Outi Ilves, Arja Häkkinen, Joost Dekker, Marko Wahlman, Sami Tarnanen, Liisa Pekkanen, Jari Ylinen, Hannu Kautiainen, Marko Neva
Department of Health Sciences, University of Jyvaskyla, 40014 Jyvaskyla, Finland. E-mail: outi.e.ilves@jyu.fi
DOI: 10.2340/16501977-2268

Objective: To study the effectiveness of a 12-month exercise therapy on kinesiophobia and physical activity in patients with spondylolisthesis after lumbar spine fusion.
Design: Randomized controlled trial.
Subjects: Patients (n = 98) with spondylolisthesis who had undergone lumbar spine fusion.
Methods: All patients (mean age 59 years) had received lumbar spine fusion surgery and identical postoperative instructions. Three months postoperatively, they were randomized into an exercise group (n = 48) or usual care group (n = 50). The exercise group received 12-month progressive home-based training with regular booster sessions, and the usual care group a single session of physiotherapy instruction. Kinesiophobia was assessed with the Tampa Scale for Kinesiophobia (TSK) and physical activity by the International Physical Activity Questionnaire (IPAQ) preoperatively, 3 months after lumbar spine fusion, and at the end of the 12-month intervention.
Results: Before the intervention, the median (first quartile; third quartile) of TSK was 32. 5 (29. 0; 37. 0) in the exercise group and 30. 0 (25. 8; 36. 0) in the usual care group, changing to 30. 0 (25; 36) in the exercise group and to 30. 5 (24; 36. 3) in the usual care group (between-group p = 0. 17). IPAQ metabolic equivalent minutes per week increased from 1,863 (1,040; 3,042) to 3,190 (1,634; 6,485) in the exercise group and from 2,569 (1,501; 4,075) to 3,590 (1,634; 6,484) in the usual care group (between-group p = 0. 92).
Conclusion: Progressive 12-month home-exercise starting 3 months postoperatively was not superior to usual care in decreasing kinesiophobia or increasing physical activity in spondylolisthesis.

Spondylolisthesis patients with disruptive pain and undergoing lumbar fusion surgery suffer from remarkable kinesiophobia before surgery. In addition to that, they are physically inactive before surgery. Surgery and early postoperative guidance relieves the kinesiophobia in three-month postoperative follow-up. Progressive home based back-specific exercise program and walking training did not have remarkable effect on kinesiophobia or physical activity compared to usual postoperative guidance.