Health Behavior Change Counseling in Surgery for Degenerative Lumbar Spinal Stenosis. Part II: Patient Activation Mediates the Effects of Health Behavior Change Counseling on Rehabilitation Engagement

摘要: Abstract Objective To determine the effect of health behavior change counseling (HBCC) on patient activation and influence rehabilitation engagement, to identify common barriers engagement among individuals undergoing surgery for degenerative lumbar spinal stenosis. Design Prospective clinical trial. Setting Academic medical center. Participants Consecutive spine patients (N=122) defined in our companion article (Part I) were assigned a control group (did not receive HBCC, n=59) or HBCC (received n=63). Intervention Brief motivational interviewing–based versus (significance, P Main Outcome Measures We assessed before after intervention. Rehabilitation was using physical therapist–reported Hopkins Engagement Rating Scale by ratio self-reported therapy home exercise completion. Common identified through thematic analysis. Results Patient predicted (standardized regression weight, .682; =.395). One-third did show improvement compared with group. Thematic analysis 3 engagement: (1) low self-efficacy because lack knowledge support (62%); (2) anxiety related fear movement (57%); (3) concern about pain management (48%). Conclusions The mediated activation. Despite improvements activation, one-third reported engagement. Addressing these should lead greater