Psychological factors outmatched morphological markers in predicting limitations in activities of daily living and participation in patients with lumbar stenosis

Abstract

BackgroundRecent demographic changes have led to a large population of older adults, many of whom experience degenerative disc diseases. Degenerative lumbar spinal stenosis (DLSS) is associated with considerable discomfort and limitations in activities of daily living (ADL). Symptomatic DLSS is one of the most frequent indications for spinal surgery. The aim of this study was to identify sociodemographic variables, morphological markers, depression as well as fear of movement that predict ADL performance and participation in social life in patients with DLSS.MethodsSixty-seven patients with DLSS (mean age 62.5 years [11.7], 50.7% females) participated in the study. Predictor variables were age, gender, duration of disease, three morphological markers (severity of the lumbar stenosis, the number of affected segments and presence of spondylolisthesis) as well as self-reported depression and fear of movement. Dependent variables were pain interference with the performance of ADLs, ADLs and participation in social life. Correlations between predictor and dependent variables were calculated before stepwise, linear regression analyses. Only significant correlations were included in the linear regression analyses.ResultsVariance explained by the predictor variables ranged between 12% (R2 = .12; pain interference-physical) and 40% (R2 = .40; ADL requiring lower extremity functioning; participation). Depression and fear of movement were the most powerful predictors for all dependent variables. Among the morphological markers only stenosis severity contributed to the prediction of ADLs requiring lower extremity functioning.ConclusionDepression and fear of movement were more important predictors of the execution of ADLs and participation in social life compared to morphological markers. Elevated depressive symptoms and fear of movement might indicate limited adaptation and coping regarding the disease and its consequences. Early monitoring of these predictors should therefore be conducted in every spine centre. Future studies should investigate whether psychological screening or a preoperative psychological consultation helps to avoid operations and enables better patient outcomes.

Physical and Psychological Factors Associated With Walking Capacity in Patients With Lumbar Spinal Stenosis With Neurogenic Claudication: A Systematic Scoping Review

“…The somatic focus subscale of the Tampa Scale of Kinesiophobia (TSK) was strongly and positively correlated with the RehaCAT lower extremity subscale while the activity avoidance subscale was moderately and positively correlated with the RehaCAT lower extremity subscale. The score of the RehaCAT activities of daily living subscale was moderately and positively correlated with the somatic focus and the activity avoidance subscales of the TSK (21). The correlation between daily step count and kinesiophobia was not significant (35).…”

“…Depression, Anxiety, and Fear Avoidance. Two studies reported on the association between either depression or fear avoidance and functional tasks (21,35). Depression was strongly and negatively correlated with the patient's participation in social, daily and work-related activities using the Aachen Activity and Participation Index (AAPI).…”

“…Furthermore, two studies reported on the association between kinesiophobia and functional tasks (21,35). The somatic focus subscale of the Tampa Scale of Kinesiophobia (TSK) was strongly and positively correlated with the RehaCAT lower extremity subscale while the activity avoidance subscale was moderately and positively correlated with the RehaCAT lower extremity subscale.…”

“…Some of these studies focused on walking distance (13)(14)(15), while others focused on walking time (16,17), or both (18,19) to report on walking capacity. Indeed, severe symptoms combined with a decrease in walking capacity, and subsequently in QoL, prompt neurosurgeons to opt for surgery in patients with LSS (20,21).…”

Effect of self-quarantine due to COVID-19 on low back and leg symptoms in patients with lumbar spinal stenosis

“…Lumbar spinal stenosis (LSS) is one of the most frequent causes of low back pain and leg numbness while moving 1 . The symptoms adversely affect the health-related quality of life (HRQoL) and activities of daily living (ADL) of older adults 2,3 ; however, a well-known feature of LSS is symptom relief with rest or when sitting down 4,5 .…”