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Casarin J, Ielmini M, Cromi A, Laganà AS, Poloni N, Callegari C, Ghezzi F. Post-traumatic stress following total hysterectomy for benign disease: an observational prospective study. J Psychosom Obstet Gynaecol 2022; 43:11-17. [PMID: 32319346 DOI: 10.1080/0167482x.2020.1752174] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 10/24/2022] Open
Abstract
PURPOSE Over the last decade, there has been growing interest in the psychophysical integrity of surgical patients in the context of healthcare events. In the present study, we aimed to evaluate the incidence rate of postoperative distress symptoms, namely post-traumatic stress disorder (PTSD), following total hysterectomy for benign disease. We also investigated possible associations between sociodemographic characteristics, clinical outcomes, anxiety, depression, and PTSD. METHODS We prospectively enrolled 100 consecutive patients who underwent total hysterectomy for benign disease between 01/01/2019 and 15/04/2019. Demographic and surgical-related characteristics have been registered. The Hospital Anxiety and Depression Scale (HADS) questionnaire was administered preoperatively (Time1), postoperatively (Time2), and at follow-up clinical evaluation, between two and three months after surgery (Time3). PTSD was defined based on the results of the Post-traumatic Stress Disorder Checklist for DSM-5 (PCL-5) at Time3. RESULTS At Time3, the median PCL-5 score was 12,8 (0-70), and 16.4% of patients had PTSD symptoms (PCL-5 > 33). No correlation between sociodemographic or gynecologic characteristics and PTSD was detected. A significant association between depression (HADS > 8) at Time2 (p = 0.002) and Time3 (p < 0.001) and PTSD symptoms was shown. CONCLUSION Hysterectomy for benign disease is associated with a non-negligible risk of PTDS; the use of the HADS questionnaires might be useful to select patients who might benefit from dedicated psychological support.
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Affiliation(s)
- Jvan Casarin
- Obstetrics and Gynecology Department, University of Insubria, Varese, Italy
| | - Marta Ielmini
- Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy
| | - Antonella Cromi
- Obstetrics and Gynecology Department, University of Insubria, Varese, Italy
| | | | - Nicola Poloni
- Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy
| | - Camilla Callegari
- Department of Medicine and Surgery, Division of Psychiatry, University of Insubria, Varese, Italy
| | - Fabio Ghezzi
- Obstetrics and Gynecology Department, University of Insubria, Varese, Italy
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Frenzel L, Vogel M, Riediger C, Frommer J, Lohmann C, Illiger S. [Postoperative Dissociation after Knee Replacement and its Influence on the Course of Pain]. Psychother Psychosom Med Psychol 2021; 71:328-334. [PMID: 33773519 DOI: 10.1055/a-1375-0984] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
Abstract
OBJECTIVE Even after successful knee replacement, one in 5 patients complains of chronic pain. Previous studies suggest that surgical interventions trigger postoperative traumatic stress in some patients. The aim of this explorative study is to investigate whether postoperative dissociation occurs as a manifestation of postoperative traumatic stress after total knee replacement. In addition, it should be investigated whether these patients have more chronic postoperative pain 1 year postoperatively and to what extent the course of pain differs from the other patients. METHODS 201 Patients who underwent primary knee TEP were studied. They answered questionnaires on knee pain (WOMAC) and dissociation (FDS-20) at 3 measurement points: 1 day preoperatively (T1), 10 weeks postoperatively (T2) and 1 year postoperatively (T3). RESULTS Data from 145 patients could be analyzed. The incidence for postoperative dissociation is 8.3%. Not only do patients with postoperative dissociation report more chronic postoperative pain after 1 year (p=0,016), but also their postoperative pain levels decreases less than in the patients without postoperative dissociation (p=0,025). DISCUSSION The findings provide evidence that postoperative dissociation occurs as a manifestation of postoperative traumatic stress after total knee replacement. Even if dissociation seems to be a defense mechanism for the regulation of overstraining affects in the short term, it is associated with more chronic postoperative pain in the long term. Furthermore, the patients with postoperative dissociation benefit less in a 1-year follow-up from total knee replacement in terms of pain reduction. CONCLUSION Strategies to reduce dissociation could lead to better results after knee TEP implementation and should be investigated in future intervention studies.
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Affiliation(s)
- Lydia Frenzel
- Universitätsklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Magdeburg, Deutschland
| | - Matthias Vogel
- Universitätsklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Magdeburg, Deutschland
| | - Christian Riediger
- Universitätsklinik für Orthopädie, Universitätsklinikum Magdeburg, Deutschland
| | - Jörg Frommer
- Universitätsklinik für Psychosomatische Medizin und Psychotherapie, Universitätsklinikum Magdeburg, Deutschland
| | - Christoph Lohmann
- Universitätsklinik für Orthopädie, Universitätsklinikum Magdeburg, Deutschland
| | - Sebastian Illiger
- Universitätsklinik für Orthopädie, Universitätsklinikum Magdeburg, Deutschland
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Abstract
STUDY DESIGN Invited narrative review. OBJECTIVES The aim of this review was to summarize current literature regarding risk factors that surgeons can optimize in the preoperative setting in the spinal surgery patient, in order to reduce complications and improve patient-reported outcomes. METHODS Review of the relevant literature by the authors. RESULTS Modifiable risk factors identified relative to the patient include obesity, malnutrition/nutrient deficiency, diabetes/hyperglycemia, preoperative anemia, vitamin D/DEXA (dual-energy radiograph absorptiometry), nicotine use/smoking, and opioid use/psychosocial factors. CONCLUSION By maximizing a patient's physiological and psychological status prior to elective spine surgery, we may move closer to achieving the goals of value-based care: improving patient-reported outcomes while decreasing the cost of care.
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Affiliation(s)
- Sukanta Maitra
- Department of Orthopaedic Surgery, UNLV School of Medicine, Las Vegas, NV, USA,Sukanta Maitra, Department of Orthopaedic Surgery, UNLV School of Medicine, Las Vegas, NV 89102, USA.
| | | | - Samuel K. Cho
- Icahn School of Medicine at Mount Sinai, New York, NY, USA
| | - Michael D. Daubs
- Department of Orthopaedic Surgery, UNLV School of Medicine, Las Vegas, NV, USA
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Low M, Burgess LC, Wainwright TW. A Critical Analysis of the Exercise Prescription and Return to Activity Advice That Is Provided in Patient Information Leaflets Following Lumbar Spine Surgery. MEDICINA (KAUNAS, LITHUANIA) 2019; 55:E347. [PMID: 31284666 PMCID: PMC6681378 DOI: 10.3390/medicina55070347] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 05/09/2019] [Accepted: 07/04/2019] [Indexed: 12/28/2022]
Abstract
Background and objectives: Lumbar spine surgery may be considered if pharmacologic, rehabilitation and interventional approaches cannot provide sufficient recovery from low back-related pain. Postoperative physiotherapy treatment in England is often accompanied by patient information leaflets, which contain important rehabilitation advice. However, in order to be an effective instrument for patients, the information provided in these leaflets must be up to date and based on the best available evidence and clinical practice. This study aims to critically analyse the current postoperative aspects of rehabilitation (exercise prescription and return to normal activity) that are provided in patient information leaflets in England as part of an evaluation of current practice following lumbar spine surgery. Materials and Methods: Patient information leaflets from English National Health Service (NHS) hospitals performing lumbar spine surgery were sourced online. A content analysis was conducted to collect data on postoperative exercise prescription and return to normal activities. Results: Thirty-two patient information leaflets on lumbar surgery were sourced (fusion, n = 11; decompression, n = 15; all lumbar procedures, n = 6). Many of the exercises prescribed within the leaflets were not based on evidence of clinical best practice and lacked a relationship to functional activity. Return to normal activity advice was also wide ranging, with considerable variation in the recommendations and definitions provided. Conclusions: This study highlights a clear variation in the recommendations of exercise prescription, dosage and returning to normal activities following lumbar spine surgery. Future work should focus on providing a consistent and patient-centred approach to recovery.
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Affiliation(s)
- Matthew Low
- Therapy Outpatient Department, The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth BH7 7DW, UK
- Orthopaedic Research Institute, Bournemouth University, Bournemouth BH8 8EB, UK
| | - Louise C Burgess
- Orthopaedic Research Institute, Bournemouth University, Bournemouth BH8 8EB, UK
| | - Thomas W Wainwright
- Therapy Outpatient Department, The Royal Bournemouth and Christchurch Hospitals NHS Foundation Trust, Bournemouth BH7 7DW, UK.
- Orthopaedic Research Institute, Bournemouth University, Bournemouth BH8 8EB, UK.
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El-Gabalawy R, Sommer JL, Pietrzak R, Edmondson D, Sareen J, Avidan MS, Jacobsohn E. Post-traumatic stress in the postoperative period: current status and future directions. Can J Anaesth 2019; 66:1385-1395. [DOI: 10.1007/s12630-019-01418-4] [Citation(s) in RCA: 20] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/12/2018] [Revised: 04/19/2019] [Accepted: 04/22/2019] [Indexed: 11/24/2022] Open
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Rhon DI, Greenlee TA, Marchant BG, Sissel CD, Cook CE. Comorbidities in the first 2 years after arthroscopic hip surgery: substantial increases in mental health disorders, chronic pain, substance abuse and cardiometabolic conditions. Br J Sports Med 2018; 53:547-553. [DOI: 10.1136/bjsports-2018-099294] [Citation(s) in RCA: 16] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/04/2018] [Indexed: 02/05/2023]
Abstract
ObjectivesWe aimed to identify the rate of seven comorbidities (mental health disorders, chronic pain, substance abuse disorders, cardiovascular disorders, metabolic syndrome, systemic arthropathy and sleep disorders) that occurred within 2 years after hip arthroscopy.MethodsData from individuals (ages 18–50 years) undergoing arthroscopic hip surgery between 2004 and 2013 were collected from the Military Health System (MHS) Data Repository (MDR). The MDR captures all healthcare encounters in all settings and locations for individuals within the MHS. Person-level data over 36 months were pulled and aggregated. Seven comorbidities related to poor outcomes from musculoskeletal disorders (mental health disorders, chronic pain, substance abuse disorders, cardiovascular disorders, metabolic syndrome, systemic arthropathy and sleep disorders) were examined 12 months prior and 24 months after surgery. Changes in frequencies were calculated as were differences in proportions between presurgery and postsurgery.Results1870 subjects were identified (mean age 32.24 years; 55.5% men) and analysed. There were statistically significant increases (p<0.001) proportionally for all comorbidities after surgery. Relative to baseline, cases of mental health disorders rose 84%, chronic pain diagnoses increased 166%, substance abuse disorders rose 57%, cardiovascular disorders rose by 71%, metabolic syndrome cases rose 85.9%, systemic arthropathy rose 132% and sleep disorders rose 111%.ConclusionsMajor (potentially ‘hidden’) clinical comorbidities increased substantially after elective arthroscopic hip surgery when compared with preoperative status. These comorbidities appear to have been overlooked in major studies evaluating the benefits and risks of arthroscopic hip surgery.Level of evidencePrognostic, level III.
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Can Early Patient-reported Outcomes Be Used to Identify Patients at Risk for Poor 1-Year Health Outcomes After Lumbar Laminectomy With Arthrodesis? Spine (Phila Pa 1976) 2018; 43:1067-1073. [PMID: 29215506 DOI: 10.1097/brs.0000000000002522] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective cohort. OBJECTIVE Determine A) between-patient variability in patient-reported outcomes (PROs) at four postoperative time points; B) within-patient correlation of 1-year PROs with PROs at three earlier time points; and C) ability of early PROs to predict 1-year PROs after lumbar laminectomy with arthrodesis. SUMMARY OF BACKGROUND DATA It is unclear whether early PROs can help identify patients at risk for poor health outcomes. METHODS Between 2015 and 2016, we assessed pre- and postoperative back pain, leg pain, disability, physical health, and mental health in 146 patients. We examined PRO variability between patients and correlations within patients during the first postoperative year. For early (≤3-mo) and 1-year PROs, we examined concordance between experiencing a minimal important difference (MID) early and at 1 year and odds of experiencing a 1-year MID given early absence of a MID. RESULTS Postoperatively, we found increasing between-patient variability of PROs. For individual patients, we found moderate to strong between-assessment correlations (intraclass correlations) between repeated PROs (back pain, 0.47; leg pain, 0.51; disability, 0.47; physical health, 0.63; mental health, 0.53). Early MIDs were experienced for back pain (57%), leg pain (52%), physical health (38%), disability (34%), and mental health (16%). Concordance was moderate for leg pain (0.48), mental health (0.46), disability (0.38), back pain (0.36), and physical health (0.25). In patients without an early MID, odds of experiencing a MID at 1 year were low for physical health (odds ratio [OR] = 0.33), back pain (OR = 0.30), leg pain (OR = 0.14), and disability (OR = 0.11) but not mental health (OR = 0.50). CONCLUSION Although postoperative recovery is variable, early PROs can identify patients at risk for poor 1-year outcomes and may help tailor care during the first year after lumbar laminectomy with arthrodesis. LEVEL OF EVIDENCE 2.
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Shiban E, Lehmberg J, Hoffmann U, Thiel J, Probst T, Friedl M, Mühlberger A, Meyer B, Shiban Y. Peritraumatic distress fully mediates the relationship between posttraumatic stress symptoms preoperative and three months postoperative in patients undergoing spine surgery. Eur J Psychotraumatol 2018; 9:1423824. [PMID: 29410774 PMCID: PMC5795762 DOI: 10.1080/20008198.2018.1423824] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/21/2016] [Accepted: 12/17/2017] [Indexed: 12/02/2022] Open
Abstract
Background: Growing evidence shows the significance of illness and surgical procedures as traumatizing stressors. Risk factors are widely investigated in various settings and samples, using numerous measures of posttraumatic stress and posttraumatic stress disorder (PTSD). While pretrauma psychological distress is acknowledged as an influential factor, peritraumatic experiences are controversially still being discussed as relevant to the development of PTSD. Objective: In a group of patients consecutively undergoing elective spine surgery (N = 89) in a German hospital, this longitudinal study addressed the question of how pretrauma PTSD symptoms and peritrauma distress interact with one another in regard to the amount of posttrauma symptoms of PTSD. Methods: Pre- and posttrauma symptoms of PTSD as well as peritrauma distress were assessed through questionnaires one week before, one week after or three months after surgery. Results: Even though all three variables showed significant correlations with one another, mediation analysis revealed that peritrauma distress fully mediated the relationship between pre- and posttrauma PTSD symptoms. Conclusions: These results add new insights to the controversial discussion on the role peritraumatic experiences play in the development of PTSD, especially in medical settings.
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Affiliation(s)
- Ehab Shiban
- Department of Neurosurgery, Technical University of Munich, Munich, Germany
| | - Jens Lehmberg
- Department of Neurosurgery, Technical University of Munich, Munich, Germany
| | - Ute Hoffmann
- Department of Neurosurgery, Technical University of Munich, Munich, Germany
| | - Jeff Thiel
- Department of Neurosurgery, Technical University of Munich, Munich, Germany
| | - Thomas Probst
- Department for Psychotherapy and Biopsychosocial Health, Danube University Krems, Krems, Austria
| | - Margret Friedl
- Department of Psychology (Clinical Psychology and Psychotherapy), University of Regensburg, Regensburg, Germany
| | - Andreas Mühlberger
- Department of Psychology (Clinical Psychology and Psychotherapy), University of Regensburg, Regensburg, Germany
| | - Bernhard Meyer
- Department of Neurosurgery, Technical University of Munich, Munich, Germany
| | - Youssef Shiban
- Department of Psychology (Clinical Psychology and Psychotherapy), University of Regensburg, Regensburg, Germany
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Sheean AJ, Schmitz MR, Ward CL, Barrow AE, Tennent DJ, Roach CJ, Burns TC, Wilken JM. Assessment of Disability Related to Femoroacetabular Impingement Syndrome by Use of the Patient-Reported Outcome Measure Information System (PROMIS) and Objective Measures of Physical Performance. Am J Sports Med 2017; 45:2476-2482. [PMID: 28609640 DOI: 10.1177/0363546517708793] [Citation(s) in RCA: 25] [Impact Index Per Article: 3.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/31/2023]
Abstract
BACKGROUND The National Institutes of Health (NIH)-sponsored Patient-Reported Outcomes Measurement System (PROMIS) has been described as a valuable tool for characterizing outcomes among patients with specific musculoskeletal conditions. Additionally, previously proposed objective measures of physical performance among patients with nonarthritic hip abnormalities are costly and not practically incorporated into routine clinical practice. PURPOSE (1) To determine the ability of the PROMIS to differentiate between patients with femoroacetabular impingement (FAI) and asymptomatic controls, (2) to determine the effect of FAI on subjects' completion of timed physical performance measures, and (3) to determine whether associations exist between established patient-reported outcome (PRO) measures and subjects' completion of physical performance measures. STUDY DESIGN Cross-sectional study; Level of evidence, 3. METHODS Twenty-two asymptomatic controls (CON group) and 20 patients with FAI completed multiple activities to assess physical ability: self-selected walking velocity (SSWV), timed stair ascent (TSA), four-square step test (FSST), and sit-to-stand five times test (STS5). All subjects also underwent a battery of PRO questionnaires: Visual Analog Scale for Pain (VAS), Modified Harris Hip Score (mHHS), International Hip Outcome Tool (iHOT-33), Hip Disability and Osteoarthritis Outcome Score (HOOS), and PROMIS. Descriptive analyses were performed and comparisons between groups were made by use of paired t tests with Bonferroni-Holm correction. Spearman's rank correlation coefficients were used to determine associations between physical performance measures and PRO. The magnitude of differences between groups for each measured variable was calculated by use of Cohen's d. RESULTS Significant differences between CON and FAI groups were observed for all hip-specific PRO measures (CON vs FAI for all; HOOS 99.2 vs 42.8, P < .001, iHOT-33 99.0 vs 26.6, P < .001, mHHS 99.6 vs 62.2, P < .001). Similarly, PROMIS scores were significantly different between groups for 8 of 9 tested domains. Patients with FAI demonstrated significant decrements in performance of all tested physical measures compared with asymptomatic controls (CON vs FAI, SSWV: 1.51 vs 1.32 m/s, P = .002; TSA: 3.05 vs 5.92 s, P = .017; FSST: 4.83 vs 8.89 s, P = .006; STS5: CON 5.53 vs FAI 10.75 s, P = .005.) Deficits in activities involving hip flexion-TSA, STS5-were strongly associated ( r < -0.7, P < .001) with increased reports of disability. CONCLUSION FAI has a negative effect on patient-reported and objectively measured function. Hip-specific and general measures such as PROMIS, FSST, TSA, and STS5 are responsive to FAI-associated debility and may be used to objectively assess surgical or rehabilitative outcomes.
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Affiliation(s)
- Andrew J Sheean
- Department of Orthopaedics, San Antonio Military Medical Center, San Antonio, Texas, USA
| | - Matthew R Schmitz
- Department of Orthopaedics, San Antonio Military Medical Center, San Antonio, Texas, USA
| | - Catherine L Ward
- Center for the Intrepid, San Antonio Military Medical Center, San Antonio, Texas, USA
| | - Aaron E Barrow
- Department of Orthopaedics, San Antonio Military Medical Center, San Antonio, Texas, USA
| | - David J Tennent
- Department of Orthopaedics, San Antonio Military Medical Center, San Antonio, Texas, USA
| | - Christopher J Roach
- Department of Orthopaedics, San Antonio Military Medical Center, San Antonio, Texas, USA
| | - Travis C Burns
- Department of Orthopaedics, San Antonio Military Medical Center, San Antonio, Texas, USA
| | - Jason M Wilken
- Center for the Intrepid, San Antonio Military Medical Center, San Antonio, Texas, USA.,Extremity Trauma and Amputation Center of Excellence, San Antonio, Texas, USA
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Patient factors in decision-making for orthopaedic surgery: a prospective analysis. CURRENT ORTHOPAEDIC PRACTICE 2017. [DOI: 10.1097/bco.0000000000000499] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/25/2022]
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Selecting caudal fusion levels: 2 year functional and stiffness outcomes with matched pairs analysis in multilevel fusion to L5 versus S1. EUROPEAN SPINE JOURNAL : OFFICIAL PUBLICATION OF THE EUROPEAN SPINE SOCIETY, THE EUROPEAN SPINAL DEFORMITY SOCIETY, AND THE EUROPEAN SECTION OF THE CERVICAL SPINE RESEARCH SOCIETY 2016; 26:1645-1651. [DOI: 10.1007/s00586-016-4790-z] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/23/2016] [Revised: 08/07/2016] [Accepted: 09/18/2016] [Indexed: 10/20/2022]
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Abstract
STUDY DESIGN Cross-sectional analysis. OBJECTIVE To compare Lumbar Stiffness Disability Index (LSDI) scores between asymptomatic adults and patients with spinal deformity. SUMMARY OF BACKGROUND DATA The LSDI was designed and validated as a tool to assess functional impacts of lumbar spine stiffness and diminished spinal flexibility. Baseline disability levels of patients with adult spinal deformity (ASD) are high as measured by multiple validated outcome tools. Baseline lumbar stiffness-related disability has not been assessed in adults with and without spinal deformity. METHODS The LSDI and Scoliosis Research Society-22r (SRS-22r) were submitted to a group of asymptomatic adult volunteers. Additionally, a multicenter cross-sectional cohort analysis of patients with ASD from 10 centers was conducted. Baseline LSDI and SRS-22r were completed for both operatively and nonoperatively treated patients with deformity. RESULTS The LSDI was completed by 176 asymptomatic volunteers and 693 patients with ASD. Mean LSDI score for asymptomatic volunteers was 3.4 +/- 6.3 out of a maximum score of 100, with significant correlation between increasing age and higher (worse) LSDI score (r = 0.30, P = 0.0001). Of the patients with spinal deformity undergoing analysis, 301 subsequently underwent surgery and 392 were subsequently treated nonoperatively. Operative patients had significantly higher preoperative LSDI scores than both nonoperative patients and asymptomatic volunteers (29.9 vs. 17.3 vs. 3.4, P < 0.0001 for both). For patients with ASD, significant correlations were found between LSDI and SRS-22 Pain and Function subscales (r = -0.75 and -0.76, respectively; P < 0.0001 for both). CONCLUSION LSDI scores are low among asymptomatic volunteers, although stiffness-related disability increases with increasing age. Patients with ASD report substantial stiffness-related disability even prior to surgical fusion. Stiffness-related disability correlates with pain- and function-related disability measures among patients with spinal deformity.
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Ernat JJ, Song DJ, Brugman SC, Shaha SH, Tokish JM, Lee GY. Mental Health Medication Use Correlates with Poor Outcome After Femoroacetabular Impingement Surgery in a Military Population. J Bone Joint Surg Am 2015; 97:1272-7. [PMID: 26246262 DOI: 10.2106/jbjs.o.00043] [Citation(s) in RCA: 28] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
BACKGROUND Femoroacetabular impingement is a common cause of hip pain in young adults. Several preoperative risk factors for poor outcomes with surgery have been identified; however, to our knowledge, no study has attempted to determine the effect of psychiatric comorbidity on outcomes with femoroacetabular impingement surgery. METHODS A retrospective review was performed on active-duty patients at one institution undergoing surgery for femoroacetabular impingement over five years. Medical records were reviewed for demographic characteristics, radiographic data, and history of mental health medication use. Return-to-duty status was considered the primary outcome measure. Outcome scores obtained included modified Harris hip scores, Single Assessment Numeric Evaluation scores, Western Ontario and McMaster Universities Osteoarthritis Index (WOMAC) scores, patient satisfaction, and Veterans RAND-12 scores. Patients taking mental health medication were compared with those who were not with regard to return to duty and validated patient-reported outcome measures. RESULTS Ninety-three patients (mean age, 32.2 years) were available for follow-up at a mean duration of 3.6 years. Of the seventeen patients discharged from service postoperatively, twelve (71%) were taking mental health medications. One-third (twenty-five) of seventy-six patients who returned to duty were taking mental health medication and this difference was significant (p < 0.006). Patients taking mental health medication had significantly poorer modified Harris hip scores (p < 0.02), WOMAC scores (p < 0.0008), and Veterans RAND-12 mental scores (p < 0.001). Antidepressant, antipsychotic, and multiple mental health medication use were all predictive of medical discharge due to hip pain. CONCLUSIONS Psychiatric comorbidities are an important risk factor in active-duty military personnel undergoing surgery for femoroacetabular impingement. Mental health medication use is associated with poorer outcome scores and can significantly lower the possibility of returning to active-duty status.
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Affiliation(s)
- J J Ernat
- Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI 96859
| | - D J Song
- Landstuhl Regional Medical Center, Geb. 3765, 66849 Landstuhl, Germany
| | - S C Brugman
- Tripler Army Medical Center, 1 Jarrett White Road, Honolulu, HI 96859
| | - S H Shaha
- Allscripts, 222 Merchandise Mart Plaza, Suite 2024, Chicago, IL 60694
| | - J M Tokish
- Steadman Hawkins Clinic of the Carolinas, Greenville Health System, 200 Patewood Drive, Suite C100, Greenville, SC 29615. E-mail address:
| | - G Y Lee
- Kaiser Permenante Hospital, 680 Iwilei Road, #600, Honolulu, HI 96817
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Functional limitations due to stiffness as a collateral impact of instrumented arthrodesis of the lumbar spine. Spine (Phila Pa 1976) 2014; 39:E1468-74. [PMID: 25202930 DOI: 10.1097/brs.0000000000000595] [Citation(s) in RCA: 42] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/01/2023]
Abstract
STUDY DESIGN Prospective cohort study. OBJECTIVE To understand whether patients actually perceive increased limitations as compared with their preoperative state due to stiffness after lumbar arthrodesis. SUMMARY OF BACKGROUND DATA Lumbar arthrodesis by intention eliminates spinal motion in an attempt to decrease pain, deformity, and instability. Independent of pain, loss of mobility can impact ability to perform certain activities of daily living. The lumbar stiffness disability index (LSDI) is a validated measure of the effect of lumbar stiffness on functional activities. To date, no prospective evaluations of stiffness impacts on patient function after lumbar arthrodesis have been reported. METHODS The LSDI, 36-Item Short Form Health Survey, and Oswestry Disability Index were administered preoperatively and at 2-year minimum follow-up to 62 adult patients undergoing lumbar fusion for degenerative disease or spinal deformity. Patients also completed a satisfaction questionnaire at 2 years. Patients were separated according to the number of lumbar arthrodesis levels. Pre- and postoperative LSDI, 36-Item Short Form Health Survey physical composite score, and Oswestry Disability Index scores were compared using paired t tests. RESULTS Significant improvements in Oswestry Disability Index were observed across all arthrodesis levels, and significant improvements in physical composite score were observed at level 1 and at 5 or more levels. Patients undergoing 1-level arthrodesis demonstrated statistically significant decreases in LSDI scores, indicating less impact from stiffness than at baseline. Patients with 3 or 4 levels and 5 or more levels of arthrodesis showed increases in LSDI scores, although none reached significance with the numbers available. Forty-six percent of patients reported that low back stiffness created significant limitations in activities of daily living, although 97% indicated that they would undergo the same procedure again and 91% reported that any increase in stiffness was an acceptable trade-off for their functional improvements from lumbar arthrodesis. CONCLUSION Patients undergoing elective lumbar arthrodesis reported relatively limited functional deficit due to stiffness at 2-year follow-up. Paradoxically, patients undergoing 1-level arthrodesis actually reported significantly less limitation due to stiffness postoperatively. Although the effects of stiffness did trend toward greater impacts among patients undergoing longer fusions, 91% of patients were satisfied with trade-offs of function and pain relief in exchange for perceived increases in lumbar stiffness.
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