Depressive burden is associated with a poorer surgical outcome among lumbar spinal stenosis patients: a 5-year follow-up study

Pakarinen, Maarit; Vanhanen, Susanna; Sinikallio, Sanna; Aalto, Timo; Lehto, Soili M.; Airaksinen, Olavi; Viinamäki, Heimo

doi:10.1016/j.spinee.2014.01.047

Cited by 78 publications

(66 citation statements)

References 36 publications

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“…Greater burdens of depression and anxiety were associated with less functional improvement. This is consistent with a large body of literature ReseaRch aRticle Karp, McGovern, Marron et al future science group suggesting that baseline mood and anxiety disorders prognosticate poor surgical outcome [11], with even mild depressive symptoms predicting poor functional outcomes 5 years after surgery [32]. In addition, self-reported poor sleep quality was correlated with less improvement on the RMDQ.…”

Section: Discussionsupporting

confidence: 87%

Clinical and Neuropsychiatric Correlates of Lumbar Spinal Surgery in Older Adults: Results of a Pilot Study

et al. 2016

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Aim:To improve selection of older lumbar surgical candidates, we surveyed correlates of functioning and satisfaction with surgery. Materials & methods: Prospective sample at lumbar spine surgery clinic. Patients (n = 48) were evaluated before surgery and after 3 months. Dependent variables were functioning and surgical satisfaction. Results: Baseline variables associated with disability at 3 months included cognitive status and widespread pain. There was clinically significant improvement with moderate effects sizes for anxiety and depression at follow-up. Patients with at least a 30% improvement in disability had better physical health-related quality of life and were less likely to report widespread pain before surgery. Conclusion: Although preliminary, two novel potential predictors of lumbar surgery outcome include diminished cognitive functioning and widespread pain. Further study of these variables on post-surgical functioning and satisfaction may improve patient selection. Summary points• In late life, low back pain with and without leg pain is frequently associated with functional disability, psychosocial impairment, poor sleep quality and depression.• A substantial body of literature has identified comorbidities that predict suboptimal spine surgery outcome, including musculoskeletal conditions, impaired gait, cardiovascular disease, and mood and anxiety disorders.• We observed that mild cognitive impairment and the presence of widespread pain may be two potential predictors of satisfaction and disability following lumbar surgery. Given the relatively high frequency at which these two conditions occur in older adults in clinical settings, future projects are warranted to understand their potential impact on surgical outcome, functioning and satisfaction.• Patients with at least a 30% improvement in disability had better physical health-related quality of life and were less likely to report widespread pain before surgery.• Depression and anxiety both improved at the 3-month follow-up with moderate effect sizes for both.For reprint orders, please contact: reprints@futuremedicine.com

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Section: Discussionsupporting

confidence: 87%

Clinical and Neuropsychiatric Correlates of Lumbar Spinal Surgery in Older Adults: Results of a Pilot Study

et al. 2016

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“…Biopsychosocial models have recently been proposed, suggesting that a complete understanding of pain-related outcomes will require consideration of psychological and social factors, as well as physical factors [14,15]. In orthopaedic literature, preoperative psychological distress such as depression and anxiety has been reported to be associated with worse clinical outcomes after surgery of the hip, knee and lumbar spine [16,17]. In two recent studies, preoperative psychological distress was not associated with clinical outcome after rotator cuff surgery [18,19].…”

Section: Introductionmentioning

confidence: 99%

The Influence of Preoperative and Postoperative Psychological Symptoms on Clinical Outcome after Shoulder Surgery: A Prospective Longitudinal Cohort Study

et al. 2016

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BackgroundPsychological symptoms are highly prevalent in patients with shoulder complaints. Psychological symptoms in patients with shoulder complaints might play a role in the aetiology, perceived disability and pain and clinical outcome of treatment. The aim of this study was to assess whether preoperative symptoms of distress, depression, anxiety and somatisation were associated with a change in function after shoulder surgery and postoperative patient perceived improvement of pain and function. In addition, the change of psychological symptoms after shoulder surgery was analyzed and the influence of postoperative symptoms of psychological disorders after surgery on the change in function after shoulder surgery and perceived postoperative improvement of pain and function.Methods and FindingsA prospective longitudinal cohort study was performed in a general teaching hospital. 315 consecutive patients planned for elective shoulder surgery were included. Outcome measures included change of Disabilities of the Arm, Shoulder and Hand (DASH) score and anchor questions about improvement in pain and function after surgery. Psychological symptoms were identified before and 12 months after surgery with the validated Four-Dimensional Symptom Questionnaire (4DSQ). Psychological symptoms were encountered in all the various shoulder diagnoses. Preoperative symptoms of psychological disorders persisted after surgery in 56% of patients, 10% of patients with no symptoms of psychological disorders before surgery developed new psychological symptoms. Preoperative symptoms of psychological disorders were not associated with the change of DASH score and perceived improvement of pain and function after shoulder surgery. Patients with symptoms of psychological disorders after surgery were less likely to improve on the DASH score. Postoperative symptoms of distress and depression were associated with worse perceived improvement of pain. Postoperative symptoms of distress, depression and somatisation were associated with worse perceived improvement of function.ConclusionsPreoperative symptoms of distress, depression, anxiety and somatisation were not associated with worse clinical outcome 12 months after shoulder surgery. Symptoms of psychological disorders before shoulder surgery persisted in 56% of patients after surgery. Postoperative symptoms of psychological disorders 12 months after shoulder surgery were strongly associated with worse clinical outcome.

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“…Lifetime prevalence is about 20% and co-morbidity is significant with, for example, cardiovascular disorders, diabetes and chronic pain (2). In various rehabilitation contexts, depression is considered a barrier to successful outcome (3)(4)(5).…”

Section: Introductionmentioning

confidence: 99%

Depression embodied: an ambiguous striving against fading

Danielsson

Rosberg

2014

Scandinavian Caring Sciences

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Although depression is associated to physical discomfort, meanings of the body in depression are rarely addressed in clinical research. Drawing on the concept of the lived body, this study explores depression as an embodied phenomenon. Using a hermeneutic phenomenological approach, the analysis of narrative-based interviews with 11 depressed adults discloses a thematic structure of an embodied process of an ambiguous striving against fading. Five subthemes elicit different dimensions of this process, interpreted as disabling or enabling: feeling estranged, feeling confined, feeling burdensome, sensing life and seeking belongingness. In relation to clinical practice, we suggest that the interdisciplinary team can focus on enhancing the enabling dimensions, for example through guided physical activities to support the patient to feel more alive, capable and connected. Moreover, we suggest that the treatment process benefits from an increased awareness of the ambiguity in the patient's struggle, acknowledging both destructive and recharging elements of the withdrawing, and the perceived conflict in-between.

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Depressive burden is associated with a poorer surgical outcome among lumbar spinal stenosis patients: a 5-year follow-up study

Cited by 78 publications

References 36 publications

Clinical and Neuropsychiatric Correlates of Lumbar Spinal Surgery in Older Adults: Results of a Pilot Study

Clinical and Neuropsychiatric Correlates of Lumbar Spinal Surgery in Older Adults: Results of a Pilot Study

The Influence of Preoperative and Postoperative Psychological Symptoms on Clinical Outcome after Shoulder Surgery: A Prospective Longitudinal Cohort Study

Depression embodied: an ambiguous striving against fading

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