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

Objectives: To 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.

Design: A parallel-group, observer-blinded randomized controlled trial.

Setting: Department of Occupational- and Physiotherapy and the Centre for Rheumatology and Spine Diseases, Rigshospitalet, Denmark.

Participants: In total, 144 participants undergoing an LSF for CLBP were randomly assigned to an intervention- or a control group.

Intervention: The intervention group received nine sessions of GAPE, based on principles of operant conditioning.

Outcome: The 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.

Results: No 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.

Conclusion: Compared 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.