Thesis (PhD)--Stellenbosch University, 2013. / ENGLISH ABSTRACT: Background: On average one in three patients following lumbar surgery (LS) for
radiculopathy experience persistent pain and disability following surgery. No perioperative
treatments have shown any ability to decrease this persistent pain and disability. In another
challenging low back pain (LBP) population, chronic LBP, pain education focusing on the
neurobiology and neurophysiology of pain, has shown an ability to reduce reported pain and
disability. The purpose of this research study was to develop and test a preoperative
neuroscience education program for LS and determine its effect on pain and disability
following LS.
Research Design and Methods: After a series of studies, a newly designed preoperative
neuroscience educational tool (PNET) was developed. Eligible patients scheduled for LS for
radiculopathy participated in a multi-center study where they were randomized to either
receive usual care (preoperative education), or a combination of usual care plus one session
covering the content of the PNET, as delivered by a physiotherapist in a one-on-one verbal
session. Prior to LS, and one, three and six months after LS, 67 patients completed a series
of self-report outcome measures consisting of LBP and leg pain rating (Numeric Rating
Scale), function (Oswestry Disability Index), fear avoidance (Fear Avoidance Beliefs
Questionnaire), pain catastrophization (Pain Catastrophization Scale), pain knowledge (Pain
Neurophysiology Questionnaire), various beliefs and experiences related to LS (Likert
Scale), and post-operative utilization of healthcare (Utilization of Healthcare Questionnaire).
Results: At six month follow up there were no statistical difference (p <0.05) between the
experimental and control groups in regards to the primary outcome measures of function (p
= 0.296), LBP (p = 0.077) and leg pain (p = 0.074). The experimental group scored
significantly better on various questions regarding beliefs and experiences having undergone
LS, compared to the control group indicating a more positive surgical experience. Analysis of
healthcare utilization showed that patients who received the preoperative neuroscience
educational program had dramatically less health care utilization (medical tests and
treatments) in the six months following LS (p = 0.001), resulting in a 38% savings in
healthcare cost.
Conclusion: The addition of a preoperative neuroscience educational program to usual care
for LS for radiculopathy resulted in a profound behavioral change leading to a more positive
surgical experience, decreased healthcare utilization and resultant savings, despite
persistent pain and disability. / AFRIKAANSE OPSOMMING: Agtergrond: Gemiddeld een uit elke drie pasiënte ervaar volgehoue pyn en gestremdheid
na lumbale chirurgie (LC) vir radikulopatie. Geen peri-operatiewe behandeling het al getoon
dat dit die vermoe het om hierdie volgehoue pyn en gestremdheid te verminder nie. In nog 'n
uitdagende lae rug pynbevolking, naamlik chroniese lae rugpyn, het pyn-onderrig, wat fokus
op die neurobiologie en neurofisiologie van pyn, getoon dat dit kan lei tot verminderde
rapportering van pyn en gestremdheid. Die doel van hierdie navorsingstudie was om 'n
preoperatiewe neuro-onderrig program vir lumbale chirurgie te ontwikkel en te toets, en die
uitwerking daarvan op pyn en gestremdheid na LC te bepaal.
Navorsingsontwerp en Metodiek: Na 'n reeks studies is 'n nuwe preoperatiewe neuroonderrig
hulpmiddel (PNET) ontwikkel. Geskikte pasiënte wat geskeduleer was vir LC weens
radikulopatie, het deelgeneem aan 'n veelvuldige- sentrum studie. Deelnemers is lukraak in
een van twee groepe ingedeel om of gewone sorg (preoperatiewe onderrig), of 'n
kombinasie van gewone sorg met een sessie wat die inhoud van die PNET gedek het.
Laasgenoemde sessie is aangebied deur 'n fisioterapeut in 'n een-tot-een verbale sessie.
Voor die LC, en een, drie en ses maande na LC, het 67 pasiënte 'n reeks van selfverslaggewende
uitkoms metings voltooi, wat insluit: Lae Rug- en beenpyn gradering
(„Numeric Pain Rating Scale‟), Funksie („Oswestry Disability Index‟), Vrees-vermyding („Fear
Avoidance Beliefs Questionnaire‟), Pyn-katastrofering („Pain Catastrophization Scale‟), Pynkennis
(„Pain Neurophysiology Questionnaire‟), verskeie oortuigings en ervarings wat
verband hou met LC („Likert Scale‟), en postoperatiewe Gesondheidsorg-benutting
(„Utilization of Healthcare Questionnaire‟).
Resultate: Tydens die ses-maande-opvolg was daar geen statistiese verskil (p <0,05)
tussen die eksperimentele- en kontrolegroepe met betrekking tot die primêre uitkoms
metings van Funksie (p = 0,296), Lae rug Pyn (p = 0.077) en beenpyn (p = 0,074), nie. Die
eksperimentele-groep het betekenisvol beter gevaar met verskeie vrae oor oortuiging en
ervarings na afloop van LC. Ontleding van gesondheidsorg benutting, het getoon dat
pasiënte wie die preoperatiewe neuro-onderrig program ontvang het, dramaties minder
Gesondheidsorg (mediese toetse en behandelings) in die ses maande na LC benodig het, (p
= 0,001), wat gelei het tot 'n 38% besparing in gesondheidsorgkoste.
Gevolgtrekking: Die byvoeging van 'n preoperatiewe neuro-onderrig program, tot die
gewone-sorg vir LC weens radikulopatie, het „n noemenswaardige gedragsverandering
veroorsaak wat tot n meer positiewe chirurgiese ervaring, verminderde gesondheidsorg
benutting en finansiele besparing gelei het, ten spyte van volgehoue pyn en gestremdheid.
| Identifer | oai:union.ndltd.org:netd.ac.za/oai:union.ndltd.org:sun/oai:scholar.sun.ac.za:10019.1/85660 |
| Date | 12 1900 |
| Creators | Louw, Adriaan |
| Contributors | Diener, Ina, Butler, David, Stellenbosch University. Faculty of Medicine and Health Sciences. Dept. of Interdisciplinary Health Sciences. Physiotherapy. |
| Publisher | Stellenbosch : Stellenbosch Universit |
| Source Sets | South African National ETD Portal |
| Language | en_ZA |
| Detected Language | English |
| Type | Thesis |
| Format | 250. 85 p. : ill. |
| Rights | Stellenbosch University |
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