Preoperative education for lumbar radiculopathy: A survey of US spine surgeons

Abstract

BackgroundWe sought to determine current utilization, importance, content, and delivery methods of preoperative education by spine surgeons in the United States for patients with lumbar radiculopathy.MethodsAn online cross-sectional survey was used to study a random sample of spine surgeons in the United States. The Spinal Surgery Education Questionnaire (SSEQ) was developed based on previous related surveys and assessed for face and content validity by an expert panel. The SSEQ captured information on demographics, content, delivery methods, utilization, and importance of preoperative education as rated by surgeons. Descriptive statistics were used to describe the current utilization, importance, content, and delivery methods of preoperative education by spine surgeons in the United States for patients with lumbar radiculopathy.ResultsOf 200 surgeons, 89 (45% response rate) responded to the online survey. The majority (64.2%) provide preoperative education informally during the course of clinical consultation versus a formal preoperative education session. The mean time from the decision to undergo surgery to the date of surgery was 33.65 days. The highest rated educational topics are surgical procedure (96.3%), complications (96.3%), outcomes/expectations (93.8%), anatomy (92.6%), amount of postoperative pain expected (90.1%), and hospital stay (90.1%). Surgeons estimated spending approximately 20% of the preoperative education time specifically addressing pain. Seventy-five percent of the surgeons personally provide the education, and nearly all surgeons (96.3%) use verbal communication with the use of a spine model.ConclusionsSpine surgeons believe that preoperative education is important and use a predominantly biomedical approach in preparing patients for surgery. Larger studies are needed to validate these findings.

The short term effects of preoperative neuroscience education for lumbar radiculopathy: A case series

“…The pre-education measures revealed the patients in this series to have moderate LBP and leg pain; moderate disability (ODI > 40%); [34][35][36] potential risk for not returning to work (FABQ-PA > 14); high levels of pain catastrophization (average PCS was 25.4); and limited knowledge of pain (NPQ ). 28 The 10 patients scheduled for LS for radiculopathy were also asked to rate their level of agreement on a 10-point scale (strongly disagree [0] -strongly agree [10]) with 7 statements regarding LS ( and "I feel prepared and ready for surgery." They tended to disagree that "leg pain after surgery is to be expected.…”

“…It has been proposed that preoperative education may decrease postoperative pain. The current preoperative counselling by orthopedic surgeons, including lumbar surgery (LS), utilize anatomical and biomechanical models for addressing pain and disability, [7][8][9][10][11] which not only has shown limited efficacy, but may even increase patient fears, anxiety and stress, thus negatively impact their outcomes. Despite this, patients, including those with LS, are interested in knowing more about pain, and education strategies teaching patients about their pain have shown efficacy in easing pain and disability.…”

The clinical application of teaching people about pain

“…Words such as "tear," "deterioration," "herniation," "wear and tear," and "degeneration" are commonly associated with these models and instead of helping patients, in fact, increase fear and anxiety (Greene, Appel, Reinert, and Palumbo, 2005;Morr et al, 2010). Accompanying these words are anatomical charts, plastic joint models, and educational booklets that perpetuate this message and overall contribute to an increased pain experience (Louw, Butler, Diener, and Puentedura, 2012;. For PNE to work, a clinical environment should aim to remove provocative images and language as means of educating people and all staff be updated on the "language of PNE."…”

Three-year follow-up of a randomized controlled trial comparing preoperative neuroscience education for patients undergoing surgery for lumbar radiculopathy

“…While pain after LS is to be expected, findings suggest that patients may in fact expect to be "pain free" which questions the current educational models used to prepare patients for such surgery (12)(13)(14)(15). Experiencing persistent pain after LS, when little to no pain is expected, may lead to fears that the surgery was not successful and further exacerbate the pain experience (16,17).…”

“…In regard to LS, a preoperative PNE program for LS has been developed (13), tested (19,20) and used in a multi-center RCT with 1-year follow-up (12). The preoperative PNE program for LS has been shown to help patients develop a more realistic expectation regarding pain after LS (14), improved satisfaction after LS, and a 45% reduction in healthcare cost in the one year following surgery (12). These results are quite remarkable, considering a single, 30-minute PNE session resulted in healthcare savings of over $2,000/patient compared to the control group (CG).…”