Research at Johns Hopkins University, Baltimore, USA, suggests that a short series of phone conversations with trained counsellors can substantially boost recovery and reduce pain in patients after spinal surgery.
As detailed in the online journal Archives of Physical Medicine and Rehabilitation, the phone calls, designed to enrich standard pre- and post-operative care by reinforcing the value of persisting with physical therapy and back-strengthening exercise regimens, are a relatively inexpensive and simple intervention that can maximise surgical outcomes.
“Phone counselling appears to be an easy, low-cost strategy that yields meaningful results by improving patient engagement in physical therapy and at-home exercise programmes that are so vital for their recovery,” says study lead investigator Richard Skolasky Jr, associate professor of orthopaedic surgery at the Johns Hopkins University School of Medicine. “Approaches like this one will play an important role in improving patient outcomes and reducing health care spending in an era when hospitals are increasingly being judged on the quality rather than quantity of care they provide.”
The new study was prompted, Skolasky says, by previous research showing that many back surgery patients skimp or give up on physical therapy and home exercises. Up to 40% continue to experience post-operative pain mainly due to loss of muscle tone after years of suffering from back pain and reduced mobility of the spine. The problem is often compounded by surgical cuts made into the deep muscle tissue during back operations.
The Johns Hopkins study involved 122 patients aged from 46 to 72, who underwent surgery at The Johns Hopkins Hospital between 2009 and 2012 to correct spinal stenosis—the most common reason for spinal surgery and is expected to affect more than 60 million people in the USA alone by 2025.
All patients were prescribed either home exercise programmes or physical therapy to help speed recovery. About one-half also received a series of phone counselling sessions from a trained spinal surgery counsellor to discuss the importance of exercise in their recovery. The first and most detailed phone session took place shortly before the patients had their surgeries. Two follow-up booster sessions took place at six weeks and three months after the operation.
Overall, patients who received the calls participated in physical therapy and home exercise at higher rates and had less pain and less disability six months after their surgery, compared with the standard-approach group. Six months after surgery, 74% of patients who received phone counselling experienced significant improvements on standard measures of physical functioning and self-reported measures of pain, compared with 41% of those who did not receive phone calls. The differences in functional outcomes between the two groups mirrored differences in physical therapy attendance rates and home-exercise completion rates within each group.
“Modern orthopaedic science has made great strides in surgical techniques to correct spinal deformities and achieved significant progress in developing physical therapies that boost the benefits of surgery, but we have not been all that good at motivating and engaging patients to partake in such post-surgical recovery programmes,” says co-investigator Stephen Wegener, associate professor of physical medicine and rehabilitation at Johns Hopkins. “The findings of our research suggest we may have found a way to add that missing ingredient that draws patients to be more active participants in their physical rehabilitation and recovery.”
The researchers note the phone conversations were modelled on well-established motivational interview techniques that engage patients in their care and make them active participants in their recovery. This type of interactive counselling has been shown to improve diabetes self-care and management of high blood pressure, and to increase safe-sex practices.
“The calls are intended to help patients become more self-aware of their own perceptions about care, and are more of a collaboration between counsellor and patient than one-way instruction,” Skolasky says.
Although the phone counselling sessions significantly boosted patient engagement rates, one-third of patients remained resistant to intervention, the study results found. The most prevalent factors in their disengagement, the investigators say, were low self-confidence in the ability to perform the exercises or get to a physical therapy session, fear of movement, and concern about pain management.
These hurdles—whether real or perceived—should be on every clinician’s radar, the investigators say, and must be addressed head on in order to improve patient engagement.