Self-management behavior and its predictors in patients with lumbar degenerative diseases after surgery: A prospective cohort study.

OBJECTIVE

To investigate self-management behavior and its predictors in patients with lumbar degenerative disease from hospital discharge to 3 months post-surgery.

METHODS

A prospective cohort study was conducted in Zhuhai, China, from October 2023 to August 2024. 190 patients undergoing lumbar surgery completed measures of self-management behaviors, patient activation, kinesiophobia, social support, pain, and functional disability at hospital discharge (T1), 1 month (T2), and 3 months (T3) post-surgery. Generalized estimating equations were used to analyze changes over time, and multiple linear regression was employed to identify predictors of self-management behaviors at each time point.

RESULTS

The self-management behaviors remained stable from T1 to T2 but declined from T2 to T3. T1 Kinesiophobia (β = -0.215) and T1 functional disability (β = -0.212); T1 self-management behaviors (β = 0.717) and T2 kinesiophobia (β = -0.161); surgical approach (β = -0.156), T3 pain (β = -0.119), T2 self-management behaviors (β = 0.702), and T1 kinesiophobia (β = -0.164) were significant predictors of T1, T2 and T3 self-management behaviors, respectively.

CONCLUSION

Kinesiophobia is the key factor hindering self-management from hospital discharge to 3 months post-surgery. Current clinical practices, including offering only rehabilitation videos and health education, may be insufficient to sustain long-term self-management; instead, systematic, structured interventions that integrate cognitive-behavioral therapy with exercise training are recommended to reduce kinesiophobia and enhance long-term functional outcomes.