Psychosocial Representations of the Illness before Lumbar Spine Surgery and Their Effects on Recovery

Abstract

Introduction Psychosocial representation of the illness means those personal and mental meanings and thoughts which the patient connects with his/her own condition. The examination of representation of the illness is very important to understand the behavior of the patients because these representations contain of the patients' beliefs about their illness or injury. These beliefs influence the cure, the duration of recovery and these beliefs affect the strategies, which the patients use to cope with the illness. In clinical environment, the nonverbal methods help the exploration of representations of the illness, since the physical status can hamper the verbal expression of burdens (for example: pain, suffering). In such cases, we can use the PRISM task (Pictorial Representation of Illness Self-Measure) to measure the burden of suffering. Methods and Materials: In our research, there have been 110 inpatients (52 men). We have examined the patients before lumbar surgery, using the following tests: Psychological Vulnerability Questionnaire, Hospital Anxiety and Depression Scale, Somatosensory Amplification Scale and PRISM-D (drawing version of PRISM task) and we followed how many days the patients stayed at the clinic after the operation. Using the PRISM-D, we are observing the patients drawing the in some spatial formations, which are the following: 1. Self-shield (the patient draws the important things around herself/himself), 2. Illness-shield (the patient draws the important things around the illness), 3. Protective line (the patient draws the important things in horizontal or/and vertical line), 4. Network (the important things and the illness are diffused in space of the current life), 5. Fusion (the important things and the illness intersect with the self or every circle intersect with each other), 6. Self-part (the illness is drawn in the self and the other important things are located far away from the self). Results We have found that those patients who have drawn their illness in their own Self (Self-part), went home later than the other patients (Self-shield: p = 0,004, Fusion: p = 0,026, Illness-shield: p = 0,008, Protective line: p = 0,036, Network: p = 0,004). But those patients, who represented their illness in Self-shield spatial formation, went home earliest (mean: 4,14 days). Although, these patients were the most vulnerable in the whole population. Conclusion Our results suggest the illness modifies the self-identity because the information related to the pain becomes the most essential in the organization of the self. It could be problematic, if majority of the self-scheme consists of illness-scheme. We can see this in Self-part spatial formation, thus it is affirmable if the illness-scheme increase within the Self, the recovery will slow down. This is often the case with the patients having low back pain.