Preoperative Cognitive-Behavioral Patient Education Versus Standard Care for Lumbar Spinal Fusion Patients

Rolving, Nanna; Søgaard, Rikke; Nielsen, Claus Vinther; Christensen, Finn Kjær; Bünger, Cody; Oestergaard, Lisa Gregersen

doi:10.1097/brs.0000000000001254

Cited by 47 publications

(46 citation statements)

References 25 publications

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“…Health-related quality of life is a key outcome in the management of LSS and its assessment during clinical practice may suggest the introduction of psychological interventions directed at promoting psychological resources in the patient with the aim to improve long-term outcome or even enhance recovery. Indeed, cognitive-behavioural patient education has been proven effective for the improvement of both clinical and quality-of-life outcomes in these patients 35 36…”

Section: Methodsmentioning

confidence: 99%

“…The assessment of both these aspects during clinical practice may suggest a comprehensive evaluation aimed to improve long-term outcome. For example, patient education and psychological interventions aimed to promote patient’s resources have been proven effective for the improvement of both clinical outcomes and quality of life in these patients 35 36…”

Section: Introductionmentioning

confidence: 99%

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Quality of life and objective functional impairment in lumbar spinal stenosis: a protocol for a systematic review and meta-analysis of moderators

et al. 2019

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BackgroundLumbar spinal stenosis (LSS) is a common degenerative spine disease associated with a strong impairment in various quality of life areas, particularly the ability to perform work-related activity. Depression is a condition frequently associated. There is no comprehensive review on quality of life and objective functional impairment in LSS. This paper presents the protocol of the first systematic review and meta-analysis summarising evidence about quality of life and functional impairment in patients with LSS compared with healthy controls. Comorbid depressive disorders, age, gender, LSS duration, disability, pain severity and study methodological quality will be investigated as moderators.MethodsThe protocol is reported according to PRISMA-P guidelines. Studies will be included if they were conducted on patients aged 18 years old or older with primary LSS and if they reported data on differences in the levels of quality of life or objective functional impairment between patients with LSS and healthy controls. Independent reviewers will search published/unpublished studies through electronic databases and additional sources, will extract the data and assess the methodological quality. Random-effects meta-analysis will be carried out by calculating effect sizes as Cohen’s d indices. Heterogeneity will be examined by the I2 and the Q statistics. Moderators will be investigated through meta-regression.ConclusionsA summary of the evidence on quality of life and functional impairment in LSS may suggest clinical and occupational health medicine strategies aimed to timely detect and prevent these outcomes. Higher percentages of patients with LSS with depression may be expected to be related to poorer quality of life. Depressive comorbidity might impact negatively on quality of life because it is associated with dysfunctional coping, disability and psychophysiological symptoms.Ethics and disseminationThe current review does not require ethics approval. The results will be disseminated through publications in peer-reviewed journals.Review registrationCRD42019132209.

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Section: Methodsmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Quality of life and objective functional impairment in lumbar spinal stenosis: a protocol for a systematic review and meta-analysis of moderators

et al. 2019

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“…Hedges' g and 95% CI precluded meta-analysis. In the acute period, two studies 39,43 reported statistically significant improvements in mobility and function. Another trial 31 reported statistically significant improvements in similar functional measures for both subacute and longer term time points.…”

Section: Hedges' Gmentioning

confidence: 99%

Effect of preoperative psychological interventions on elective orthopaedic surgery outcomes: a systematic review and meta‐analysis

Tong

Dannaway

Enke

et al. 2019

ANZ Journal of Surgery

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Background Orthopaedic surgery is largely successful; however, a proportion of patients are dissatisfied and report pain and poor function. Psychological factors have been shown to influence orthopaedic surgical outcomes. This systematic review and meta‐analysis investigates the types and effectiveness of preoperative psychological interventions in elective orthopaedic surgery. Methods A registered systematic review (PROSPERO CRD42017073833) was performed on literature (1960–January 2018) using eight databases. Prospective controlled clinical trials involving adult and adolescent elective orthopaedic surgery were included. Interventions examined included relaxation, cognitive behavioural therapy, hypnosis, emotional counselling and mixed psychotherapies; general procedural education was excluded. Outcomes extracted included pain, anxiety, quality of life and disability. Results A total of 19 studies met the inclusion criteria (n = 1893 patients). Meta‐analyses were performed for pain, anxiety and quality of life. Analysis did not find enough evidence to confirm reduction in post‐operative pain (seven studies, 666 patients; g = −0.15 (95% CI −0.42, 0.13), P = 0.305). Pooled data from six studies on acute post‐operative anxiety (589 patients) showed a moderate statistically significant benefit (g = −0.26 (−0.49, −0.03), P = 0.024). There was an improved quality of life (mental component) at longer term follow‐up (g = 0.25 (0.02, 0.49), P = 0.034). Conclusions These studies provide evidence that psychological interventions have a positive effect on anxiety in the acute post‐operative period, and on mental components of quality of life at longer term follow‐up.

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“…Patient information, helping to manage expectations, has long been considered a key element of enhanced recovery pathways (ERPs) (Grocott et al 2012) and has traditionally been delivered in surgical and anaesthetic pre-assessment clinics. More sophisticated psychological preparation for surgery, for example using cognitive behavioural education, may provide additional benefit (Rolving et al 2016). As we dissect the functions of the various elements of the pathway to surgery it becomes clear that diagnosis, prognosis and shared decision-making do not have to be undertaken at the same time and place as preparation for surgery.…”

Section: Opportunities To Add Value Before Surgerymentioning

confidence: 99%

Re-designing the pathway to surgery: better care and added value

et al. 2017

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The case for radical pathway re-design before surgery is in part driven by healthcare system pressures which are in turn the result of continuously rising demand in the face of tightly constrained resources. Such circumstances tend to drive revolutionary, rather than incremental, change. The current approach to preoperative assessment, that typically occurs in the weeks leading up to surgery, but is all too often only a few days before surgery, results in a lost opportunity for perioperative physicians to improve patient care. Re-engineering this process based on a patient-focused, pathway-driven vision of perioperative medicine offers a means of exploiting this opportunity. This review explores drivers for change, the opportunity offered by pathway re-design, and suggests a variety of strategies to add value in the preoperative pathway, each of which is facilitated by early engagement between perioperative physician and patient: collaborative decision-making, collaborative behavioural change, targeted comorbidity management as well as expectation management and psychological preparation for surgery including surgery schools.

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Preoperative Cognitive-Behavioral Patient Education Versus Standard Care for Lumbar Spinal Fusion Patients

Abstract: Preoperative CBT appears to be more effective and cost neutral when considering the overall health care sector and labor market perspective, supporting the implementation of preoperative CBT in the course of treatment for LSF surgery in a Danish context.

Cited by 47 publications

References 25 publications

Quality of life and objective functional impairment in lumbar spinal stenosis: a protocol for a systematic review and meta-analysis of moderators

Quality of life and objective functional impairment in lumbar spinal stenosis: a protocol for a systematic review and meta-analysis of moderators

Effect of preoperative psychological interventions on elective orthopaedic surgery outcomes: a systematic review and meta‐analysis

Re-designing the pathway to surgery: better care and added value

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