Demoralization, Patient Activation, and the Outcome of Spine Surgery

Block, Andrew R.

doi:10.3390/healthcare4010011

Cited by 15 publications

(9 citation statements)

References 56 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…Both kinesiophobia and demoralization are significant psychological variables that can affect the outcome and rehabilitation of patients. 12,13 The purpose of this study is to assess the relationship of fear avoidance and demoralization on gait and balance and determine a threshold score for the TSK and the DS that identifies spine patients with gait dysfunction amplified by underlying psychological factors. This was accomplished by correlating scores on scales measuring kinesiophobia and demoralization with gait variables, and determining clinically relevant cutoff scores on those psychological scales that are associated with poorer gait and balance parameters.…”

Section: Discussionmentioning

confidence: 99%

Functional Ability Classification Based on Moderate and Severe Kinesophobia and Demoralization Scores in Degenerative Spine Patients

Haddas

Lieberman

Sandu

et al. 2021

Spine

Self Cite

View full text Add to dashboard Cite

Study Design. A prospective cohort study. Objective. To assess the relationship of fear avoidance and demoralization on gait and balance and determine a threshold score for the Tampa Scale for Kinesophobia (TSK) and the Demoralization Scale (DS) that identifies spine patients with gait and balance dysfunction amplified by underlying psychological factors. Summary of Background Data. Fear avoidance and demoralization are crucial components of mental health that impact the outcomes in spine surgery. However, interpreting their effect on patient function remains challenging. Further establishing this correlation and identifying a threshold of severity can aid in identifying patients in whom a portion of their altered gait and balance may be amplified by underlying psychologic distress. Methods. Four hundred five symptomatic spine patients were given the TSK and DS questionnaires. Patient's gait and balance were tested with a human motion capture system. A TSK score of 41 and a DS score of 30 were chosen as thresholds to classify moderate versus severe dysfunction based on literature and statistical analysis. Results. Higher TSK and DS scores were correlated with worse walking speed (P < 0.001), longer stride time (P ¼ 0.001), decreased stride length (P < 0.048), and wider step width (<0.001) during gait as well as increased sway across planes (P ¼ 0.001) during standing balance. When classified by TSK scores >41, patients with more severe fear avoidance had slower walking speed (P < 0.001), longer stride time (P ¼ 0.001), shorter stride length (P ¼ 0.004), increased step width (P < 0.001), and increased sway (P ¼ 0.001) compared with their lower scoring counterparts. Similarly, patients with DS > 30 had slower walking speed (P ¼ 0.012), longer stride time (P ¼ 0.022), and increased sway (P ¼ 0.003) compared with their lower scoring counterparts. Conclusion. This study demonstrates that fear avoidance and demoralization directly correlate with worsening gait and balance. Furthermore, patients with TSK > 41 and DS > 30 have more underlying psychological factors that contribute to significantly worse function compared with lower scoring peers. Understanding this relationship and using these guidelines can help identify and treat patients whose gait dysfunction may be amplified by psychologic distress.

show abstract

Section: Discussionmentioning

confidence: 99%

Functional Ability Classification Based on Moderate and Severe Kinesophobia and Demoralization Scores in Degenerative Spine Patients

Haddas

Lieberman

Sandu

et al. 2021

Spine

Self Cite

View full text Add to dashboard Cite

show abstract

“…Loss of sense of dignity may also partially account for the association between physical problems and demoralization in advanced cancer patients [38]. Demoralization was found to be associated with lower pain reduction, reduced functional improvement, and decreased satisfaction among spine surgery patients [39].…”

Section: The Demoralization Construct and Painmentioning

confidence: 99%

The Role of Demoralization and Meaning in Life (DEMIL) in Influencing Suicidal Ideation Among Patients Affected by Chronic Pain: Protocol of a Single-Center, Observational, Case-Control Study (Preprint)

Costanza¹,

Chytas²,

Mazzola³

et al. 2020

Preprint

View full text Add to dashboard Cite

UNSTRUCTURED Chronic pain is a significant risk factor for suicidal ideation (SI) and suicidal behavior (SB), including a 20-40% prevalence rate of SI, a prevalence between 5-14% of suicidal attempts (SA), and a doubled risk of death by suicide in patients with chronic pain compared to controls. In most studies, associations between chronic pain and suicidality are robust even after adjusting for the effect of socio-demographics and psychiatric comorbidity, and particularly for depressive conditions. A number of specific conditions that can modulate suicidality risk in patients with chronic pain have been investigated, but there is a need for better characterization of other potential risk and protective factors. This project will explore the role of demoralization and Meaning in Life (MiL) constructs in modulating SI in patients with chronic pain. The interest of exploring these constructs in chronic pain patients with SI arises from the common clinical observation that experiencing chronic pain often requires a revision of one’s life goals and expectations. Hence, the impact of chronic pain is not limited to patients’ biopsychosocial functioning, but it affects the existential domain as well. We wish that our project can contribute to a better understanding of the suffering experienced by a person with chronic pain and how this may lead to SI. Concerning clinical implications, the major goals of this study are to: 1) delineate a more precise and individualized suicidal risk profile; 2) improve detection and prevention strategies by investigating SI also in individuals who do not present with a clinically diagnosed depression; and 3) enhance the panel of intervention means by broadening supportive or psychotherapeutic actions. Results of this study will be the basis for a future psychotherapeutic intervention guideline that is oriented towards demoralization and MiL constructs for patients with chronic pain, taking in consideration the existential condition of a person who suffers and strives to deal with his or her pain and suffering.

show abstract

“…Some findings indicate a possible relationship between demoralization and the pain experience, with functional disability found to be correlated with demoralization in a sample of inpatients independently of illness severity. 22,23 SB in demoralization was specifically addressed by Kissane, who emphasized a predictable progression to a desire to die or to commit suicide in a number of medically ill patients and psychiatrically ill patients who were not developing a clinical depression but were demoralized. 18,19,24 The issue is to examine the relationship between demoralization and depression in individuals presenting with SB.…”

Section: Introductionmentioning

confidence: 99%

Demoralization and Suicidal Ideation in Chronic Pain Patients

Chytas¹,

Costanza²,

Mazzola³

et al. 2023

PRBM

View full text Add to dashboard Cite

The literature has clearly stressed that patients suffering from chronic pain are at high risk of suicidal behavior (SB). Hence the need to improve the characterization of this behavior risk profile in these patients. Some findings indicate a possible relationship between demoralization and pain, with functional disability found to be correlated with demoralization. The primary objective of this study was to investigate the relationship between demoralization and suicidal ideation (SI) in patients with chronic pain. The secondary objective was to verify whether demoralization can occur independently of depression in these patients. Inclusion criteria were patients with chronic pain, with SI or not, matched for age and gender, aged > 18 years. Seventy patients with SI and 70 patients without SI were included. Between-group difference was statistically significant (F=1.064; t= 7.21, p<0.001, d=1.22), confirming the presence of numerous and intense depressive symptoms in the patients of the SI group. Regarding the Demoralization Scale (DS), the difference between the two groups was statistically highly significant (F=1.49; t=9.44; p<0.001, d=1.6). There was also a strong positive correlation between DS and Beck Depression Inventory (BDI-II) (R=0.749; p<0.001 for the study group and R=0.704; p<0.001 for the control group). Furthermore, there was a strong positive correlation between the DS and the Scale for Suicide Ideation (SSI) in the SI patients group, meaning that high demoralization is associated with higher suicidal ideation as well. Our findings did not allow us to distinguish between the notions of depression and demoralization, since the two constructs show almost the same strong positive correlation with suicidal thoughts, the two also being strongly correlated with each other.

show abstract

Demoralization, Patient Activation, and the Outcome of Spine Surgery

Cited by 15 publications

References 56 publications

Functional Ability Classification Based on Moderate and Severe Kinesophobia and Demoralization Scores in Degenerative Spine Patients

Functional Ability Classification Based on Moderate and Severe Kinesophobia and Demoralization Scores in Degenerative Spine Patients

The Role of Demoralization and Meaning in Life (DEMIL) in Influencing Suicidal Ideation Among Patients Affected by Chronic Pain: Protocol of a Single-Center, Observational, Case-Control Study (Preprint)

Demoralization and Suicidal Ideation in Chronic Pain Patients

Contact Info

Product

Resources

About