Phone counselling reduces pain and disability after surgery

A short series of phone conversations with trained counsellors can substantially boost recovery and reduce pain after people have back surgery, experts report in the Archives of Physical Medicine and Rehabilitation.
A total of 122 people aged 46–72 years who had surgery to correct spinal stenosis (degeneration of the spinal bones and painful compression of the spinal cord) were split into groups. Everyone was prescribed either home exercise programmes or physiotherapy. About half also received a series of phone counselling sessions from a trained spinal surgery counsellor to discuss the importance of exercise in their recovery.
The phone calls were designed to improve care before and after operations by reinforcing the importance of physiotherapy and back-strengthening exercises. They were intended to be more of a collaboration between the counsellor and the patient as opposed to one-way instruction. The first and most detailed phone session was a few weeks before surgery and two follow-up sessions took place at six weeks and three months after the operation.
Results
People who had the phone calls participated in physiotherapy and home exercise at higher rates and had less pain and less disability six months after their surgery, compared with the standard-approach group.
Six months after surgery, 74% of people who had phone counselling had significant improvements on standard measures of physical functioning and self-reported measures of pain, compared with 41% of those who did not receive phone calls.
“Modern orthopedic science has made great strides in surgical techniques to correct spinal deformities and achieved significant progress in developing physical therapies that boost the benefits of surgery, but we haven’t been all that good at motivating and engaging patients to partake in such post-surgical recovery programs,” explains Dr Stephen Wegener, who is involved in the work. “The findings of our research suggest we may have found a way to add that missing ingredient that draws patients to be more active participants in their physical rehabilitation and recovery.”
But while the phone counselling sessions did boost patient engagement rates, one-third of people remained resistant to intervention. This was due to their low self-confidence in the ability to perform the exercises or get to a physiotherapy session, fear of movement, and concern about pain management.
These hurdles – whether real or perceived – should be on every healthcare professional’s radar, the investigators say, and must be addressed head on in order to improve patient engagement.

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Image credit: Martin Cathrae