Effects of internet-based cognitive behavioral therapy on kinesiophobia, exercise adherence, and back muscle function after lumbar fusion surgery

Abstract Background To evaluate the efficacy of an Internet-based Cognitive Behavioral Therapy (ICBT) program in improving kinesiophobia, exercise adherence, pain intensity, lumbar function, and spinal alignment parameters in patients following lumbar surgery. Methods In this two-arm randomized controlled trial conducted at a tertiary hospital rehabilitation center, 90 adult patients (aged 18–55 years) who underwent single-level posterior lumbar fusion for lumbar disc herniation were randomly assigned to ICBT (n = 45) or control (n = 45) groups. The ICBT group received a 6-month digital rehabilitation program combining cognitive behavioral therapy and core muscle training, while controls received conventional postoperative care. Primary outcomes were kinesiophobia (measured by Tampa Scale of Kinesiophobia), exercise adherence (assessed using Orthopedic Patient Exercise Adherence Scale), and pain intensity (evaluated by Numerical Rating Scale). Secondary outcomes included lumbar function (measured by Japanese Orthopaedic Association scores) and spinal stability parameters (trunk deviation, pelvic torsion, and vertebral rotation angles). Results Outcomes were assessed at baseline, 1 week, 1 month, 3 months, and 6 months post-intervention. The ICBT group demonstrated significantly lower TSK scores at 1, 3, and 6 months post-intervention (30.31 ± 3.27, 25.38 ± 2.40, and 22.09 ± 2.04 vs. 39.56 ± 2.89, 36.40 ± 3.04, and 30.29 ± 2.90, respectively; all P < 0.05). Exercise compliance was progressively higher in the ICBT group at 1, 3, and 6 months (57.84 ± 3.37, 65.16 ± 3.51, and 66.33 ± 3.33 vs. 51.16 ± 5.40, 53.60 ± 4.40, and 50.33 ± 3.57, respectively; all P < 0.001). Pain scores showed greater reduction in the ICBT group from 1 month onwards (median 2.00, 1.00, and 0.00 vs. 3.00, 2.00, and 1.00 at 1, 3, and 6 months, respectively; all P < 0.01). The ICBT group also demonstrated superior outcomes in JOA scores (27.36 ± 1.75 vs. 23.09 ± 2.11, P < 0.001) and spinal stability parameters (all P < 0.001) at both 3 and 6 months post-intervention. Conclusions Internet-based cognitive behavioral therapy combined with core muscle training effectively reduced pain intensity, improved functional recovery, and enhanced spinal stability in patients following lumbar fusion surgery. This digital intervention offers a promising approach for post-surgical rehabilitation management. Trial registration The trial was registered in the ClinicalTrials.gov with the registration number: NCT07030582, (Date: 17/05/2025).