The psychology of spine surgery.

Block, Andrew R.

doi:10.1037/10613-000

Cited by 84 publications

(129 citation statements)

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“…Measurement science has extended such work to facilitate the interpretation of changes in outcomes in terms of their clinical significance [1][2][3], and has paved the way for evidence-based clinical treatment guidelines [4][5][6]. As part of this evolution, studies in spine research have documented a wide range of factors that influence treatment outcome, including medical factors (e.g., co-morbidities [7]), sociodemographic factors [8] (e.g., gender, age), and behavioral factors [8,9] (workers' compensation status [10,11]). …”

Section: Background Contextmentioning

confidence: 99%

“…A recent book on psychological factors related to spine surgery noted a cluster of about ten psychosocial and medical risk factors with sufficient empirical documentation to merit continued consideration [8]. Such factors included psychological or personality factors (e.g., hostility, anxiety, depression, history of psychological disturbance), behavioral factors (e.g., smoking, substance abuse, worker's compensation status, obesity), social support, and attitudinal factors (e.g., job dissatisfyaction) [8].…”

Section: Background Contextmentioning

confidence: 99%

“…Such factors included psychological or personality factors (e.g., hostility, anxiety, depression, history of psychological disturbance), behavioral factors (e.g., smoking, substance abuse, worker's compensation status, obesity), social support, and attitudinal factors (e.g., job dissatisfyaction) [8]. They note that psychosocial factors are often found to be stronger predictors of surgical outcome than are medical diagnostic factors, and derived an algorithm for determining surgical prognosis on the basis of these risk factors [8]. We believe that more research on psychosocial factors in spine outcome research is warranted, and present preliminary findings to support this recommendation.…”

Section: Background Contextmentioning

confidence: 99%

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Relevance of Lifestyle and Attitudinal Factors to Spine Surgery Outcomes: Empirical Results on a Heterogeneous Sample

Schwartz¹,

Quaranto²,

Samaha³

et al. 2011

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Background Context: Patient demographic and medical indicators influence the well-being of spine surgery patients. It may, however, be worthwhile to evaluate other lifestyle and attitudinal factors. We hypothesized that such factors would explain at least as much variance in outcome as more commonly considered covariates. Purpose: To compare explained variance in outcome of lifestyle and attitudinal factors as compared to standard demographic and medical covariates. Study Design/Setting: Cross-sectional observational study of patients drawn from an active clinic and internet-based support group. Patient Sample: A heterogeneous sample of 376 patients was recruited, comprised of people with diagnoses of cervical (n = 80), lumbar (n = 228), and scoliosis (n = 68) spine disorders. Outcome Measures: Quality of Life (QOL) outcomes were measured using the Oswestry Disability Index, Neck Disability Index, Rand-36, PROMIS Pain Impact, NRS Back and Leg Pain, Scoliosis Research Society-22r, and Global Health. Methods: This study compared explained variance in QOL outcomes of demographic and medical versus lifestyle and attitudinal factors. Demographic and medical factors included age, gender, body mass index, and co-morbidities. Lifestyle factors included exercise and commuting practice. Attitudinal factors related to social connectedness: giving and receiving emotional support, feeling overwhelmed by others' needs, helping orientation, and general helping behaviors. Regression analyses estimated explained variance. Patient groups differed in most factors evaluated, so the regression analyses were computed separately by group. R2 statistics were characterized as null, small (0.02), medium (0.15), and large (0.35) effect sizes (ES), and proportions were compared for the medical/demographic versus lifestyle/attitudinal factors by group. Results: Similar proportions of variance were explained by demographic/medical and lifestyle/attitudinal covariates across groups, with half of effect sizes being small in magnitude and 6% being medium. Lumbar patients tended to have more small effect sizes among lifestyle and attitudinal covariates than among medical/demographic covariates (z = -1.29, p < 0.10). Similar patterns were found for both generic and disease-specific outcomes. Conclusions: Spine surgery outcome research should investigate lifestyle and attitudinal factors to enhance the personal and salutogenic relevance of the research. Time spent commuting, exercise practice, and social connectedness appear to be relevant factors. A pre-operative evaluation of overweight and smoking status, limited social connectedness, and long daily commutes could alert the surgeon to delay or avoid performing procedures on these patients to avoid poor outcomes.

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Section: Background Contextmentioning

confidence: 99%

Section: Background Contextmentioning

confidence: 99%

Section: Background Contextmentioning

confidence: 99%

See 1 more Smart Citation

Relevance of Lifestyle and Attitudinal Factors to Spine Surgery Outcomes: Empirical Results on a Heterogeneous Sample

Schwartz¹,

Quaranto²,

Samaha³

et al. 2011

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show abstract

“…One of the most influential methods of presurgical biopsychosocial assessment was developed by Block and colleagues (Block, 1996;Block, Gatchel, Deardorff, & Guyer, 2003;Block et al, 2001). Although Block's method of presurgical psychological assessment is based on literature review, unlike den Boer, it did not employ a systematic method of literature review.…”

Section: Block's Model Of Presurgical Psychological Assessmentmentioning

confidence: 99%

“…Although Block's method of presurgical psychological assessment is based on literature review, unlike den Boer, it did not employ a systematic method of literature review. Block and colleagues identified three groups of risk factors, which were psychosocial risk factors, medical risk factors (Block, 1996;Block et al, 2001) and more recently ''adverse clinical features'' (Block et al, 2003). Unlike den Boer's criteria, this approach offers a method of assessing risk by tallying the number of risk factors that are present.…”

Section: Block's Model Of Presurgical Psychological Assessmentmentioning

confidence: 99%

Assessment of Biopsychosocial Risk Factors for Medical Treatment: A Collaborative Approach

Bruns

Disorbio

2009

J Clin Psychol Med Settings

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There is a growing body of evidence that psychosocial variables have a significant ability to predict the outcome of medical treatment procedures, especially when the procedure is performed to reduce pain. The study described in this paper serves as an illustration of the valuable role psychologists can play in dealing with the challenges of biopsychosocial assessment of patients who are candidates for medical treatments, especially elective, invasive procedures. Based on a convergent model of risk factors that can potentially influence outcomes from spinal surgery and spinal cord stimulation, exclusionary and cautionary risk factors were identified, and the BHI 2 and BBHI 2 tests were used to assess them. An estimate of the prevalence of these risk factors was calculated using data obtained from 1,254 patient and community subjects gathered from 106 sites in 36 US states. Standardized Cautionary Risk and Exclusionary Risk scores demonstrated a test-retest reliability of .85 to .91. Evidence of validity of these scores was also provided based on subjective and objective criteria, using multiple groups of patients and community subjects. Recommendations are made regarding how biopsychosocial assessments could be used in collaborative settings for presurgical candidates to identify risks that could compromise a patient's ability to benefit from other medical treatments as well. Once identified, appropriate interventions could ameliorate these risks, or lead to the consideration of other treatments that are more likely to be effective. Methods of refining this approach for specific clinical applications are also discussed.

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Chapter 14 or 18 for Pain Complaints? Avoiding the Common but Mistaken Dichotomy of Psychological vs Organic

Barth¹,

Brigham²

2005

AMA Guides® Newsletter

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In accordance with the AMA Guides to the Evaluation of Permanent Impairment (AMA Guides), Chapter 18, Pain, pain that is attributable to mental illness does not also qualify for an additional pain-related evaluation. Evaluators must discriminate between presentations of pain that represent mental illness vs those that do not and must decide whether to rate using Chapter 18 or 14. Dichotomous thinking often opposes the notion of psychological vs physiological-organic presentations, but all presentations of pain include psychological aspects, and all mental illnesses include physiological aspects. One type of illustrative mental illness involves conditions that are overtly mental but have been found via extensive scientific study to have a physiological basis (eg, schizophrenia and Alzheimer's disease). Another presentation that is claimed to be of a medical nature actually overlaps with psychological issues (eg, complex regional pain syndrome, type 1 [CRPS-1] and fibromyalgia). Further, the AMA Guides summarizes the lack of a strong correlation between tissue damage or physiology and pain: Pain can exist without tissue damage, and tissue damage can exist without pain. Pain, chronic pain, and impairment from pain are largely, even primarily, psychological phenomena. Accordingly, the determination whether to rely on the pain chapter or the mental/behavioral chapter in the evaluation of a pain presentation cannot be reduced to a misleading dichotomy of psychological vs organic pain.

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The psychology of spine surgery.

Cited by 84 publications

References 0 publications

Relevance of Lifestyle and Attitudinal Factors to Spine Surgery Outcomes: Empirical Results on a Heterogeneous Sample

Relevance of Lifestyle and Attitudinal Factors to Spine Surgery Outcomes: Empirical Results on a Heterogeneous Sample

Assessment of Biopsychosocial Risk Factors for Medical Treatment: A Collaborative Approach

Chapter 14 or 18 for Pain Complaints? Avoiding the Common but Mistaken Dichotomy of Psychological vs Organic

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