Cognitive Processes during Recovery: Moving toward Personalized Spine Surgery Outcomes

Schwartz, Carolyn E.; Rapkin, Bruce D.; Borowiec, Katrina; Finkelstein, Joel

doi:10.3390/jpm12101545

Cited by 5 publications

(1 citation statement)

References 44 publications

(50 reference statements)

Supporting

Mentioning

Contrasting

Order By: Relevance

“…One notable factor of particular relevance to personalized medicine is cognitive-appraisal processes (i.e., how people recall past experiences and to whom they compare themselves) [ 10 ]. Past research has documented that appraisal processes are relevant to chronic pain [ 11 , 12 , 13 , 14 ] and spine-specific disability and mental-health functioning and suggested that such processes are modifiable targets of intervention [ 15 ].…”

Section: Introductionmentioning

confidence: 99%

Functional Status Correlates of Change and Stability in Appraisal after Spine Surgery: Earlier versus Later Effects

Schwartz,

Borowiec,

Rapkin

et al. 2024

JPM

Self Cite

View full text Add to dashboard Cite

Spine surgery generally yields a notable improvement in patients’ health state, and there is variability in measured patient outcomes after spine surgery. The present work aimed to describe for clinicians how appraisal underlies their patients’ experience of healthcare interventions. This prospective longitudinal cohort study (n = 156) included adults undergoing spine surgery for degenerative spinal conditions. The analysis was a descriptive illustration of the relationship between change in the spine-related disability using the Oswestry Disability Index and change in cognitive-appraisal processes using the Quality-of-Life Appraisal Profilev2-Short Form, early versus later during the recovery trajectory (i.e., between baseline and 3 months post-surgery; and between 3 and 12 months post-surgery). Cognitive-appraisal processes related to Sampling of Experience showed greater change soon after surgery, whereas Standards of Comparison appraisals changed more later in the recovery trajectory. Different appraisal processes were emphasized by patients who reported worsening of the spine-related disability, as compared to those who reported no change or improvement. These findings suggest that changes in appraisal differ depending on the individual’s experience of the impact of spine surgery. Appraisal processes thus reflect an ongoing dynamic in adaptation to changing function.

show abstract

Section: Introductionmentioning

confidence: 99%

Functional Status Correlates of Change and Stability in Appraisal after Spine Surgery: Earlier versus Later Effects

Schwartz,

Borowiec,

Rapkin

et al. 2024

JPM

Self Cite

View full text Add to dashboard Cite

show abstract

Double-blinded is not better than “mutually enlightened”: implications of Lord-Besson et al.

Schwartz

Rapkin

2023

JNCI Cancer Spectrum

View full text Add to dashboard Cite

Associations of cognitive appraisal and patient activation on disability and mental health outcomes: a prospective cohort study of patients undergoing spine surgery

Skolasky,

Finkelstein,

Schwartz

2024

BMC Musculoskelet Disord

View full text Add to dashboard Cite

Background With the increased use of patient-reported outcomes measures (PROMs) to assess spine surgery outcomes, it is important to understand how patients interpret their health changes over time. The measurement of cognitive-appraisal processes enables the quantification of how individuals think about quality of life (QOL). This study examined how appraisal processes were associated with patients’ views of their role in managing their health—patient activation. Methods This longitudinal cohort study from August 2019 to January 2022 included 222 adults undergoing spine surgery for cervical (n = 107) and/or lumbar (n = 148) pathology at an academic medical center. PROMs assessed disability (Neck Disability Index for cervical or Oswestry Disability Index for lumbar) and mental health (PROMIS-29 v2.0), cognitive-appraisal processes (QOLAPv2-SF), and patient activation (Patient Activation Measure). ANOVA models were used to examine the relationships between QOL and cognitive appraisal processes before and after surgery, overall and stratified by patient-activation stage. Effect sizes facilitated interpretation. Results There were significant improvements in pain-related disability and mental health following surgery. Cognitive appraisal processes explained substantial amounts of variance, particularly with changes in mental health (45% before surgery, 75% at three months, and 63%, at 12-months after surgery). With respect to physical disability, less disability was associated with a lesser focus on negative aspects of QOL. Appraisal explained the most variance before surgery for high-activation patients. At 12-months post-surgery, however, appraisal explained the most variance for the low-activation patients. Appraisal explained similar amounts of variance in mental health at baseline and three-months post-surgery for all activation groups, but substantially more variance in the low-activation group at 12-months post-surgery. There were differences in the direction of appraisal-outcome associations by activation group in selected appraisal items/domains. Conclusions Cognitive-appraisal processes demonstrate a significant relationship with QOL among spine surgery patients. These processes explain substantial variance in pain-related disability and mental health, especially among those high in activation before surgery and those low in activation at 12-months post-surgery. Our findings suggest that patients’ ways of thinking about their health may be effective targets of motivational coaching, to help them become more engaged over the recovery trajectory.

show abstract

Cognitive Processes during Recovery: Moving toward Personalized Spine Surgery Outcomes

Cited by 5 publications

References 44 publications

Functional Status Correlates of Change and Stability in Appraisal after Spine Surgery: Earlier versus Later Effects

Functional Status Correlates of Change and Stability in Appraisal after Spine Surgery: Earlier versus Later Effects

Double-blinded is not better than “mutually enlightened”: implications of Lord-Besson et al.

Associations of cognitive appraisal and patient activation on disability and mental health outcomes: a prospective cohort study of patients undergoing spine surgery

Contact Info

Product

Resources

About