Three-year follow-up of a randomized controlled trial comparing preoperative neuroscience education for patients undergoing surgery for lumbar radiculopathy

Adriaan Louw; Ina Diener; Merrill R Landers; Kory Zimney; Emilio J Puentedura

doi:10.21037/jss.2016.12.04

Three-year follow-up of a randomized controlled trial comparing preoperative neuroscience education for patients undergoing surgery for lumbar radiculopathy

J Spine Surg. 2016 Dec;2(4):289-298. doi: 10.21037/jss.2016.12.04.

Authors

Adriaan Louw¹, Ina Diener², Merrill R Landers³, Kory Zimney⁴, Emilio J Puentedura³

Affiliations

¹ International Spine Pain Institute, Story City, IA, USA.
² Department of Physiotherapy, Stellenbosch University, Stellenbosch, South Africa.
³ Department of Physical Therapy, School of Allied Health Sciences, University of Nevada Las Vegas, Las Vegas, NV, USA.
⁴ Department of Physical Therapy, South Dakota University, SD, USA.

Abstract

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.

Keywords: Preoperative; education; health care costs; lumbar surgery (LS); neuroscience; outcomes; postoperative; radiculopathy.