The use of presurgical psychological screening to predict the outcome of spine surgery

Block, Andrew R.; Ohnmeiss, Donna D.; Guyer, Richard D.; Rashbaum, Ralph F.; Hochschuler, Stephen H.

doi:10.1016/s1529-9430(01)00054-7

Cited by 167 publications

(128 citation statements)

References 14 publications

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“…Patients, health insurances and governmental bodies increasingly expect appropriate documentation of the efficacy of medical treatment [3,4]. As a result of outcomes research, indications can be optimised [5][6][7], therapy and predictors critically questioned, and success or deterioration measured [8,9]. Patient safety has been improved by the analysis of side effects and contraindications, and different surgeons and hospitals have been compared [10,11].…”

Section: Introductionmentioning

confidence: 99%

Validity and responsiveness of the Core Outcome Measures Index (COMI) for the neck

et al. 2011

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Purpose Patient-orientated outcome questionnaires are essential to evaluate treatment success. To compare different treatments, hospitals, and surgeons, standardised questionnaires are required. The present study examined the validity and responsiveness of the Core Outcome Measurement Index for neck pain (COMI-neck), a short, multidimensional outcome instrument. Methods Questionnaires were completed by patients with degenerative problems of the cervical spine undergoing cervical disc arthroplasty before (N = 89) and 3 months after (N = 75) surgery. The questionnaires comprised the EuroQol-Five Dimension (EQ-5D), the North American Spine Society Cervical Spine Outcome Assessment Instrument (NASS-cervical) and the COMI-neck. Results The COMI and NASS-cervical scores displayed no notable floor or ceiling effects at any time point whereas for the EQ-5D, the highest or lowest values were reached in around 32.5% of patients at follow-up. With one exception (symptom-specific well-being), the individual COMI items and the COMI summary score correlated to the expected extent (R = 0.4-0.8) with the scores of the chosen reference questionnaires. The area under the curve (AUC) generated by ROC analysis was significantly higher for the COMI (0.96) than for any other instrument/subscale when self reported treatment outcome was used as the external criterion, dichotomised as ''good'' (operation helped a lot/ helped) versus ''poor'' (operation helped only a little/didn't help/made things worse). The COMI had a high effect size (standardised response mean; SRM) (2.34) for the good global outcome group and a low SRM for the poor outcome group (0.34). The EQ-5D and the NASS-cervical lacked this ability to differentiate between the two groups, showing less distinct SRMs for good and poor outcome groups. Conclusions This study provides evidence that the COMI-neck is a valid and responsive questionnaire in the population of patients examined. Further investigations should examine its applicability in other patient groups with less severe neck pain or undergoing other treatment modalities.

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Section: Introductionmentioning

confidence: 99%

Validity and responsiveness of the Core Outcome Measures Index (COMI) for the neck

et al. 2011

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“…Higher levels of psychological distress correlate with greater pain and decreased function in patients with low back pain [3,10], surgical spine conditions [1,4,31,32], hip and knee arthritis [11,14,16], femoroacetabular impingement [22,24], shoulder and rotator cuff pathology [6,23,27,28], and orthopaedic hand and elbow conditions [17,25,33,34].…”

Section: Introductionmentioning

confidence: 99%

One-year Patient-reported Outcomes After Arthroscopic Rotator Cuff Repair Do Not Correlate With Mild to Moderate Psychological Distress

Potter

Wylie

Greis

et al. 2015

Clinical Orthopaedics &Amp; Related Research

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Background Patients with shoulder and rotator cuff pathology who exhibit greater levels of psychological distress report inferior preoperative self-assessments of pain and function. In several other areas of orthopaedics, higher levels of distress correlate with a higher likelihood of persistent pain and disability after recovery from surgery. To our knowledge, the relationship between psychological distress and outcomes after arthroscopic rotator cuff repair has not been similarly investigated. Questions/purposes (1) Are higher levels of preoperative psychological distress associated with differences in outcome scores (visual analog scale [VAS] for pain, Simple Shoulder Test, and American Shoulder and Elbow Surgeons score) 1 year after arthroscopic rotator cuff repair? (2) Are higher levels of preoperative psychological distress associated with less improvement in outcome scores (VAS for pain, Simple Shoulder Test, and American Shoulder and Elbow Surgeons score) 1 year after arthroscopic rotator cuff repair? (3) Does the prevalence of psychological distress in a population with full-thickness rotator cuff tears change when assessed preoperatively and 1 year after arthroscopic rotator cuff repair? Methods Eighty-five patients with full-thickness rotator cuff tears were prospectively enrolled; 70 patients (82%) were assessed at 1-year followup. During the study period, the three participating surgeons performed 269 rotator cuff repairs; in large part, the low overall rate of enrollment was related to two surgeons enrolling only two patients total in the initial 14 months of the study. Psychological distress was quantified using the Distress Risk Assessment Method questionnaire, and patients completed self-assessments including the VAS for pain, the Simple Shoulder Test, and the American Shoulder and Elbow Surgeons score preoperatively and 1 year after arthroscopic rotator cuff repair. Fifty of 85 patients (59%) had normal levels of distress, 26 of 85 (31%) had moderate levels of distress, and nine of 85 (11%) had severe levels of distress. Statistical models were used to assess the effect of psychological distress on patient self-assessment of shoulder pain and function at 1 year after surgery. Results With the numbers available, distressed patients were not different from nondistressed patients in terms of One of the authors certifies that he (PEG), or a member of his immediate family, has or may receive payments or benefits, during the study period, an amount of less than USD 10,000 of research support funding from DePuy Mitek (Raynham, MA, USA). One of the authors certifies that he (RTB), or a member of his immediate family, has or may receive payments or benefits, during the study period, an amount of USD 10,000 to USD 100,000 of research support funding from DePuy Mitek. One of the authors certifies that he (RZT), or a member of his immediate family, has or may receive payments or benefits, during the study period, an amount of USD 100,000 to USD 1,000,000 of research support funding from the Depart...

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“…Many possible reasons for mixed lumbar fusion surgery outcomes exist, including instrumentation failure, inadequate surgical technique and poor patient selection. Factors previously suggested to be predictive of pain and disability-related outcomes include pre-surgical pain/function [42], negative personality traits [19,31,40,41,44], emotional status [41], anxiety/depression [3,23,28,40,41], fear avoidance (FA) beliefs [28], negative outcome expectations [20,48] negative coping [3], smoking status [41], gender [9], exercise [9], litigation [23], duration of back pain and workers' compensation [3,19,40,41].…”

Section: Introductionmentioning

confidence: 99%

Leg pain and psychological variables predict outcome 2–3 years after lumbar fusion surgery

2011

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Prediction studies testing a thorough range of psychological variables in addition to demographic, workrelated and clinical variables are lacking in lumbar fusion surgery research. This prospective cohort study aimed at examining predictions of functional disability, back pain and health-related quality of life (HRQOL) 2-3 years after lumbar fusion by regressing nonlinear relations in a multivariate predictive model of pre-surgical variables. Before and 2-3 years after lumbar fusion surgery, patients completed measures investigating demographics, work-related variables, clinical variables, functional self-efficacy, outcome expectancy, fear of movement/(re)injury, mental health and pain coping. Categorical regression with optimal scaling transformation, elastic net regularization and bootstrapping were used to investigate predictor variables and address predictive model validity. The most parsimonious and stable subset of pre-surgical predictor variables explained 41.6, 36.0 and 25.6% of the variance in functional disability, back pain intensity and HRQOL 2-3 years after lumbar fusion. Pre-surgical control over pain significantly predicted functional disability and HRQOL. Pre-surgical catastrophizing and leg pain intensity significantly predicted functional disability and back pain while the pre-surgical straight leg raise significantly predicted back pain. Postoperative psychomotor therapy also significantly predicted functional disability while pre-surgical outcome expectations significantly predicted HRQOL. For the median dichotomised classification of functional disability, back pain intensity and HRQOL levels 2-3 years post-surgery, the discriminative ability of the prediction models was of good quality. The results demonstrate the importance of pre-surgical psychological factors, leg pain intensity, straight leg raise and postoperative psychomotor therapy in the predictions of functional disability, back pain and HRQOL-related outcomes.

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The use of presurgical psychological screening to predict the outcome of spine surgery

Cited by 167 publications

References 14 publications

Validity and responsiveness of the Core Outcome Measures Index (COMI) for the neck

Validity and responsiveness of the Core Outcome Measures Index (COMI) for the neck

One-year Patient-reported Outcomes After Arthroscopic Rotator Cuff Repair Do Not Correlate With Mild to Moderate Psychological Distress

Leg pain and psychological variables predict outcome 2–3 years after lumbar fusion surgery

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