Presurgical biopsychosocial factors predict multidimensional patient: outcomes of interbody cage lumbar fusion

LaCaille, Rick A.; DeBerard, M. Scott; Masters, Kevin S.; Colledge, Alan L.; Bacon, William R.

doi:10.1016/j.spinee.2004.08.004

Cited by 103 publications

(63 citation statements)

References 37 publications

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“…In particular, many researchers have identified the need to isolate the specific factors and to assess interventions to address pain and depression in the perioperative period. Presurgical biopsychosocial variables can predict patient outcomes and provide a possible focus for targeted interventions 3 . Depression has been associated with poorer short-term outcomes after lumbar spinal stenosis surgery, and Sinikallio et al suggested that routine preoperative assessment of depression might be beneficial in practice 4 .…”

Section: Spinementioning

confidence: 99%

The Role of Emotional Health in Functional Outcomes After Orthopaedic Surgery: Extending the Biopsychosocial Model to Orthopaedics

Ayers

Franklin

Ring

2013

Journal of Bone and Joint Surgery

179

113

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Section: Spinementioning

confidence: 99%

The Role of Emotional Health in Functional Outcomes After Orthopaedic Surgery: Extending the Biopsychosocial Model to Orthopaedics

Ayers

Franklin

Ring

2013

Journal of Bone and Joint Surgery

179

113

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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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“…Beyond this, successful outcome could alternately be defined in terms of successful fusion, improvement in quality of life, patient satisfaction, decrease in opioid use, or reduction in medical utilization. The multidimensional nature of treatment outcome is illustrated by one study that found while an objectively successful fusion occurred in 84% of lumbar fusion patients, nearly half were dissatisfied with their outcome, and many were totally disabled at follow-up (LaCaille et al, 2005). Further, den Boer's findings suggest that risk factors that predict one type of outcome may not necessarily predict others.…”

Section: Future Directionsmentioning

confidence: 99%

“…Additionally, a number of studies have suggested that litigation (Bernard, 1993;DeBerard, Masters, Colledge, Schleusener, & Schlegel, 2001;Epker & Block, 2001;Junge, Dvorak, & Ahrens, 1995;LaCaille et al, 2005;Taylor et al, 2000) and insurance compensation or worker's compensation (Bernard, 1993;Deyo, Mirza, Heagerty, Turner, & Martin, 2005;Epker & Block, 2001;Glassman et al, 1998;Greenough, Taylor, & Fraser, 1994;GrothMarnat & Fletcher, 2000;Klekamp, McCarty, & Spengler, 1998;Mannion & Elfering, 2006;Taylor et al, 2000) are also associated with poor surgical outcome. Other identified risk factors for poor surgical outcome include anger (Dvorak, Valach, Fuhrimann, & Heim, 1988;Herron, Turner, & Weiner, 1988), neuroticism , psychological distress (Andersen, Christensen, & Bunger, 2006;Derby et al, 2005;Deyo et al, 2005;Graver, Haaland, Magnaes, & Loeb, 1999; Van Susante, Van de Schaaf, & Pavlov, 1998), psychological trauma in childhood (Schofferman, Anderson, Hines, Smith, & Keane, 1993;Schofferman et al, 1992), chemical dependency (Spengler, Freeman, Westbrook, & Miller, 1980;Uomoto, Turner, & Herron, 1988), spousal reinforcement of pain behaviors , no support from spouse (Schade, Semmer, Main, Hora, & Boos, 1999), self-perception of pre-surgical good health (Katz et al, 1999), fear of movement or reinjury (den Boer, Oostendorp, Beems, Munneke, & Evers, 2006), negative outcome expectancy (den Boer, Oostendorp, Beems, Munneke, & E...…”

mentioning

confidence: 99%

“…For example, while some studies have found tobacco use to be a predictor of poor outcome from fusion surgery (Andersen et al, 2001;LaCaille et al, 2005;Manniche et al, 1994), others have not (Christensen et al, 1999). Similarly, while some studies have found pain drawings to be predictive of a poor outcome from spinal surgery (Dzioba & Doxey, 1984;Takata & Hirotani, 1995), other studies have not (Hagg, Fritzell, Hedlund et al, 2003).…”

mentioning

confidence: 99%

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Assessment of Biopsychosocial Risk Factors for Medical Treatment: A Collaborative Approach

Bruns

Disorbio

2009

J Clin Psychol Med Settings

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There is a growing body of evidence that psychosocial variables have a significant ability to predict the outcome of medical treatment procedures, especially when the procedure is performed to reduce pain. The study described in this paper serves as an illustration of the valuable role psychologists can play in dealing with the challenges of biopsychosocial assessment of patients who are candidates for medical treatments, especially elective, invasive procedures. Based on a convergent model of risk factors that can potentially influence outcomes from spinal surgery and spinal cord stimulation, exclusionary and cautionary risk factors were identified, and the BHI 2 and BBHI 2 tests were used to assess them. An estimate of the prevalence of these risk factors was calculated using data obtained from 1,254 patient and community subjects gathered from 106 sites in 36 US states. Standardized Cautionary Risk and Exclusionary Risk scores demonstrated a test-retest reliability of .85 to .91. Evidence of validity of these scores was also provided based on subjective and objective criteria, using multiple groups of patients and community subjects. Recommendations are made regarding how biopsychosocial assessments could be used in collaborative settings for presurgical candidates to identify risks that could compromise a patient's ability to benefit from other medical treatments as well. Once identified, appropriate interventions could ameliorate these risks, or lead to the consideration of other treatments that are more likely to be effective. Methods of refining this approach for specific clinical applications are also discussed.

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Presurgical biopsychosocial factors predict multidimensional patient: outcomes of interbody cage lumbar fusion

Cited by 103 publications

References 37 publications

The Role of Emotional Health in Functional Outcomes After Orthopaedic Surgery: Extending the Biopsychosocial Model to Orthopaedics

The Role of Emotional Health in Functional Outcomes After Orthopaedic Surgery: Extending the Biopsychosocial Model to Orthopaedics

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

Assessment of Biopsychosocial Risk Factors for Medical Treatment: A Collaborative Approach

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