Application of Chain Management Based on the IMB Model in Patients With Kinesiophobia Following Lumbar Fusion Surgery

Condition(s) studied

Investigational drug(s) / intervention(s)

Basic Postoperative Care: Postoperative: Primary nurses provided disease and surgery education, guided pain self-assessment, assisted logrolling (every 2 h), and taught ankle pump exercises (3-4 times/day, 20-30 sets each time) to prevent DVT and straight leg raising (3 times/day, 5 min each time) to prevent nerve root adhesion. After drain removal, patients were taught brace wearing, standing posture correction, and gait/balance training.Discharge: A discharge education sheet was provided, instructing patients to avoid bending, weight-bearing, prolonged sitting, and cold exposure, and to lie on a firm mattress. At 3 weeks postoperatively, lumbar and back muscle exercises were taught.After discharge: Routine telephone follow-ups were conducted at 1 and 3 months, and patients were reminded to return for follow-up on time.

chain management based on the Information-Motivation-Behavioral Skills model: The intervention group received IMB model-based chain management for kinesiophobia after lumbar fusion. A 9-member multidisciplinary team (spine surgery, rehabilitation, psychology, pain) was formed to implement the protocol, adjust rehabilitation and analgesia, provide cognitive behavioral intervention, and collect data. During hospitalization, daily assessment triggered chain responses for refusal to move after 3 days, increased catastrophizing, pain NRS≥4 with fear, or failure to meet activity goals for 2 days. Responses included rehabilitation adjustment, psychological intervention within 24h, and analgesia adjustment. The vertical chain used the postoperative timeline (assessment-intervention-reassessment), with visual materials for older or less educated patients.

Study summary

This study aims to investigate the application effect of chain management based on the Information-Motivation-Behavioral Skills (IMB) model in patients with kinesiophobia after lumbar fusion surgery. The intervention is designed to provide IMB model-based chain management, with routine nursing intervention as the control, and to evaluate the degree of kinesiophobia (TSK), pain intensity (NRS), lumbar function (ODI), and spinal posture indicators (trunk deviation angle, pelvic torsion angle, and the sum of the maximum left and right vertebral rotation angles) at different time points before and after the intervention. The ultimate objectives are to reduce the level of kinesiophobia, relieve pain, improve lumbar stability and lumbar function, and promote postoperative rehabilitation in patients after lumbar fusion surgery.

Eligibility

Primary outcome measure(s)

• Tampa Scale for Kinesiophobia — The TSK scores were collected at baseline and at 1 months, and 6 months post-intervention.
  Kinesiophobia was assessed using a scale containing 17 items. A 4-point Likert scoring method was used, with each item scored from 0 to 4, and the total score ranging from 17 to 68. Higher scores indicate a more significant pathological fear of movement.

Trial sites (1)

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