{"doi":"10.1093/ptj/pzaa112","title":"Psychosocial Mechanisms of Cognitive-Behavioral–Based Physical Therapy Outcomes After Spine Surgery: Preliminary Findings From Mediation Analyses","abstract":"OBJECTIVE: Changing Behavior through Physical Therapy (CBPT), a cognitive-behavioral-based program, has been shown to improve outcomes after lumbar spine surgery in patients with a high psychosocial risk profile; however, little is known about potential mechanisms associated with CBPT treatment effects. The purpose of this study was to explore potential mediators underlying CBPT efficacy after spine surgery. METHODS: In this secondary analysis, 86 participants were enrolled in a randomized trial comparing a postoperative CBPT (n = 43) and education program (n = 43). Participants completed validated questionnaires at 6 weeks (baseline) and 3 and 6 months following surgery for back pain (Brief Pain Inventory), disability (Oswestry Disability Index), physical health (12-Item Short-Form Health Survey), fear of movement (Tampa Scale for Kinesiophobia), pain catastrophizing (Pain Catastrophizing Scale), and pain self-efficacy (Pain Self-Efficacy Questionnaire). Parallel multiple mediation analyses using Statistical Package for the Social Sciences (SPSS) were conducted to examine whether 3- and 6-month changes in fear of movement, pain catastrophizing, and pain self-efficacy mediate treatment outcome effects at 6 months. RESULTS: Six-month changes, but not 3-month changes, in fear of movement and pain self-efficacy mediated postoperative outcomes at 6 months. Specifically, changes in fear of movement mediated the effects of CBPT treatment on disability (indirect effect = -2.0 [95% CI = -4.3 to 0.3]), whereas changes in pain self-efficacy mediated the effects of CBPT treatment on physical health (indirect effect = 3.5 [95% CI = 1.2 to 6.1]). CONCLUSIONS: This study advances evidence on potential mechanisms underlying cognitive-behavioral strategies. Future work with larger samples is needed to establish whether these factors are a definitive causal mechanism. IMPACT: Fear of movement and pain self-efficacy may be important mechanisms to consider when developing and testing psychologically informed physical therapy programs.","journal":"Physical Therapy","year":2020,"id":68397,"datarank":0.0,"base_score":0.0,"endowment":0.0,"self_citation_contribution":0.0,"citation_network_contribution":0.0,"self_endowment_contribution":0.0,"citer_contribution":0.0,"corpus_percentile":null,"corpus_rank":null,"citation_count":22,"citer_count":0,"citers_with_citation_signal":0,"citers_with_endowment":0,"datacite_reuse_total":0,"is_dataset":false,"is_dataset_confidence":0.9509,"is_data_producer":false,"deposit_databanks":null,"is_oa":true,"file_count":0,"downloads":0,"has_version_chain":false,"published_date":"2020-01-01","fair_score":null,"fair_percentile":null,"algorithm_id":"datarank_citation_only_1hop_v6","ranking_scope":"data_only","authors":[{"id":328074,"name":"Dawn M. Ehde","orcid":"0000-0002-9555-2347","position":1,"is_corresponding":false},{"id":362193,"name":"Jacquelyn S. Pennings","orcid":"0000-0002-6070-3205","position":2,"is_corresponding":false},{"id":363104,"name":"Susan Vanston","orcid":null,"position":3,"is_corresponding":false},{"id":361426,"name":"Tatsuki Koyama","orcid":"0000-0002-8908-9165","position":4,"is_corresponding":false},{"id":362194,"name":"Sharon Phillips","orcid":"0000-0002-4230-4454","position":5,"is_corresponding":false},{"id":362195,"name":"Shannon L. Mathis","orcid":"0000-0002-8331-4560","position":6,"is_corresponding":false},{"id":363105,"name":"Matthew J. McGirt","orcid":null,"position":7,"is_corresponding":false},{"id":362196,"name":"Dan M. Spengler","orcid":"0000-0003-2010-8732","position":8,"is_corresponding":false},{"id":363106,"name":"Oran S. Aaronson","orcid":null,"position":9,"is_corresponding":false},{"id":362197,"name":"Joseph Cheng","orcid":"0000-0002-1881-012X","position":10,"is_corresponding":false},{"id":362198,"name":"Clinton J. Devin","orcid":"0000-0001-6618-6280","position":11,"is_corresponding":false},{"id":326509,"name":"Stephen T. Wegener","orcid":"0000-0002-0867-2229","position":12,"is_corresponding":false},{"id":362199,"name":"Kristin R. Archer","orcid":"0000-0003-0433-1942","position":13,"is_corresponding":false},{"id":362192,"name":"Rogelio A. Coronado","orcid":"0000-0002-7112-4903","position":0,"is_corresponding":true}],"reference_count":89,"raw_metadata":null,"created_at":"2026-07-18T21:40:52.680475Z","pmid":"32556249","pmcid":null,"fwci":null,"citation_percentile":null,"influential_citations":0,"oa_status":null,"license":null,"views":0,"total_file_size_bytes":0,"version_count":0,"fair_f":null,"fair_a":null,"fair_i":null,"fair_r":null,"fair_zscore":null,"fair_rationale":null,"fair_model":null,"fair_agent_version":null,"fair_fulltext_source":null,"fair_has_llm":null,"fair_computed_at":null,"clinical_trials":[],"software_tools":[],"db_accessions":[],"linked_datasets":[],"topics":[]}