation analysis was performed to test each mediator separately. Analysis was performed on each outcome of interest separately (Oswestry disability index, patient-specific function, EQ general health and moderate/vigorous physical activity). Mediation analysis was carried out using PROCESS. Beta coefficients and bootstrapped 95% CIs were used to interpret the results.Results: None of the potential mediators was found to mediate the relationship between allocation to the intervention and 3-month scores on any of the health outcomes tested.

Best Practice Physiotherapy for Patients with Low Back Pain in Primary Care : Clinical Outcomes and Explanatory Factors

“…Of the mentioned studies that also had pain as an outcome, there were no indirect effects found for pain outcome 102,105 . Few studies investigated mediators of treatment effect in clinical outcomes beside disability and pain [106][107][108] . The theoretical rationale in treatment for low back pain Theoretical models that underpin the rationale for an intervention hypothesise that changes in specific factors mediate the treatment effect and need to be successfully targeted 103 .…”

“…A recently published study by Mansell et al 107 is the only study investigating mediators in LBP interventions for patients in the pre-surgery phase. Exercise self-efficacy, fear of movement and pain catastrophising were not found to mediate post-surgery effects on disability and general health of a cognitive behavioural physical therapy-based prehabilitation for patients undergoing lumbar fusion surgery 107 .…”

“…A recently published study by Mansell et al 107 is the only study investigating mediators in LBP interventions for patients in the pre-surgery phase. Exercise self-efficacy, fear of movement and pain catastrophising were not found to mediate post-surgery effects on disability and general health of a cognitive behavioural physical therapy-based prehabilitation for patients undergoing lumbar fusion surgery 107 . The inconsistent findings regarding the mediating effect of self-efficacy and fear-avoidance beliefs constructs may be due to the studies´ differences in the study populations, measurement timepoints, outcome measures, and statistical analyses.…”

“…The study by Mansell et al 107 is the only other study evaluating mediators for outcomes reflecting HRQoL in patients with LBP. Fear of movement was found to be a treatment target for improving patients´ self-rated health.…”