Preoperative Neuroscience Education for Lumbar Radiculopathy

Another in our ‘getting your thesis out there‘ series.  This one from Adriaan Louw, PT, PhD. Congrats Adriaan on finishing your thesis!

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 physical therapist 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 one year 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 one-year following LS (p = 0.001), resulting in a 42% 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.

About Adriaan Louw

Adriaan LouwAdriaan earned both an undergraduate as well as a master’s degree in research and spinal surgery rehabilitation from the University of Stellenbosch in Cape Town, South Africa. He is a guest lecturer/adjunct faculty at Rockhurst University, St. Ambrose University and the University of Las Vegas Nevada. In addition, he maintains a clinical practice and is co-owner of The Ortho Spine and Pain Clinic in Story City, Iowa. Adriaan has been teaching postgraduate, spinal   manual therapy and pain science classes throughout the US and internationally for 15 years. He is a Certified Spinal Manual Therapist through ISPI. In addition, Adriaan has presented at numerous national and international manual therapy, pain science and medical conferences and has authored and co-authored articles, books and book chapters related to spinal disorders and pain science. Recently, Adriaan completed his Ph.D. which centers on therapeutic neuroscience education and spinal disorders.

E-mail: ALouw@AOL.com

Thesis online here

Published works associated with this thesis:

1.     Louw A, Butler DS, Diener I, Puentedura EJ. Preoperative education for lumbar radiculopathy: A Survey of US Spine Surgeons. International Journal of Spine Surgery. 2012;6:130-139.

2.     Louw A, Butler DS, Diener I, & Puentedura EJ (2013). Development of a preoperative neuroscience educational program for patients with lumbar radiculopathy. American journal of physical medicine & rehabilitation / Association of Academic Physiatrists, 92 (5), 446-52 PMID: 23478459

3.     Louw A, Diener I, Butler DS, & Puentedura EJ (2011). The effect of neuroscience education on pain, disability, anxiety, and stress in chronic musculoskeletal pain. Archives of physical medicine and rehabilitation, 92 (12), 2041-56 PMID: 22133255

4.     Louw A, Diener I, Butler DS, & Puentedura EJ (2013). Preoperative education addressing postoperative pain in total joint arthroplasty: review of content and educational delivery methods. Physiotherapy theory and practice, 29 (3), 175-94 PMID: 23035767

5.     Louw A, Louw Q, Crous LCC. Preoperative Education for Lumbar Surgery for Radiculopathy. South African Journal of Physiotherapy. July 2009 2009;65(2):3-8.

Submitted for publication/under review – associated with the thesis:

1.     Sham Surgery in Orthopedics – A Systematic Review of the Literature.

2.     Provocative Terms in Preoperative Education for Lumbar Surgery.

3.     Changes in Brain Activation after Preoperative Neuroscience Education: A single fMRI Case Study.

4.     Immediate effect of Preoperative Neuroscience Education: A Case Series.

5.     A Multicenter-randomized controlled trial: Preoperative neuroscience education for lumbar radiculopathy

6.     Graded Motor Imagery Immediately After Multi-Level Lumbar Surgery: A Case Study