脊柱手术后的远程医疗正念

实验性的：远程医疗正念干预 (MBI)

八次每周一次的远程健康正念课程，与正念教练进行一对一的授课

行为的：远程医疗正念干预 (MBI)

远程医疗 MBI 改编自针对慢性疼痛的基于正念的认知疗法，包括八次每周 75 分钟的个人会议（第一次会议分配 90 分钟），正念干预师提供远程医疗干预（在线音频和摄像机） ) 除了患者接受他们通常的术后护理。 参与者将在完成 2 周的术后评估后和手术后 4 周内开始干预。 参与者将被要求在会议之间每天练习大约 20-40 分钟的技能。

有源比较器：远程医疗教育 (EDU)

每周八次与物理治疗师进行一对一的术后教育课程

行为的：远程医疗教育

参与者将在随机化时（手术后 2-4 周内）和 8 次每周 30 分钟的远程医疗会议以及常规的术后护理收到一份书面教育手册。 物理治疗师在每周一次的远程医疗会议（通过音频和摄像机在线）期间与参与者单独审查教育材料。

干预满意度

总体满意度大于或等于 7 分（满分 10 分）的参与者比例

Enrollment Rate

Proportion of participants approached who are eligible and enroll in the study

Participant Study Retention

Proportion of participants who complete the study (6 month assessment)

Session Attendance

Average proportion of sessions attended out of 8 sessions

Home Practice Completion

Average days practiced out of days assigned practice (MBI group only)

疼痛困扰

一项评估过去 7 天疼痛程度的项目，从 0 = 完全没有到 4 = 极度疼痛。 较低的分数表示较低的疼痛烦扰度。

Pain Interference Short-form 8a

Pain Interference short-form 8a from the Patient Reported Outcomes Measurement Information System scale. Measures interference of pain over the past 7 days. Consists of 8 items with response options from 1 = not at all to 5 = very much. The total score is a T-score based on a population with mean score of 50 and standard deviation of 10. A lower score indicates lower pain interference, or a better outcome.

Back Pain Intensity

1 item assessing back pain intensity on a scale of 0-10 over the past 7 days, described as pain when off medication or medication has worn off. Lower scores indicate less pain, or better outcome.

Leg Pain Intensity

1 item assessing leg pain intensity on a scale of 0-10 over the past 7 days, described as pain when off medication or medication has worn off. Lower scores indicate less pain, or better outcome.

Anxiety Short Form 4a

Anxiety short-form 4a - Patient Reported Outcomes Measurement Information System. 4 items assessing anxiety symptoms in the past 7 days (e.g. "I felt fearful") with response options from 1 = never to 5 = always. The total score is a T-score based on a population with mean score of 50 and standard deviation of 10. Lower scores represent lower anxiety, a better outcome

Physical Function

Physical Function short-form 4a - Patient Reported Outcomes Measurement Information System. 4 items assessing physical function in the past 7 days (e.g. "Are you able to do chores such as vacuuming or yard work?") with response options from 1 = Unable to do to 5 = Without any difficulty. The total score is a T-score based on a population with mean score of 50 and standard deviation of 10. Higher scores represent better physical function, a better outcome

Depression Short Form 4a

Depression short-form 4a - Patient Reported Outcomes Measurement Information System scale. 4 items assessing depressive symptoms over the past 7 days (e.g. "I felt worthless) with response options from 1 = never to 5 = always. The total score is a T-score based on a population with mean score of 50 and standard deviation of 10. A lower score indicates less depression, a better outcome.

Sleep Disturbance Short Form 4a

Sleep disturbance short-form 4a - Patient Reported Outcomes Measurement Information System scale. 4 items assessing sleep disturbance over the past 7 days (e.g. "I had difficulty falling asleep) with response options from 1 = not at all to 5 = very much (1 item reverse-scored). The total score is a T-score based on a population with mean score of 50 and standard deviation of 10. A lower score indicates less sleep disturbance, a better outcome.

Oswestry Disability Index

Assesses impact of pain on level of functioning in 10 areas (e.g. walking, sleep, social life) with 10 items with response options with scores 0 to 5. Total scores are calculated as a percentage, ranging from 0% to 100%. Lower scores indicate a lower level of disability due to pain, a better outcome.

Pain Catastrophizing Scale

13 items assessing thoughts and feelings when in pain (e.g. "I become afraid that the pain will get worse" with response options ranging from 0 = never to 4 = all the time. Total scores range from 0 to 52 units on the scale. Lower scores indicate lower pain catastrophizing, a better outcome.

Pain Self-efficacy Questionnaire

10 items assessing confidence in ability to do certain things despite pain (e.g. "I can enjoy things, despite the pain" with response options 0 = not at all to 6 = completely. Total scores range from 0 to 60 units on the scale. Higher scores indicate greater pain self-efficacy, a better outcome.

Perceived Stress Scale - 4

4 items assessing perceived level of stress in the past month (e.g. "In the last month, how often have you felt that you were unable to control the important things in your life?"), with response options ranging from 0 = never to 4 = very often (2 items reverse-scored). Total scores range from 0 to 16 units on the scale. Lower scores indicate lower perceived stress, a better outcome.

Tampa Scale for Kinesiophobia -13

13 items assessing fear of movement (e.g. "I'm afraid that I might injure myself if I exercise" with response options ranging from 1 = strongly disagree to 4 = strongly agree. Total scores range from 13 to 52 units on the scale. Lower scores indicate lower levels of kinesiophobia, a better outcome.

Five Facet Mindfulness Questionnaire - 15

15 items assessing 5 facets of mindfulness, including observing, describing, acting with awareness, non-judging of inner experience, and non-reactivity to inner experience. Response options range from 1 = never to 5 = always (7 items reverse scored). Total scores are an average of the sum of all items, ranging from 1 to 5 units on the scale. Higher scores indicate higher levels of mindfulness, a better outcome.

Number of Participants Indicating They Currently Use Opioids

Participants were asked in one item "Are you currently taking an opioid medication?" Response options included "Yes" or "No." A response of Yes counted as 1 and No counted as 0 when calculating total frequency of participants reporting current opioid use.

Pain Tolerance

The duration of time participants tolerated an inflated blood pressure cuff: Using an ischemic task involving squeezing a dynamometer followed by inflated blood pressure cuff on arm, the time in seconds at which the participant indicated they could no longer tolerate the stimulus (inflated blood pressure cuff). Scores could range from 0 seconds to 300 seconds, as the task was discontinued at 300 seconds if reached prior to the participant indicating to stop the task.

Pain Threshold

Duration at which participants indicate a stimulus is experienced as painful: Using an ischemic task involving squeezing a dynamometer followed by inflated blood pressure cuff on arm, the point in seconds at which the stimulus (inflated blood pressure cuff) is first reported by the participant as painful. Scores could range from 0 seconds to 300 seconds, as the task was discontinued at 300 seconds if participants did not yet indicate that the stimulus was painful.

Temporal Summation of Pain

Using a punctate stimuli (von frey hairs of 100g and 180g of force to the finger), the difference between reported pain intensity during a single prick and the reported highest pain intensity during repeated brief pricks at a constant intensity. Pain intensity was measured on a scale of 0 to 100. The difference score was calculated by subtracting the pain intensity with single prick from the pain intensity with repeated pricks and could range from 0 to 100 units of difference on the pain intensity scale. Lower values are a more favorable outcome.