The Effect of Graded Activity and Pain Education after Lumbar Spinal Fusion on Sedentary Behavior 3 and 12 Months Post-Surgery: a Randomized Controlled Trial

ObjectivesTo examine the effect of an early post-surgical intervention consisting of graded activity and pain education (GAPE) in patients with chronic low back pain (CLBP) undergoing lumbar spinal fusion (LSF) on sedentary behaviour, disability, pain, fear of movement, self-efficacy for exercise and health-related quality of life (HRQoL) at three-, six- and 12 months follow-up.DesignA parallel-group, observer-blinded randomized controlled trial.SettingDepartment of Occupational- and Physiotherapy and the Centre for Rheumatology and Spine Diseases, Rigshospitalet, Denmark.ParticipantsIn total, 144 participants undergoing an LSF for CLBP were randomly assigned to an intervention- or a control group.InterventionThe intervention group received nine sessions of GAPE, based on principles of operant conditioning.OutcomeThe primary outcome was reduction in time spent in sedentary behaviour, measured by an accelerometer at three months. The secondary outcomes were reduction in time spent in sedentary behaviour at 12 months and changes from baseline to three-, six- and 12 months on disability, pain, fear of movement, self-efficacy for exercise and HRQoL.ResultsNo difference in changes in sedentary behaviour between groups was found three months after surgery. At 12 months after surgery there was a significant difference between groups (mean difference: -25.4 minutes/day (95% CI -49.1 to -1.7)) in favour of the intervention group.ConclusionCompared with usual care, GAPE had no effect on short-term changes in sedentary behaviour but GAPE had a statistically, but possibly not clinically effect on sedentary behaviour 12 months after LSF. Further, the behavioural intervention was safe to perform.