Can the anxiety domain of EQ-5D and mental health items from SF-36 help predict outcomes after surgery for lumbar degenerative disorders?

Abstract

<jats:sec> <jats:title>OBJECTIVE</jats:title> <jats:p>Studies have shown that anxious or depressed patients may have poorer outcomes after lumbar fusion. These conclusions were drawn from questionnaires specifically designed to measure anxiety and depression. The objective of this study is to determine if responses to the EQ-5D anxiety/depression domain or the items used to calculate the 36-Item Short-Form Health Survey (SF-36) Mental Component Summary (MCS) can predict outcomes after lumbar fusion surgery.</jats:p></jats:sec> <jats:sec> <jats:title>METHODS</jats:title> <jats:p>Patients enrolled in the National Neurosurgery Quality and Outcomes Database from a single center with 1-year follow-up were identified. The outcomes collected include the Oswestry Disability Index (ODI), EQ-5D, SF-36, and the back- and leg-pain numeric rating scales (range 0–10). Linear regression modeling was performed to predict the 1-year ODI scores using the EQ-5D anxiety/depression domain and the 14 items used to calculate SF-36 MCS.</jats:p></jats:sec> <jats:sec> <jats:title>RESULTS</jats:title> <jats:p>Complete data were available for 312 (88%) of 353 eligible patients. The mean patient age was 58.5 years, 175 (56%) patients were women, and 52 patients were smokers. After controlling for other factors, the item in the SF-36 that asks “Have you felt downhearted and depressed?” is the strongest predictor of the 1-year ODI score (r<jats:sup>2</jats:sup> = 0.191; p = 0.000) and 1-year EQ-5D score (r<jats:sup>2</jats:sup> = 0.205; p = 0.000). Neither the EQ-5D anxiety/depression domain nor the diagnoses of anxiety or depression were predictors of 1-year outcomes.</jats:p></jats:sec> <jats:sec> <jats:title>CONCLUSIONS</jats:title> <jats:p>Patient responses to SF-36 item “Have you felt downhearted and depressed?” account for 20% of the variability of the 1-year ODI and EQ-5D scores and can be used by clinicians to screen for anxiety or depression in patients prior to lumbar fusion surgery. Clinicians may offer psychological support to these patients preoperatively in order to improve treatment outcomes.</jats:p></jats:sec>

The five-repetition sit-to-stand test: evaluation of a simple and objective tool for the assessment of degenerative pathologies of the lumbar spine

“…It has been shown that objective functional tests are more robust against the influence of mental health status than a PROM. 1,25 Moreover, patients prefer performing an objective functional test over completing a battery of PROMs, perhaps because it provides direct and tangible feedback and is less time-consuming. 15 Considering these factors, the 5R-STS may constitute an excellent follow-up tool that could even be performed by patients themselves at home, either unsupervised or with televised supervision.…”

Improvement in Patient Mental Well-being After Surgery for Cervical Spondylotic Myelopathy

“…Patient-oriented questionnaire scores, including the visual analog scale (VAS) for neck and arm pain and arm numbness, and the 36-item Short-Form Health Survey (SF-36), were performed preoperatively and at 6 months, 1 year, and 2 years postoperatively, and at 5 years if possible. The SF-36 is a 36-item scale measuring 8 domains of health-related quality of life: physical functioning (PF), physical role limitations (RP), bodily pain (BP), general health perceptions (GH), energy/vitality (VT), social functioning (SF), emotional role limitations (RE), and mental health (MH) 17 . The domain scores were then summarized as the physical component summary (PCS) and mental Mental well-being after laminoplasty 9 component summary (MCS) scores, according to an algorithm proposed by a previous report 18 .…”

Association between depression and anxiety on symptom and function after surgery for lumbar spinal stenosis

“…Lebow et al 28 argued that pain from disc herniation might contribute to preoperative depression and anxiety and that discectomy improves mental health and well-being during the postoperative period over months with improvement in anxiety and depression. Three studies showed level of depression measured preoperatively did not predict the surgical outcome 15 , 28 , 29 and that depression improved postoperatively in patients with a favorable outcome and did not improve in patients with a poor treatment outcome, suggesting that psychological disorders may be the result of DLSS related complaints 29 , 30 . However, other studies found preoperative depression to be associated with poorer life satisfaction after surgery 31 and poorer treatment outcome (symptom severity, disability and walking capacity) after surgery 31 , 32 .…”

“…Depression has been shown to negatively influence treatment efficacy in patients with DLSS 13 . The evidence on anxiety and the interaction between anxiety and depression is less well studied and conflicting 14 , 15 .…”