The risk identification and mitigation model for presurgical psychological assessments.

Abstract

For the conclusions reached in presurgical psychological assessments (PPA) to be valid and effective across the spectrum of medical problems, many conditions must be met. The PPA process requires a strong empirical foundation as well as flexibility with regard to the types of testing implemented and the types of adverse psychosocial factors assessed during the clinical interview. Further, psychological factors that have been demonstrated to have positive effects on surgical outcomes-mitigating factors-should be assessed. Mitigating factors in this context are good prognostic indicators that would lessen the effect of risk factors, such as evidence of sustained health behavior changes, self-efficacy, and resilience. Standardized methods of integrating data need to be developed, and the range of recommendations should be considered.Recently, we developed a general framework for PPA, the risk identification and mitigation (RIM) model (Block & Marek, 2020; see Figure 1.1), that is designed to be the basis for assessments that are empirically based and systematic. RIM is a five-step process: (a) identification of risk factors via psychological testing; (b) clinical interviewing and medical records review;

Differences in presurgical MMPI-3 scores across trajectories of recovery from spine surgery.

“…Mental health variables, such as the severity of depression and anxiety, are consistently predictive of long-term postsurgical outcomes (Celestin et al, 2009; Dorow et al, 2017), but this literature has predominately used brief symptom screeners, such as the Patient Health Questionnaire (PHQ) or Hospital Anxiety and Depression Scale (Hébert et al, 2020; Lin et al, 2018; Mancuso et al, 2018). Although screeners and brief, symptom-focused measures capture severity, they are not sufficiently comprehensive in presurgical evaluations where practitioners must assess for a breadth of psychopathology and over- and underreporting response styles (e.g., exaggeration of symptoms to receive favorable outcomes, such as insurance coverage; Marek & Block, 2023). The Minnesota Multiphasic Personality Inventory (MMPI) is one of the more commonly used broadband instruments for presurgical evaluations across medical specialties (Block & Marek, 2020), and empirical support for the reliability and validity of its scale scores in presurgical evaluations of spine surgery candidates has accumulated (Block et al, 2013, 2017; Block & Marek, 2020; Marek et al, 2020, 2022, 2023).…”