Continued disability and pain after lumbar disc surgery: The role of cognitive-behavioral factors (original) (raw)
Related papers
Disability and Rehabilitation, 2010
Purpose. The primary aim of this study was to analyse the predictive value of cognitive and behavioural factors, in relation to pain, disability and quality of life (QoL) one year after lumbar disc surgery. Method. The study design was prospective. Fifty-nine patients scheduled for first time lumbar disc surgery were included. Pain, disability, QoL, coping, fear avoidance beliefs, expected outcome and sick leave were assessed preoperatively and 12 months after surgery. Multiple backward stepwise logistic regression analyses were performed to study the contribution of the preoperatively measured independent behavioural/cognitive factors (coping, fear avoidance beliefs and assessed chance to return to work within 3 months) to the dependent variables pain, disability and quality of life at 12 months after surgery. Results. Low expectations on work return within 3 months after surgery was significantly predictive for residual leg pain, odds ratio (OR) ¼ 8.2, back pain, OR ¼ 9.7, disability, OR ¼ 13.8 and sick leave, OR ¼ 19.5. Low QoL, was best predicted by preoperatively high scores on fear avoidance beliefs OR ¼ 6.6 and being a woman OR ¼ 6.0. The regression model explained 26-40% of the variance in pain, disability, QoL and sick leave. Conclusions. Eliciting patients' expectations on work return after surgery could contribute to early identification of those who run the risk of developing long-term disability and sick-leave.
Pre-surgery physiotherapy and pain thresholds in patients with degenerative lumbar spine disorders
Background: Patients scheduled for spinal surgery often experience long duration of pain, which may influence the pain-regulation system, function and health and have an impact on post-surgery outcome. Prehabilitation potentially augments functional capacity before surgery, which may have beneficial effects after surgery. Aim: The overall aim of the thesis is to study pre-surgery physiotherapy and somatosensory function in patients with degenerative lumbar spine disorders and to explore the patients' experiences of pre-surgery physiotherapy. Methods: Somatosensory function was measured with quantitative sensory testing (QST). Pre-surgery physiotherapy was evaluated with patient-reported outcome measures (n = 197). Patients' experiences of how symptoms are explained and their experiences of the influences on back-related health after pre-surgery physiotherapy were explored. Results: Half of the patients reported back or leg pain for more than 2 years. On a group level, the somatosensory profiles were within the reference range. On an individual level, an altered somatosensory profile was found in 23/105 patients, these were older, more often women, and reported higher pain, larger pain distribution and worse SF-36 MCS (mental health component summary). Patients with disc herniation, more sensitive to pressure pain in the hand presurgery, was associated with poorer function, self-efficacy, anxiety and depression score pre-surgery, worse function, self-efficacy and leg pain 3 months post-surgery and worse health related quality of life, self-efficacy, depression score 1 year postsurgery. The results for sensitivity for cold pain were similar, except that it even was associated with poorer function and pain 1 year post-surgery.
The journal of pain : official journal of the American Pain Society, 2015
The purpose of this study was to determine the efficacy of a cognitive-behavioral based physical therapy (CBPT) program for improving outcomes in patients following lumbar spine surgery. A randomized controlled trial was conducted in 86 adults undergoing a laminectomy with or without arthrodesis for a lumbar degenerative condition. Patients were screened preoperatively for high fear of movement using the Tampa Scale for Kinesiophobia. Randomization to either CBPT or an Education program occurred at 6 weeks after surgery. Assessments were completed pre-treatment, post-treatment and at 3 month follow-up. The primary outcomes were pain and disability measured by the Brief Pain Inventory and Oswestry Disability Index. Secondary outcomes included general health (SF-12) and performance-based tests (5-Chair Stand, Timed Up and Go, 10 Meter Walk). Multivariable linear regression analyses found that CBPT participants had significantly greater decreases in pain and disability and increases in...
Physiotherapy, 2010
Objectives To assess the extent to which perceived pain and psychological factors explain levels of disability and health-related quality of life (HRQOL) in patients scheduled for lumbar fusion surgery, and to test the hypothesis that relationships between pain intensity, mental health, fear of movement/(re)injury, disability and HRQOL are mediated by cognitive beliefs and appraisals. Design Cross-sectional, correlation study. Setting Orthopaedic outpatient setting in a tertiary hospital. Participants One hundred and seven chronic back pain patients scheduled for lumbar fusion surgery. Measures Visual analogue scale for pain intensity, Short Form 36 mental health subscale, Tampa Scale for Kinesiophobia, Back Beliefs Questionnaire, Self-efficacy Scale, Coping Strategy Questionnaire, Oswestry Disability Index and European Quality of Life Questionnaire. Results The group effect of multiple mediators significantly influenced the relationships between pain intensity and mental health, fear of movement/(re)injury, functional disability and HRQOL. Pain catastrophising significantly mediated the relationship between pain intensity and mental health, control over pain significantly mediated the relationship between mental health and functional disability, self-efficacy and pain outcome expectancy significantly mediated the relationship between mental health and HRQOL, and self-efficacy also significantly mediated the relationship between pain intensity, fear of movement/(re)jury and functional disability. The model explained 28, 30, 52 and 42% of the variation in mental health, fear of movement/(re)injury, functional disability and HRQOL, respectively. Conclusions This study highlights the strong influence and mediation roles of psychological factors on pain, mental health, fear of movement/(re)injury, disability and HRQOL in patients scheduled for lumber fusion. Future research should focus on screening as well as pre-and post-operative interventions based on these psychological factors for the potential improvement of lumber fusion surgery outcomes.
Duration of symptoms as a predictor of outcome after lumbar disc surgery
Acta Neurochirurgica, 1994
Retrospectively 93 consecutive patients operated on for lumbar disc herniation were studied in order to evaluate the prognostic value of symptoms (lumbar pain and sciatica) and sick-leave. Surgical results were evaluated I 3 years postoperatively by a questionaire. The duration of the present attack of sciatica and sick-leave prior to surgery was significantly longer in the group with unsatisfactory outcome compared to the group with satisfactory outcome. Patients with duration of the present attack of sciatica of less than 6 months had a significantly better result concerning outcome compared to patients with duration of 6-12 months and more than 12 months.
Investigating and predicting early lumbar spine surgery outcomes
Journal of allied health, 2015
To examine short-term changes in patients' clinical status following lumbar spine surgery (LSS) and to explore presurgical variables that predict surgical outcomes. Prospective cohort study. A total of 46 patients underwent LSS. Patients completed the following questionnaires 1 week before LSS and 2 weeks after discharge from the hospital: back and leg visual pain analogue scale, Ronald Morris questionnaire (RMQ), Modified Somatic Perception questionnaire (MSPQ), SF-36, Fear-Avoidance Beliefs Questionnaire, Beck's Depression Inventory, EuroQol questionnaire, and patient-perception of improvement. Regression models were constructed to examine predictors of pain, function, quality of life, and patient-perception of improvement at 2 weeks postsurgery. Patients demonstrated significant improvement in back and leg pain and function. MSPQ and symptom duration were significant predictors of back pain, while type of diagnosis and use of opioids were significant predictors of leg pai...