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Morales A, El Chamaa A, Mehta S, Rushton A, Battié MC. Depression as a prognostic factor for lumbar spinal stenosis outcomes: a systematic review. 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 2024; 33:851-871. [PMID: 37917206 DOI: 10.1007/s00586-023-08002-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/18/2023] [Accepted: 10/12/2023] [Indexed: 11/04/2023]
Abstract
PURPOSE Lumbar spinal stenosis (LSS) is associated with increased levels of psychological distress, including depression; however, the prognostic value of depression remains unclear. The purpose of this systematic review was to synthesize the evidence on the prognostic value of depression for a range of outcomes in patients with LSS. METHODS Inclusion criteria were prospective cohort studies that investigated depression in patients diagnosed with LSS. Searches were conducted in 7 databases. Critical appraisal, data extraction, and judgement of cumulative evidence were conducted independently by two reviewers. A meta-analysis was not conducted due to a lack of unique cohorts for each outcome, varying follow-up times, and differences in measurements for both prognostic factors and outcomes. RESULTS Twenty-three articles were included. There was evidence for an association between preoperative depression and postoperative disability and symptom severity outcomes for patients with LSS. Odds ratios ranged from 1.15 to 2.94 for postoperative disability and 1.16-1.20 for symptom severity at various follow-up times. Using GRADE, evidence supporting depression as a prognostic factor for these LSS outcomes was deemed to be of moderate quality. Similarly strong evidence suggested depressive symptoms are of no prognostic value for postoperative walking capacity. CONCLUSION Depression appears to have small to moderate prognostic value for LSS outcomes, with the strongest evidence for postoperative disability and symptom severity. The prognostic value of depression for LSS outcomes should be further explored using standardized measures in additional cohorts, including patients managing their condition conservatively, who have been neglected in related research.
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Affiliation(s)
- Ariel Morales
- School of Physical Therapy, Western University, London, ON, Canada
| | - Alaa El Chamaa
- School of Physical Therapy, Western University, London, ON, Canada
| | - Swati Mehta
- Schulich School of Medicine & Dentistry, Western University, London, ON, Canada
| | - Alison Rushton
- School of Physical Therapy, Faculty of Health Sciences and Western's Bone & Joint Institute, Western University, 1201 Western Road, London, ON, N6A 1H1, Canada
| | - Michele C Battié
- School of Physical Therapy, Faculty of Health Sciences and Western's Bone & Joint Institute, Western University, 1201 Western Road, London, ON, N6A 1H1, Canada.
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Knutsson B, Jong M, Sayed-Noor A, Sjödén G, Augutis M. Waiting for lumbar spinal stenosis surgery: suffering and a possibility to discover coping abilities. Orthop Rev (Pavia) 2022; 14:30716. [PMID: 35106129 DOI: 10.52965/001c.30716] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Accepted: 09/30/2021] [Indexed: 11/06/2022] Open
Abstract
Objective The objective of this study was to describe aspects of suffering related to being a person with LSS and how suffering is managed before LSS surgery. Methods/design/setting A Swedish county hospital. Interviews with 18 consecutive patients on the waiting list for LSS surgery. The themes that emerged from content analysis were further interpreted using Antonovsky salutogenic model as a sensitizing concept. Results The suffering from LSS before surgery included the main theme of experiencing an impaired physical and social life and struggling to be believed and taken seriously. This had coping strategies to manage symptoms before surgery: a good physician-patient relationship alleviates the burden of long waiting times; ways to manage pain and disability; ambiguous expectations and hope for recovery, and; ways to handle concerns before surgery). Conclusion Being a person with LSS includes suffering and a possibility to discover coping abilities or having support structures for doing so. Our study emphasizes the importance of a supportive dialogue, where physicians and patients make the suffering from LSS and care before LSS surgery more comprehensible and manageable.
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Affiliation(s)
- Björn Knutsson
- Department of Surgical and Perioperative Science, Umeå University
| | - Mats Jong
- Department of Health Sciences/Public Health, Mid Sweden University
| | - Arkan Sayed-Noor
- Department of clinical science and education, Södersjukhuset, Karolinska Institutet Stockholm
| | - Göran Sjödén
- Department of clinical science and education, Södersjukhuset, Karolinska Institutet Stockholm
| | - Marika Augutis
- Department of Neurobiology, Care Sciences and Society. Division Clinical Geriatrics, Karolinska Institutet, Stockholm
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A Simple Method for Assessing the Mental Health Status of Students in Higher Education. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2019; 16:ijerph16234733. [PMID: 31783500 PMCID: PMC6926560 DOI: 10.3390/ijerph16234733] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/27/2019] [Revised: 11/22/2019] [Accepted: 11/25/2019] [Indexed: 11/17/2022]
Abstract
Mental health problems are common among students in higher education all over the world, so identifying those who are at higher risk would allow the targeted provision of help. Our goal was to develop an assessment tool to identify students at risk for vulnerable mental health status. This tool was created from the 12-item General Health Questionnaire and Antonovsky’s abbreviated sense of coherence scale and was tested to distinguish between those with high or low mental resilience. Predictive ability was characterized by likelihood ratios taking the Beck Depression Inventory and perceived health as references. One-quarter (95% CI 21.1% to 29.7%) of the students had been in vulnerable mental health characterized by low sense of coherence and high distress, whereas 28.4% (95% CI 24.2% to 33.1%) seemed resilient, having high sense of coherence and low distress. The high negative predictive value of the assessment tool reliably identified resilient students in comparison with both the Beck Depression Inventory (98.6%) and perceived health status (83.9%). Use of the assessment tool is recommended for students to distinguish between those at decreased and increased risk in terms of mental health. Mental health services should be offered to students at higher risk.
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Sinikallio S, Pakarinen M, Tuomainen I, Airaksinen O, Viinamäki H, Aalto TJ. Preoperative sense of coherence associated with the 10-year outcomes of lumbar spinal stenosis surgery. J Health Psychol 2017; 24:989-997. [PMID: 28810389 DOI: 10.1177/1359105316687633] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A prospective 10-year follow-up study was conducted to determine the significance of the preoperative sense of coherence, with respect to the preoperative and 10-year clinical characteristics, among lumbar spinal stenosis patients ( N = 99). In addition, the predictive value of the preoperative sense of coherence regarding the 10-year surgery outcome was also evaluated. In a logistic regression analysis, a weak preoperative sense of coherence and low functional ability predicted the patients' functional ability 10 years after the surgery. Moreover, those patients with weak sense of coherence before surgery showed poorer functional ability 10 years after the surgery, but not preoperatively. A weak preoperative sense of coherence seems to associate with poorer long-term outcome after surgery; therefore, various rehabilitation strategies are discussed.
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Affiliation(s)
| | - Maarit Pakarinen
- 1 University of Eastern Finland, Finland.,2 Kuopio University Hospital, Finland
| | | | | | - Heimo Viinamäki
- 1 University of Eastern Finland, Finland.,2 Kuopio University Hospital, Finland
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Lukkala PS, Honkanen RJ, Rauma PH, Williams LJ, Quirk SE, Kröger H, Koivumaa-Honkanen H. Life Satisfaction and Morbidity among Postmenopausal Women. PLoS One 2016; 11:e0147521. [PMID: 26799838 PMCID: PMC4723073 DOI: 10.1371/journal.pone.0147521] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/18/2015] [Accepted: 01/05/2016] [Indexed: 12/21/2022] Open
Abstract
OBJECTIVE To investigate associations between morbidity and global life satisfaction in postmenopausal women taking into account type and number of diseases. MATERIALS AND METHODS A total of 11,084 women (age range 57-66 years) from a population-based cohort of Finnish women (OSTPRE Study) responded to a postal enquiry in 1999. Life satisfaction was measured with a 4-item scale. Self-reported diseases diagnosed by a physician and categorized according to ICD-10 main classes were used as a measure of morbidity. Enquiry data on health and lifestyle were used as covariates in the multivariate logistic models. RESULTS Morbidity was strongly associated with life dissatisfaction. Every additional disease increased the risk of life dissatisfaction by 21.1% (p < .001). The risk of dissatisfaction was strongest among women with mental disorders (OR = 5.26; 95%CI 3.84-7.20) and neurological disorders (OR = 3.62; 95%CI 2.60-5.02) compared to the healthy (each p < .001). Smoking, physical inactivity and marital status were also associated with life dissatisfaction (each p < .001) but their introduction to the multivariate model did not attenuate the pattern of associations. CONCLUSIONS Morbidity and life dissatisfaction have a disease-specific and dose-dependent relationship. Even if women with mental and neurological disorders have the highest risk for life dissatisfaction, monitoring life satisfaction among aging women regardless of disorders should be undertaken in order to intervene the joint adverse effects of poor health and poor well-being.
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Affiliation(s)
- Pyry S. Lukkala
- School of Medicine, Faculty of Health Sciences, University of Eastern Finland (UEF), Kuopio, Finland
- Bone and Cartilage Research Unit, Surgery, Institute of Clinical Medicine, UEF, Kuopio, Finland
- * E-mail:
| | - Risto J. Honkanen
- Bone and Cartilage Research Unit, Surgery, Institute of Clinical Medicine, UEF, Kuopio, Finland
| | - Päivi H. Rauma
- Bone and Cartilage Research Unit, Surgery, Institute of Clinical Medicine, UEF, Kuopio, Finland
- Social Pharmacy, School of Pharmacy, Faculty of Health Sciences, UEF, Kuopio, Finland
| | - Lana J. Williams
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Australia
| | - Shae E. Quirk
- IMPACT Strategic Research Centre, School of Medicine, Deakin University, Geelong, Australia
| | - Heikki Kröger
- Bone and Cartilage Research Unit, Surgery, Institute of Clinical Medicine, UEF, Kuopio, Finland
- Department of Orthopaedics, Traumatology and Handsurgery, Kuopio University Hospital (KUH), Kuopio, Finland
| | - Heli Koivumaa-Honkanen
- Institute of Clinical Medicine, Psychiatry, UEF, Kuopio, Finland
- Department of Psychiatry: KUH, Kuopio, South-Savonia Hospital District, Mikkeli, North Karelia Central Hospital, Joensuu, SOSTERI, Savonlinna, SOTE, Iisalmi, Lapland Hospital District, Rovaniemi, Finland
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Pakarinen M, Sinikallio S, Koivumaa-Honkanen H, Aalto T, Airaksinen O, Lehto SM, Viinamäki H. Low sense of coherence during postoperative recovery is associated with a poorer lumbar spinal stenosis - surgical outcome: A 5-year follow-up study. J Health Psychol 2015; 22:347-355. [PMID: 26430067 DOI: 10.1177/1359105315603471] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
This study investigated the association between the 3-month postoperative sense of coherence and the 5-year postoperative outcome of decompressive surgery for lumbar spinal stenosis. The participants with a lower sense of coherence at the 3-month follow-up had a poorer functional ability and lower satisfaction with surgery, higher pain ratings, lower life satisfaction and more depressive symptoms 5 years postoperatively. A low 3-month sense of coherence associated with greater pain and a poorer functional ability 5 years postoperatively. Evaluating sense of coherence and depressive symptoms in patients who have had lumbar spinal stenosis surgery may help in identifying those in need of enhanced support for postoperative recovery.
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Affiliation(s)
- Maarit Pakarinen
- 1 Kuopio University Hospital, Finland.,2 University of Eastern Finland, Finland
| | | | - Heli Koivumaa-Honkanen
- 1 Kuopio University Hospital, Finland.,2 University of Eastern Finland, Finland.,3 South-Savonia Hospital District, Finland.,4 North Karelia Central Hospital, Finland.,5 SOSTERI, Finland.,6 SOTE, Finland
| | | | | | - Soili M Lehto
- 1 Kuopio University Hospital, Finland.,2 University of Eastern Finland, Finland
| | - Heimo Viinamäki
- 1 Kuopio University Hospital, Finland.,2 University of Eastern Finland, Finland
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Depression as a prognostic factor of lumbar spinal stenosis: a systematic review. Spine J 2014; 14:837-46. [PMID: 24417814 DOI: 10.1016/j.spinee.2013.09.052] [Citation(s) in RCA: 67] [Impact Index Per Article: 6.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Revised: 09/12/2013] [Accepted: 09/27/2013] [Indexed: 02/03/2023]
Abstract
BACKGROUND CONTEXT The clinical syndrome of lumbar spinal stenosis (LSS) is a commonly diagnosed lumbar condition associated with pain and disability. Psychological factors, including depression, also affect these and other health-related outcomes. Yet, the prognostic value of depression specifically in the context of LSS is unclear. PURPOSE The aim of this systematic review was to examine the literature on depression as a prognostic factor of outcomes in patients with LSS. STUDY DESIGN Best-evidence synthesis. PATIENT SAMPLE Patients receiving the diagnosis of LSS and surgery. METHODS A best-evidence synthesis was conducted, including articles published between 1980 and May 2012. Each article meeting inclusion criteria, including a longitudinal design, was critically appraised on its methodological quality by two authors independently, who then met to reach consensus. Only studies deemed scientifically admissible were included in the review. RESULTS Among the 20 articles that met the inclusion criteria, 13 were judged scientifically admissible. The evidence supports an association between preoperative depression and postoperative LSS-related symptom severity (a combination of pain, numbness, weakness and balance issues) and disability. The effect size for these associations was variable, ranging from no effect to a moderate effect. For example, an increase of 5 points on a 63-point depression scale doubled the odds of being below the median in LSS-related symptom severity at follow-up. Findings on the association between preoperative depression and postoperative pain alone and walking capacity were more variable. CONCLUSIONS Findings support that preoperative depression is likely a prognostic factor for postoperative LSS-related symptom severity and disability at various follow-up points. The prognostic value of depression on the outcomes of pain and walking capacity is less clear. Nonetheless, depression should be considered in the clinical care of this population.
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Zani B, Prati G. Psychosocial functioning in adults with beta-thalassaemia major: Evidence for resilience. J Health Psychol 2013; 20:380-92. [DOI: 10.1177/1359105313502565] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
Our aims were to compare the psychosocial functioning of a sample of adults with beta-thalassaemia major to that of a control sample and to examine the protective role of quality of relationship with parents during adolescence and perceived quality of care. A total of 85 Italian beta-thalassaemia major participants and 73 controls completed an ad hoc questionnaire. Compared with controls, beta-thalassaemia major participants did not differ on relationships with significant others and coping strategies. Beta-thalassaemia major participants reported higher scores on job satisfaction, self-esteem and self-description. The relationship with parents during adolescence and the perceived quality of care significantly predicted higher well-being and psychosocial functioning.
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Helminen EE, Sinikallio SH, Valjakka AL, Väisänen-Rouvali RH, Arokoski JP. Effectiveness of a cognitive-behavioral group intervention for knee osteoarthritis pain: protocol of a randomized controlled trial. BMC Musculoskelet Disord 2013; 14:46. [PMID: 23356455 PMCID: PMC3626912 DOI: 10.1186/1471-2474-14-46] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/07/2012] [Accepted: 01/24/2013] [Indexed: 12/17/2022] Open
Abstract
Background Knee osteoarthritis is the most common type of arthritis, with pain being its most common symptom. Little is known about the psychological aspects of knee osteoarthritis pain. There is an emerging consensus among osteoarthritis specialists about the importance of addressing not only biological but also psychosocial factors in the assessment and treatment of osteoarthritis. As few studies have evaluated the effect of psychological interventions on knee osteoarthritis pain, good quality randomized controlled trials are needed to determine their effectiveness. Methods/Design We intend to conduct a 6-week single-blinded randomized controlled trial with a 12-month follow-up. Altogether, 108 patients aged from 35 to 75 years with clinical symptoms and radiographic grading (KL 2–4) of knee osteoarthritis will be included. The clinical inclusion criteria are pain within the last year in or around the knee occurring on most days for at least one month, and knee pain of ≥40 mm on a 100-mm visual analogue scale in the WOMAC pain subscale for one week prior to study entry. Patients with any severe psychiatric disorder, other back or lower limb pain symptoms more aggravating than knee pain, or previous or planned lower extremity joint surgery will be excluded. The patients will be randomly assigned to a combined GP care and cognitive-behavioral intervention group (n = 54) or to a GP care control group (n = 54). The cognitive-behavioral intervention will consist of 6 weekly group sessions supervised by a psychologist and a physiotherapist experienced in the treatment of pain. The main goals of the intervention are to reduce maladaptive pain coping and to increase the self-management of pain and disability. The follow-up-points will be arranged at 3 and 12 months. The primary outcome measure will be the WOMAC pain subscale. Secondary outcome measures will include self-reports of pain and physical function, a health related quality of life questionnaire, and various psychological questionnaires. Personnel responsible of the data analysis will be blinded. Discussion This study addresses the current topic of non-pharmacological conservative treatment of knee OA-related pain. We anticipate that these results will provide important new insights to the current care recommendations. Trial registration Current Controlled Trials ISRCTN64794760
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Affiliation(s)
- Eeva-Eerika Helminen
- Department of Physical and Rehabilitation Medicine, Kuopio University Hospital, P.O.B 1777 Kuopio, FI-70211, Finland.
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