{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,10]],"date-time":"2026-09-10T12:46:48Z","timestamp":1789044408059,"version":"build-2803163510"},"reference-count":45,"publisher":"Ovid Technologies (Wolters Kluwer Health)","issue":"1","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["The Journal of Bone and Joint Surgery"],"published-print":{"date-parts":[[2018,1,3]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Spine surgery outcomes are variable. Patients who participate in and take responsibility for their recovery have improved health outcomes. Interventions to increase patient involvement in their care may improve health outcomes after a surgical procedure. We conducted a prospective interventional trial to compare the effectiveness of health behavior change counseling with usual care to improve health outcomes after lumbar spine surgical procedures.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>In this study, 122 patients with lumbar spinal stenosis undergoing a decompression surgical procedure from December 2009 through August 2012 were enrolled. Participants were assigned, according to enrollment date, to health behavior change counseling or usual care. Health behavior change counseling is a brief, telephone-based intervention intended to increase rehabilitation engagement through motivational interviewing strategies that elicit and strengthen motivation for change. Health behavior change counseling was designed to identify patients with low patient activation, to maximize postoperative rehabilitation engagement, to decrease pain and disability, and to improve functional recovery. Participants were assessed before the surgical procedure and for 3 years after the surgical procedure for pain intensity (Brief Pain Inventory), disability (Oswestry Disability Index), and physical health (12-Item Short-Form Health Survey, version 2). Differences in changes in health outcomes after the surgical procedure were compared between the health behavior change counseling group and the usual care group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>By 12 months, health behavior change counseling participants reported significantly greater reductions in pain intensity (p = 0.008) and disability (p = 0.028) and significantly greater improvement in physical health compared with usual care participants (p = 0.025). These differences were attenuated by 24 and 36 months after the surgical procedure. Early improvements in health outcomes were mediated by improvements in physical therapist-rated engagement and self-reported attendance at physical therapy sessions in the health behavior change counseling group.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions:<\/jats:title>\n                    <jats:p>Health behavior change counseling improved health outcomes during the first 12 months after the surgical procedure through changes in rehabilitation engagement. Wider use of health behavior change counseling may lead to improved outcomes not only after lumbar spine surgery but also in other conditions for which rehabilitation is key to recovery.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Level of Evidence:<\/jats:title>\n                    <jats:p>\n                      Therapeutic\n                      <jats:underline>Level II<\/jats:underline>\n                      . See Instructions for Authors for a complete description of levels of evidence.\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.2106\/jbjs.17.00418","type":"journal-article","created":{"date-parts":[[2018,1,4]],"date-time":"2018-01-04T20:24:43Z","timestamp":1515097483000},"page":"21-30","source":"Crossref","is-referenced-by-count":22,"title":["Telephone-Based Intervention to Improve Rehabilitation Engagement After Spinal Stenosis Surgery"],"prefix":"10.2106","volume":"100","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-2598-4427","authenticated-orcid":false,"given":"Richard L.","family":"Skolasky","sequence":"first","affiliation":[{"name":"Departments of Orthopaedic Surgery (R.L.S., A.M.M., and L.H.R.III) and Physical Medicine and Rehabilitation (S.T.W.), The Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Anica M.","family":"Maggard","sequence":"additional","affiliation":[{"name":"Departments of Orthopaedic Surgery (R.L.S., A.M.M., and L.H.R.III) and Physical Medicine and Rehabilitation (S.T.W.), The Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stephen T.","family":"Wegener","sequence":"additional","affiliation":[{"name":"Departments of Orthopaedic Surgery (R.L.S., A.M.M., and L.H.R.III) and Physical Medicine and Rehabilitation (S.T.W.), The Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lee H.","family":"Riley","sequence":"additional","affiliation":[{"name":"Departments of Orthopaedic Surgery (R.L.S., A.M.M., and L.H.R.III) and Physical Medicine and Rehabilitation (S.T.W.), The Johns Hopkins University School of Medicine, Baltimore, Maryland"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","reference":[{"issue":"1","key":"bib1-20230811","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1111\/jep.12271","article-title":"The Affordable Care Act: a case study for understanding and applying complexity concepts to health care reform","volume":"22","author":"Larkin","year":"2016","journal-title":"J Eval Clin Pract."},{"issue":"9859","key":"bib3-20230811","doi-asserted-by":"crossref","first-page":"2197","DOI":"10.1016\/S0140-6736(12)61689-4","article-title":"Disability-adjusted life years (DALYs) for 291 diseases and injuries in 21 regions, 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010","volume":"380","author":"Murray","year":"2012","journal-title":"Lancet."},{"issue":"9859","key":"bib4-20230811","doi-asserted-by":"crossref","first-page":"2163","DOI":"10.1016\/S0140-6736(12)61729-2","article-title":"Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010","volume":"380","author":"Vos","year":"2012","journal-title":"Lancet."},{"issue":"12","key":"bib5-20230811","doi-asserted-by":"crossref","first-page":"1441","DOI":"10.1097\/01.brs.0000166503.37969.8a","article-title":"United States trends in lumbar fusion surgery for degenerative conditions","volume":"30","author":"Deyo","year":"2005","journal-title":"Spine (Phila Pa 1976)."},{"issue":"19","key":"bib6-20230811","doi-asserted-by":"crossref","first-page":"2077","DOI":"10.1097\/BRS.0b013e3181b1fad1","article-title":"Trends in health care expenditures","volume":"34","author":"Martin","year":"2009","journal-title":"Spine (Phila Pa 1976)."},{"issue":"23","key":"bib7-20230811","doi-asserted-by":"crossref","first-page":"2707","DOI":"10.1097\/01.brs.0000248132.15231.fe","article-title":"United States\u2019 trends and regional variations in lumbar spine surgery: 1992-2003","volume":"31","author":"Weinstein","year":"2006","journal-title":"Spine (Phila Pa 1976)."},{"issue":"1","key":"bib9-20230811","doi-asserted-by":"crossref","first-page":"68","DOI":"10.1111\/papr.12188","article-title":"Lumbar spinal stenosis: therapeutic options review","volume":"15","author":"Costandi","year":"2015","journal-title":"Pain Pract."},{"issue":"4","key":"bib10-20230811","first-page":"CD001352","article-title":"Surgery for degenerative lumbar spondylosis","volume":"19","author":"Gibson","year":"2005","journal-title":"Cochrane Database Syst Rev."},{"issue":"7","key":"bib11-20230811","doi-asserted-by":"crossref","first-page":"734","DOI":"10.1016\/j.spinee.2012.11.059","article-title":"North American Spine Society. 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