Functional recovery in lumbar spine surgery: Influence of a brief Health Behavior

描述（由申请人提供）：脊柱外科手术是美国最常见和最昂贵的住院手术之一，在过去的二十年中，特别是在60岁以上或脊柱退行性疾病的患者中，发病率急剧上升。脊柱手术后的恢复是高度可变的，不能用传统研究的因素来解释。医学研究所（IOM）向美国医疗保健系统提出了一项挑战，以改善以患者为中心的医疗保健。这一挑战源于这样一个事实：以患者为中心的护理对医疗保健的计划、交付和评估方式产生了深远的影响。最近的证据支持以患者为中心的干预措施通过赋予患者个体权力来改善结果的假设。这种授权可以通过自我效能和患者激活的增加来实现。这种方法是几个主要干预项目的核心原则。这个项目是我们之前资助的研究患者激活在预测术后健康行为中的作用的工作的直接延伸。有一个有效和可靠的工具来识别患者激活度低的个体，因此，有恢复不良的风险，这说明需要一种干预策略。目前的建议旨在调查简短的健康行为改变咨询（HBCC）对患者激活和术后健康行为和功能恢复的影响。我们计划招募两个连续的队列，接受选择性手术治疗腰椎退行性疾病的个体。第一组患者将接受标准的术前护理。第二组将接受标准的术前护理，并进行额外的简短HBBC干预（以患者为中心的指导方法，用于激发改变行为的动机）。两组术后随访24个月。

DESCRIPTION (provided by the applicant): Spine surgery is one of the most common and costly inpatient procedures in the United States with rates increasing dramatically during the past two decades, especially among those greater than 60 years of age or with degenerative conditions of the spine. Recovery following spine surgery is highly variable and cannot be explained by traditionally studied factors. The Institute of Medicine (IOM) issued a challenge to the American health care system to improve the patient-centeredness of healthcare. This challenge arises from the fact that patient-centered care has a profound impact on the way that healthcare is planned, delivered, and evaluated. Recent evidence supports the hypothesis that patient-centered interventions improve outcomes through empowerment of the individual patient. This empowerment can be achieved through increases in self-efficacy and patient activation. This approach is a central tenet of several major intervention programs. This project is the direct extension of our previously funded work investigating the role of patient activation in predicting post-operative health behavior. Having a valid and reliable tool to identify individuals with low patient activation and, therefore, at risk for poor recovery speaks to the need for an intervention strategy. The current proposal seeks to investigate the impact of a brief Health Behavior Change Counseling (HBCC) on patient activation and post-operative health behavior and functional recovery. We plan to enroll two consecutive cohorts of individuals undergoing elective surgery for degenerative disease of the lumbar spine. The first cohort will undergo standard preoperative care. The second cohort will undergo standard pre-operative care with an additional brief HBBC intervention session (a patient-centered directive method for eliciting motivation to change behavior). Both groups will be following for 24 months post-operatively.