Evaluation of Dram Score as a Predictor of Poor Postoperative Outcome in Spine Surgery

Abstract

The Distress Risk Assessment Method (DRAM) was presented by Main, Wood and Hillis in 1992 as a simple means of assessing the risk of failure due to psychosocial factors in spine surgery. To our knowledge, it has not been used in our setting. The aim of this study was to analyse the usefulness of the Spanish translation of this instrument to predict poor outcomes. Methods: A prospective blind study was conducted including 65 patients undergoing spine surgery. We created two groups of patients based on DRAM score: not distressed (NDRAM) or distressed (DDRAM). A visual analogue scale for pain and the 12-Item Short Form Health Survey (SF-12) were used at baseline, 6 weeks and 6 months. Results: 24 patients were classified as DDRAM and 38 as NDRAM, with 3 patients not completing the questionnaires. The analysis found no significant differences in the demographic or clinical variables at baseline. At 6 weeks and 6 months, the NDRAM group showed improvements in low back pain (p < 0.001; p = 0.005), leg pain (p < 0.001; p = 0.017), physical health (p = 0.031; p = 0.003) and mental health (p = 0.137; p = 0.049). In contrast, in the DDRAM group, though leg pain score improved (p < 0.001; p = 0.002), there was no improvement at 6 weeks or 6 months in low back pain (p = 0.108; p = 0.287), physical health (p = 0.620; p = 0.263) or mental health (p = 0.185; p = 0.329). Conclusions: In our setting, the DRAM is a useful screening tool, and it has allowed the creation of a program between psychiatry and spine surgery.

Treatment of type 2 diabetes and stress using neuro-emotional technique: case report

“…Typically, a high DRAM score is considered a poor predictor of treatment success ( 68 ). The four DRAM classifications as per Main et al.…”

Predicting chronic postsurgical pain: current evidence and a novel program to develop predictive biomarker signatures

“…23 Use of biosignatures can be used to develop a risk score for chronic pain that could subsequently be tested with targeted interventions to determine their role in the transition to chronic pain, similar to the previously developed distress risk assessment method (DRAM), which evaluates psychological distress in patients before surgery and predicts poorer outcomes after spinal surgery and other medical procedures. 56,84 Putting such predictive markers to practical use in the clinic may require a greater level of outreach and education to surgeons and other clinicians to discuss the potential risks and benefits of surgery to an individual patient. The final A2CPS data set will be available for machine learning and related analytical techniques requiring large data sets.…”

Spine Surgeon Assessments of Patient Psychological Distress are Inaccurate and Bias Treatment Recommendations

“…8 Similarly, patients with abnormal DRAM scores undergoing spine procedures have been shown to have lower improvement in postoperative outcomes and satisfaction. [9][10][11][12] Unfortunately, psychological screening tools are used infrequently in spine clinics, and the ability of surgeons to accurately predict psychological distress in patients is unclear. [13][14][15] Furthermore, it is unknown whether surgeon-rated levels of patient psychological distress have an impact on surgical decision making.…”

“…The DRAM has been widely utilized for over two decades and has been correlated with increasing risk of poor outcomes with increasing psychological distress in the nonoperative treatment of low back pain 8. Similarly, patients with abnormal DRAM scores undergoing spine procedures have been shown to have lower improvement in postoperative outcomes and satisfaction 9–12. Unfortunately, psychological screening tools are used infrequently in spine clinics, and the ability of surgeons to accurately predict psychological distress in patients is unclear 13–15.…”