Do Patient Expectations of Spinal Surgery Relate to Functional Outcome?

Yee, Albert; Adjei, Nana; Do, Jennifer; Ford, Michael; Finkelstein, Joel

doi:10.1007/s11999-008-0194-7

Cited by 119 publications

(119 citation statements)

References 19 publications

(34 reference statements)

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“…The finding that gender, BMI, previous back surgery, leg pain intensity, comorbidities, pain in the thoracic spine, somatization, treatment expectations, and walking distance were predictive of spinal surgery referral is in line with previous studies showing that they are also indicative of spinal surgery outcome [12,[19][20][21][22][23]. This can be interpreted as that surgeons are aware of and adhere to some extent to the current literature and (international) guidelines.…”

Section: Comparison With the Literaturesupporting

confidence: 88%

Which patient-reported factors predict referral to spinal surgery? A cohort study among 4987 chronic low back pain patients

et al. 2017

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Purpose It is unknown which chronic low back pain (CLBP) patients are typically referred to spinal surgery. The present study, therefore, aimed to explore which patient-reported factors are predictive of spinal surgery referral among CLBP patients. Methods CLBP patients were consecutively recruited from a Dutch orthopedic hospital specialized in spine care (n = 4987). The outcome of this study was referral to spinal surgery (yes/no), and was assessed using hospital records. Possible predictive factors were assessed using a screening questionnaire. A prediction model was constructed using logistic regression, with backwards selection and p \ 0.10 for keeping variables in the model. The model was internally validated and evaluated using discrimination and calibration measures.Results Female gender, previous back surgery, high intensity leg pain, somatization, and positive treatment expectations increased the odds of being referred to spinal surgery, while being obese, having comorbidities, pain in the thoracic spine, increased walking distance, and consultation location decreased the odds. The model's fit was good (X 2 = 10.5; p = 0.23), its discriminative ability was poor (AUC = 0.671), and its explained variance was low (5.5%). A post hoc analysis indicated that consultation location was significantly associated with spinal surgery referral, even after correcting for case-mix variables. Conclusion Some patient-reported factors could be identified that are predictive of spinal surgery referral. Although the identified factors are known as common predictive factors of surgery outcome, they could only partly predict spinal surgery referral.

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Section: Comparison With the Literaturesupporting

confidence: 88%

Which patient-reported factors predict referral to spinal surgery? A cohort study among 4987 chronic low back pain patients

et al. 2017

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“…7 The expectations of patients, their characteristics, and assessments of psychosocial factors should be integrated into any treatment plan for lumbar canal stenosis, as these can determine which patients will benefit from the proposed surgical treatment. 24,25 In our study, like that of Mannion et al, 20 after being questioned about expectations, 40% of patients were overly optimistic, considering the improvement of the following items: leg pain, walking ability, independence in daily activities, and mental well-being. This percentage increased to 50% when evaluating the results related to sports activities, back pain, social contacts, and physical ability.…”

Section: Discussionsupporting

confidence: 63%

“…These results were similar to those reported in other studies. 7,24 Diseases of the cervical or lumbar spine have a large impact on both the physical and mental HRQoL domains. The disabilities caused by diseases negatively impact the HRQoL and are associated with a high prevalence of depressive symptoms.…”

Section: Discussionmentioning

confidence: 99%

Health-related quality of life and expectations of patients before surgical treatment of lumbar stenosis

et al. 2014

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Objective: To evaluate the expectations of patients awaiting surgical treatment of lumbar canal stenosis and the association of Health-Related Quality of Life (HRQoL) with symptoms of anxiety and depression. Methods: The sample included 49 patients from a university hospital. HRQoL was assessed by the Oswestry Disability Index (ODI) and 36-item Medical Outcomes Survey Short Form (SF-36) and symptoms of anxiety and depression by the Hospital Anxiety and Depression Scale (HADS). Expectations were investigated by means of questions used in international studies. Data were analyzed descriptively and by Student's t test. Results: The mean time of disease progression was 34.5 months, the mean age was 58.8 years and 55.1% of the patients were women. Most patients had the expectation of improving with surgical treatment and 46.9% expected to be "much better" with regard to leg pain, walking ability, independence in activities and mental well being. The scores of anxiety and depression were respectively, 34.7% and 12.2%. We observed statistically significant differences between the groups with and without anxiety in the domains: General Health, Mental Health, and Vitality. Between the groups with and without depression there were statistically significant differences in the General Health and Mental Health domains. Conclusion: Patients showed great expectation to surgical treatment and the symptoms of anxiety and depression were related to some domains of HRQoL. Thus, the study contributes to broaden our knowledge and we can therefore guide the patients as to their expectations with respect to the real possibilities arising from surgery.

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“…Furthermore, the predictive power of psychological variables is also supported by our finding that patients planning to receive early post-operative rehabilitation with a biopsychosocial approach are predicted to have less prospective functional disability levels than patients receiving traditional post-operative exercise therapy. Previous studies that have included pre-surgical outcome expectations in multivariate models have found its predictive significance when testing pain, functional and HRQOL-related outcomes [5,20,29,33,39,48]. Our results showed that patient's expectations of future back pain-related outcome was the most important predictor of prospective HRQOL, but was not predictive of pain or functional related outcomes.…”

Section: Discussionmentioning

confidence: 46%

“…Many possible reasons for mixed lumbar fusion surgery outcomes exist, including instrumentation failure, inadequate surgical technique and poor patient selection. Factors previously suggested to be predictive of pain and disability-related outcomes include pre-surgical pain/function [42], negative personality traits [19,31,40,41,44], emotional status [41], anxiety/depression [3,23,28,40,41], fear avoidance (FA) beliefs [28], negative outcome expectations [20,48] negative coping [3], smoking status [41], gender [9], exercise [9], litigation [23], duration of back pain and workers' compensation [3,19,40,41].…”

Section: Introductionmentioning

confidence: 99%

Leg pain and psychological variables predict outcome 2–3 years after lumbar fusion surgery

2011

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Prediction studies testing a thorough range of psychological variables in addition to demographic, workrelated and clinical variables are lacking in lumbar fusion surgery research. This prospective cohort study aimed at examining predictions of functional disability, back pain and health-related quality of life (HRQOL) 2-3 years after lumbar fusion by regressing nonlinear relations in a multivariate predictive model of pre-surgical variables. Before and 2-3 years after lumbar fusion surgery, patients completed measures investigating demographics, work-related variables, clinical variables, functional self-efficacy, outcome expectancy, fear of movement/(re)injury, mental health and pain coping. Categorical regression with optimal scaling transformation, elastic net regularization and bootstrapping were used to investigate predictor variables and address predictive model validity. The most parsimonious and stable subset of pre-surgical predictor variables explained 41.6, 36.0 and 25.6% of the variance in functional disability, back pain intensity and HRQOL 2-3 years after lumbar fusion. Pre-surgical control over pain significantly predicted functional disability and HRQOL. Pre-surgical catastrophizing and leg pain intensity significantly predicted functional disability and back pain while the pre-surgical straight leg raise significantly predicted back pain. Postoperative psychomotor therapy also significantly predicted functional disability while pre-surgical outcome expectations significantly predicted HRQOL. For the median dichotomised classification of functional disability, back pain intensity and HRQOL levels 2-3 years post-surgery, the discriminative ability of the prediction models was of good quality. The results demonstrate the importance of pre-surgical psychological factors, leg pain intensity, straight leg raise and postoperative psychomotor therapy in the predictions of functional disability, back pain and HRQOL-related outcomes.

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Do Patient Expectations of Spinal Surgery Relate to Functional Outcome?

Cited by 119 publications

References 19 publications

Which patient-reported factors predict referral to spinal surgery? A cohort study among 4987 chronic low back pain patients

Which patient-reported factors predict referral to spinal surgery? A cohort study among 4987 chronic low back pain patients

Health-related quality of life and expectations of patients before surgical treatment of lumbar stenosis

Leg pain and psychological variables predict outcome 2–3 years after lumbar fusion surgery

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