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Houlihan LM, Meeke J, Dunlea O, O'Sullivan MGJ, Lim C, Kaar G. Biopsychosocial variations in quality of life outcome following microdiscectomy. Surg Neurol Int 2020; 11:339. [PMID: 33194273 PMCID: PMC7656005 DOI: 10.25259/sni_449_2020] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/20/2020] [Accepted: 08/19/2020] [Indexed: 11/04/2022] Open
Abstract
Background Lumbar microdiscectomy is one of the most frequently performed neurosurgical procedures. In this review, we ask why patients' outcomes vary so widely even within the same unit, with the same surgeon performing the procedure and utilizing the technique? Methods In a cohort of 87 patients, we investigated how/whether multiple patient variables impacted outcomes following single-level lumbar microdiscectomy. We studied whether early surgical intervention improved the patients' quality of life (QOL) versus late intervention. Furthermore, we assessed other variables that could influence patient-perceived improvement. Preoperatively and postoperatively, we additionally utilized the following internationally standardized questionnaires (EQ-5D, Oswestry, and Core Outcome Measures Index [COMI]). Results A generalized substantial improvement in QOL was identified throughout the cohort population (<0.05). There was no difference in health measurement scores for those undergoing early versus late surgery. However, there was a statistically significant improvement in all QOL scores for privately insured patients versus publicly insured patients (e.g., on COMI, EQ-5D, and ODI Scores). Conclusion There was no objective statistically significant difference in QOL health scores between patients undergoing early versus late surgical lumbar microdiscectomy. This would suggest that the length of time patients is symptomatic before surgery did not significantly impact postoperative outcome. Of interest, however, was the difference in QOL health scores for private versus public patients suggesting that there are more subjective, complex, and psychosocial issues that influence outcome.
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Affiliation(s)
| | - James Meeke
- Department of Neurosurgery, Cork University Hospital, Cork, Ireland
| | - Orla Dunlea
- Department of Neurosurgery, Cork University Hospital, Cork, Ireland
| | | | - Chris Lim
- Department of Neurosurgery, Cork University Hospital, Cork, Ireland
| | - George Kaar
- Department of Neurosurgery, Cork University Hospital, Cork, Ireland
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Impact of depressive disorders on quality of life after middle ear surgery in patients with chronic otitis media. Eur Arch Otorhinolaryngol 2020; 278:3217-3225. [PMID: 33011956 PMCID: PMC8328900 DOI: 10.1007/s00405-020-06397-7] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/14/2020] [Accepted: 09/23/2020] [Indexed: 01/31/2023]
Abstract
Purpose The aim of this study was to determine whether preoperative depressive symptoms influence health-related quality of life (HRQOL) after middle ear surgery in patients with chronic otitis media (COM). Methods This prospective clinical case study was conducted at a tertiary referral center. All 102 patients who had undergone middle ear surgery for COM were assessed clinically and by audiometric testing (pure tone audiometry) in pre- and postoperative settings. Disease-specific HRQOL was assessed by the validated chronic otitis media outcome test 15 (COMOT-15) and the Zurich chronic middle ear inventory (ZCMEI-21). General HRQOL was measured using the short form 36 (SF-36). Depressive symptoms were assessed using the patient health questionnaire (PHQ-D). The Charlson comorbidity index (CCI) was used to classify comorbidities. The middle ear status was determined using the ossiculoplasty outcome parameter staging (OOPS) index. Results After middle ear surgery, the total COMOT-15 and ZCMEI-21 scores improved significantly (p < 0.001). General HRQOL (total SF-36 score) was unaffected by surgery (p < 0.05). Patients without elevated depressive symptoms had significantly better total scores for the COMOT-15 (p < 0.01), ZCMEI-21 (p < 0.001), and for SF-36 (p < 0.001) postoperatively. The results of the multiple regression analyses show that, after adjusting for the OOPS, CCI, and hearing improvement, preoperative depressiveness was significantly associated with worse postoperative COMOT-15 and ZCMEI-21 outcome scores (β = 0.425 and β = 0.362, p < 0.001). Conclusion Preoperative depressiveness was an essential predictive factor for HRQOL in patients with COM. This should be considered during patient selection to provide more suitable preoperative counseling.
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Clinical outcomes of lumbar diseases specific test in patients who undergo endoscopy-assisted tubular surgery with lumbar herniated nucleus pulposus: an analysis using the Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ). EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 30:207-213. [PMID: 31595359 PMCID: PMC7000494 DOI: 10.1007/s00590-019-02574-5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/06/2019] [Accepted: 10/01/2019] [Indexed: 11/22/2022]
Abstract
Purpose This study was to evaluate clinical outcomes using a patient-oriented test that scores health-related quality of life (HRQOL) for patients after minimally invasive surgery using microendoscopic discectomy (MED) for lumbar disc hernia. Few studies regarding MED in terms of disease-specific quality of life measures using Japanese Orthopaedic Association Back Pain Evaluation Questionnaire (JOABPEQ) have been published. Methods Retrospective analysis of the surgical and clinical outcomes with regard to reducing pain and improving the functional status for 31 patients who underwent MED for lumbar disc hernia was conducted. These patients were evaluated at 3-year follow-up. The evaluations were based on a visual analogue scale (VAS), the Japanese Orthopaedic Association (JOA) scoring system, and the JOABPEQ, which is an objective, patient-oriented test that assesses HRQOL in patients with lumbar disorders. Results A low rate of improvement was seen only in mental health until 1 year, the low rate of improvement in mental health and was independently correlated with body mass index (BMI), pre-operative scores on the Brief Scale for Psychiatric problems in Orthopaedic Patients (BS-POP), and scores on the BS-POP at 12 months post-operatively. Conclusions All categories of VAS, JOA scores, and all domains of JOABPEQ were significantly higher over 3 years than those obtained pre-operatively. But only mental health domain showed mild improvement until 1 year. Moreover, BMI showed a negative correlation with improvements in the mental health domain post-operatively. As patients may be mentally exhausted from lumbar disc herniation, pre-operative mental health may be improved by surgical treatment.
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Kim EJ, Chotai S, Schneider BJ, Sivaganesan A, McGirt MJ, Devin CJ. Effect of Depression on Patient-Reported Outcomes Following Cervical Epidural Steroid Injection for Degenerative Spine Disease. PAIN MEDICINE 2019; 19:2371-2376. [PMID: 30357417 DOI: 10.1093/pm/pny196] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Objective To assess the effect depression has on outcomes after cervical epidural steroid injections (CESIs). Design Retrospective review of a prospectively collected database. Setting Single institution tertiary care center. Subjects Fifty-seven patients with cervical spondylosis and cervical radicular pain who were deemed appropriate surgical candidates but elected to undergo CESI first were included. Methods Twenty-one of 57 (37%) patients with depression (defined as Zung Depression Scale >33) were included. Patient-reported outcomes including Neck Disability Index (NDI), numeric rating scale (NRS) for arm pain (AP), NRS for neck pain (NP), and EuroQol-5D (EQ-5D) were collected at baseline and three-month follow-up. Minimal clinically important differences were then calculated to provide dichotomous outcome measures of success. Results Overall, 24 and 28 patients achieved at least 50% improvement in AP and NP, respectively. In terms of disability, 25/57 (43.9%) patients achieved >13.2-point improvement on the NDI overall. In patients with depression, 4/21 (19.0%) and 5/21 (23.8%) achieved at least 50% improvement on the NRS for AP and NP, respectively, compared with 20/36 (55.5%) and 23/36 (63.8%) in patients without depression. This difference was statistically significant for both pain measures (P < 0.002 AP, P < 0.006 NP). Statistically fewer patients, 5/21 (24%), with depression achieved ≥13.2-point improvement on the NDI compared with 20/36 (55%) nondepressed patients (P < 0.01). There was no difference in outcomes between groups on the EQ-5D. Conclusions Patients with cervical spondylosis and comorbid depression who undergo CESI are less likely to achieve successful outcomes in both pain and function compared with nondepressed patients at three months.
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Affiliation(s)
- Elliott J Kim
- Departments of Orthopaedic Surgery.,Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Silky Chotai
- Departments of Orthopaedic Surgery.,Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Byron J Schneider
- Departments of Orthopaedic Surgery.,Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Ahilan Sivaganesan
- Departments of Orthopaedic Surgery.,Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
| | - Matthew J McGirt
- Department of Neurological Surgery, Carolina Neurosurgery and Spine Associates, Charlotte, North Carolina, USA
| | - Clint J Devin
- Departments of Orthopaedic Surgery.,Neurological Surgery, Vanderbilt University Medical Center, Nashville, Tennessee
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Comparative responsiveness of four visual analogue scales in microdiscectomy for lumbar disc herniation. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2019; 29:1199-1204. [PMID: 30955091 DOI: 10.1007/s00590-019-02429-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/04/2019] [Accepted: 04/02/2019] [Indexed: 10/27/2022]
Abstract
INTRODUCTION There is a paucity of studies reporting responsiveness of visual analogue scale (VAS) measures in patients treated by discectomy for symptomatic lumbar disc herniation. The aim of this study was to evaluate the responsiveness of different types of VAS. METHODS VAS score was measured separately for constant leg pain (VAS-LP-constant), severe episode of leg pain (VAS-LP-severe), constant backache (VAS-BP-constant) and severe episode of backache (VAS-BP-severe) in a cohort of patients undergoing discectomy surgery for sciatica. VAS was evaluated preoperatively and postoperatively at final follow-up. Responsiveness was determined using standardised response mean (SRM), effect size (ES) and the area under the curve (AUC) analysis using receiver operating characteristic curves. For AUC analysis, the success of discectomy from the patient's perspective was chosen as the external anchor. RESULTS Ninety-eight patients were included in this prospective study. Outcome was assessed at a mean follow-up of 12 weeks postoperatively. The SRM of VAS-LP-severe, VAS-LP-constant, VAS-BP-severe and VAS-BP-constant was 2.16, 2.16, 0.87 and 0.53, respectively. The ES of VAS-LP-severe, VAS-LP-constant, VAS-BP-severe and VAS-BP-constant was 3.53, 2.70, 0.89 and 0.53, respectively. The AUC of VAS-LP-severe, VAS-LP-constant, VAS-BP-severe and VAS-BP-constant was 0.88, 0.75, 0.74 and 0.59, respectively. CONCLUSION We recommend the use of VAS-LP-Severe as the most responsive VAS measure when evaluating the results of discectomy surgery for sciatica.
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Kim E, Chotai S, Stonko D, Wick J, Sielatycki A, Devin CJ. A retrospective review comparing two-year patient-reported outcomes, costs, and healthcare resource utilization for TLIF vs. PLF for single-level degenerative spondylolisthesis. 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 2017; 27:661-669. [PMID: 28585094 DOI: 10.1007/s00586-017-5142-3] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 09/19/2016] [Revised: 04/18/2017] [Accepted: 05/15/2017] [Indexed: 10/19/2022]
Abstract
PURPOSE The purpose of this study was to compare patient-reported outcomes (PROs), morbidity, and costs of TLIF vs PLF to determine whether one treatment was superior in the setting of single-level degenerative spondylolisthesis. METHODS Patients undergoing TLIF or PLF for single-level spondylolisthesis were included for retrospective analysis. EQ-5D, ODI, SF-12 MCS/PCS, NRS-BP/LP scores were collected at baseline and 24 months after surgery. 90-day post-operative complications, revision surgery rates, and satisfaction scores were also collected. Two-year resource use was multiplied by unit costs based on Medicare payment amounts (direct cost). Patient and caregiver workday losses were multiplied by the self-reported gross-of-tax wage rate (indirect cost). Total cost was used to assess mean total 2-year cost per QALYs gained after surgery. RESULTS 62 and 37 patients underwent TLIF and PLF, respectively. Patients in the PLF group were older (p < 0.01). No significant differences were seen in baseline or 24-month PROs between the two groups. There was a significant improvement in all PROs from baseline to 24 months after surgery (p < 0.001). Both groups had similar rates of 90-day complications, revision surgery, satisfaction, and similar gain in QALYs and cost per QALYs gained. There was no significant difference in 24-month direct, indirect, and total cost. CONCLUSIONS Overall costs and health care utilization were similar in both the groups. Both TLIF and PLF for single-level degenerative spondylolisthesis provide improvement in disability, pain, quality of life, and general health.
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Affiliation(s)
- Elliott Kim
- Department of Orthopaedic Surgery, Vanderbilt Spine Institute, Vanderbilt University School of Medicine, Medical Center East, South Tower, Suite 4200, Nashville, TN, 37232-8774, USA
| | - Silky Chotai
- Department of Orthopaedic Surgery, Vanderbilt Spine Institute, Vanderbilt University School of Medicine, Medical Center East, South Tower, Suite 4200, Nashville, TN, 37232-8774, USA
| | - David Stonko
- Department of Orthopaedic Surgery, Vanderbilt Spine Institute, Vanderbilt University School of Medicine, Medical Center East, South Tower, Suite 4200, Nashville, TN, 37232-8774, USA
| | - Joseph Wick
- Department of Orthopaedic Surgery, Vanderbilt Spine Institute, Vanderbilt University School of Medicine, Medical Center East, South Tower, Suite 4200, Nashville, TN, 37232-8774, USA
| | - Alex Sielatycki
- Department of Orthopaedic Surgery, Vanderbilt Spine Institute, Vanderbilt University School of Medicine, Medical Center East, South Tower, Suite 4200, Nashville, TN, 37232-8774, USA
| | - Clinton J Devin
- Department of Orthopaedic Surgery, Vanderbilt Spine Institute, Vanderbilt University School of Medicine, Medical Center East, South Tower, Suite 4200, Nashville, TN, 37232-8774, USA.
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Jabłońska R, Ślusarz R, Królikowska A, Haor B, Antczak A, Szewczyk M. Depression, social factors, and pain perception before and after surgery for lumbar and cervical degenerative vertebral disc disease. J Pain Res 2017; 10:89-99. [PMID: 28115868 PMCID: PMC5222600 DOI: 10.2147/jpr.s121328] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
OBJECTIVES The purpose of this study was to evaluate the effects of psychosocial factors on pain levels and depression, before and after surgical treatment, in patients with degenerative lumbar and cervical vertebral disc disease. PATIENTS AND METHODS The study included 188 patients (98 women, 90 men) who were confirmed to have cervical or lumbar degenerative disc disease on magnetic resonance imaging, and who underwent a single microdiscectomy procedure, with no postoperative surgical complications. All patients completed two questionnaires before and after surgery - the Beck Depression Inventory scale (I-IV) and the Visual Analog Scale for pain (0-10). On hospital admission, all patients completed a social and demographic questionnaire. The first pain and depression questionnaire evaluations were performed on the day of hospital admission (n=188); the second on the day of hospital discharge, 7 days after surgery (n=188); and the third was 6 months after surgery (n=140). RESULTS Patient ages ranged from 22 to 72 years, and 140 patients had lumbar disc disease (mean age, 42.7±10.99 years) and 44 had cervical disc disease (mean age, 48.9±7.85 years). Before surgery, symptoms of depression were present in 47.3% of the patients (11.7% cervical; 35.6% lumbar), at first postoperative evaluation in 25.1% of patients (7% cervical; 18.1% lumbar), and 6 months following surgery in 31.1% of patients (7.5% cervical; 23.6% lumbar). Patients with cervical disc disease who were unemployed had the highest incidence of depression before and after surgery (p=0.037). Patients with lumbar disc disease who had a primary level of education or work involving standing had the highest incidence of depression before and after surgery (p=0.368). CONCLUSION This study highlighted the association between social and demographic factors, pain perception, and depression that may persist despite surgical treatment for degenerative vertebral disc disease.
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Affiliation(s)
| | | | | | - Beata Haor
- Neurological and Neurosurgical Nursing Department
| | - Anna Antczak
- Neurological and Neurosurgical Nursing Department
| | - Maria Szewczyk
- Department of Surgery Nursing, Faculty of Health Science, The Ludwik Rydygier Collegium Medicum in Bydgoszcz, The Nicolaus Copernicus University,Toruń, Bydgoszcz, Poland
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Engel-Yeger B, Keren A, Berkovich Y, Sarfaty E, Merom L. The role of physical status versus mental status in predicting the quality of life of patients with lumbar disk herniation. Disabil Rehabil 2016; 40:302-308. [PMID: 27866425 DOI: 10.1080/09638288.2016.1253114] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/20/2022]
Abstract
PURPOSE To explore the role of physical status versus mental status in predicting the quality of life (QOL) of patients with lumbar disk herniation (LDH). METHOD In this correlative study 51 patients with LDH were recruited in their conservative stage of treatment. After profiling their physical status, all participants reported about pain level (according to VAS), pain perception using the Pain Catastrophizing Scale (PCS), and disability level (according to Oswestry Low Back Pain Disability Questionnaire). Their mental status was evaluated using the Spielberger's State-Trait Anxiety Inventory (STAI) and the Beck Depression Inventory (BDI-II). Their QOL was evaluated by the World Health Organization Quality of Life Questionnaire, brief version (WHOQOL-BREF). RESULTS Physical status/disability level correlated with anxiety and depression. While Physical status predicted physical QOL, mental status, and mainly anxiety and depression were the significant predictors of psychological, social, and environmental QOL. CONCLUSIONS Mental status may play a significant role in reducing most QOL domains among patients with LDH. The evaluation and intervention process should consider both physical and mental status and their relation to the person's QOL. Since QOL is a major parameter in determining intervention type and success this elaborated perspective may contribute to the intervention planning and outcomes. Implications for rehabilitaion A significant mental distress may accompany the physical disability of patients with LDH. The role of this mental distress in reducing the QOL of patients with LDH may be greater than that of their physical disability. The evaluation and intervention for patients with LDH should refer to both physical and mental status and explore their impacts on quality of life in order to elevate intervention success.
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Affiliation(s)
- Batya Engel-Yeger
- a Department of Occupational Therapy, Faculty of Social Welfare and Health Sciences , University of Haifa , Haifa , Israel
| | - Amit Keren
- b Rambam Health Care Campus , Orthopedic Spine Unit , Haifa , Israel
| | - Yaron Berkovich
- b Rambam Health Care Campus , Orthopedic Spine Unit , Haifa , Israel
| | - Elad Sarfaty
- c The Ruth and Bruce Rappaport Faculty of Medicine , Technion , Haifa , Israel
| | - Lior Merom
- b Rambam Health Care Campus , Orthopedic Spine Unit , Haifa , Israel.,d Assuta Medical Center , Haifa , Israel
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Dorow M, Löbner M, Stein J, Pabst A, Konnopka A, Meisel HJ, Günther L, Meixensberger J, Stengler K, König HH, Riedel-Heller SG. The Course of Pain Intensity in Patients Undergoing Herniated Disc Surgery: A 5-Year Longitudinal Observational Study. PLoS One 2016; 11:e0156647. [PMID: 27243810 PMCID: PMC4887011 DOI: 10.1371/journal.pone.0156647] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/03/2016] [Accepted: 05/17/2016] [Indexed: 12/02/2022] Open
Abstract
Objectives The aims of this study are to answer the following questions (1) How does the pain intensity of lumbar and cervical disc surgery patients change within a postoperative time frame of 5 years? (2) Which sociodemographic, medical, work-related, and psychological factors are associated with postoperative pain in lumbar and cervical disc surgery patients? Methods The baseline survey (T0; n = 534) was conducted 3.6 days (SD 2.48) post-surgery in the form of face-to-face interviews. The follow-up interviews were conducted 3 months (T1; n = 486 patients), 9 months (T2; n = 457), 15 months (T3; n = 438), and 5 years (T4; n = 404) post-surgery. Pain intensity was measured on a numeric rating-scale (NRS 0–100). Estimated changes to and influences on postoperative pain by random effects were accounted by regression models. Results Average pain decreased continuously over time in patients with lumbar herniated disc (Wald Chi² = 25.97, p<0.001). In patients with cervical herniated disc a reduction of pain was observed, albeit not significant (Chi² = 7.02, p = 0.135). Two predictors were associated with postoperative pain in lumbar and cervical disc surgery patients: the subjective prognosis of gainful employment (p<0.001) and depression (p<0.001). Conclusion In the majority of disc surgery patients, a long-term reduction of pain was observed. Cervical surgery patients seemed to benefit less from surgery than the lumbar surgery patients. A negative subjective prognosis of gainful employment and stronger depressive symptoms were associated with postoperative pain. The findings may promote multimodal rehabilitation concepts including psychological and work-related support.
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Affiliation(s)
- Marie Dorow
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
- * E-mail:
| | - Margrit Löbner
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Janine Stein
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Alexander Pabst
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
| | - Alexander Konnopka
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Hans J. Meisel
- Department of Neurosurgery, Berufsgenossenschaftliche Kliniken Bergmannstrost, Halle (Saale), Germany
| | - Lutz Günther
- Department of Neurosurgery, Klinikum St. Georg gGmbH, Leipzig, Germany
| | | | - Katarina Stengler
- Department of Psychiatry and Psychotherapy, University of Leipzig, Leipzig, Germany
| | - Hans-Helmut König
- Department of Health Economics and Health Services Research, University Medical Center Hamburg-Eppendorf, Hamburg, Germany
| | - Steffi G. Riedel-Heller
- Institute of Social Medicine, Occupational Health and Public Health, University of Leipzig, Leipzig, Germany
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Responsiveness of depression and its influence on surgical outcomes of lumbar degenerative diseases. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2015; 25 Suppl 1:S35-41. [DOI: 10.1007/s00590-015-1651-0] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/31/2015] [Accepted: 05/14/2015] [Indexed: 01/22/2023]
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Asher R, Mason AE, Weiner J, Fessler RG. The Relationship Between Preoperative General Mental Health and Postoperative Quality of Life in Minimally Invasive Lumbar Spine Surgery. Neurosurgery 2015; 76:672-9. [DOI: 10.1227/neu.0000000000000695] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023] Open
Abstract
Abstract
BACKGROUND:
In assessing poor lumbar surgery outcomes, researchers continue to investigate psychosocial predictors of patient postoperative quality of life. This is the first study of its kind to investigate this relationship in an exclusively minimally invasive patient sample.
OBJECTIVE:
To determine the association between preoperative mental health and postoperative patient-centered outcomes in patients undergoing minimally invasive lumbar surgery.
METHODS:
In 83 adults undergoing single-level minimally invasive lumbar spine surgery, Pearson correlation and partial correlation analyses were conducted between all demographic and clinical baseline variables and Oswestry Disability Index (ODI), Visual Analogue Scale (VAS), and 36-item Short-Form Health Survey Version 2.0 (SF-36v2) scores at 6 to 12 months postoperatively. SF-36v2 mental component summary scores (MCS) were used to assess pre- and postoperative general mental health. Post hoc analysis consisted of Pearson correlations between baseline SF-36v2, ODI, and VAS scores, and an identical set of correlations at outcomes.
RESULTS:
Preoperative MCS showed no significant association with outcomes VAS, ODI, or physical component summary scores. Baseline disability correlated significantly and more strongly with baseline MCS (P < .001, r = −0.40) than baseline pain levels (VAS back not significant, VAS leg P = .015, r = 0.27). Outcomes disability correlated significantly and more strongly with outcome back and leg pain levels (P < .001, r = 0.60 and 0.66) than outcome MCS (P = .031, r = −0.24).
CONCLUSION:
In a patient sample with mental health scores comparable to the population mean, there is no relationship between preoperative general mental health and postoperative patient-centered outcomes. Surgeons should consider the dynamic relationships between patient disability, mental health, and pain levels in assessing quality of life at different time points.
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Affiliation(s)
- Rachel Asher
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois
| | - Ashley E. Mason
- Osher Center for Integrative Medicine, Department of Medicine, University of California at San Francisco, San Francisco, California
| | - Joseph Weiner
- Northwestern University Feinberg School of Medicine, Chicago, Illinois
| | - Richard G. Fessler
- Department of Neurological Surgery, Rush University Medical Center, Chicago, Illinois
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Bragazzi NL, Puente GD, Natta WM. Somatic perception, cultural differences and immigration: results from administration of the Modified Somatic Perception Questionnaire (MSPQ) to a sample of immigrants. Psychol Res Behav Manag 2014; 7:161-6. [PMID: 24966706 PMCID: PMC4062560 DOI: 10.2147/prbm.s55393] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022] Open
Abstract
The number of immigrants in Italy has doubled every 10 years from 1972 and Genoa hosts two large communities of immigrants from South America and Africa. We investigated differences in the somatic perception between immigrants and Italians and between South Americans and Africans living in the city of Genoa. During a 7 month period, an anonymous questionnaire asking for sociodemographic information and the Modified Somatic Perception Questionnaire (MSPQ) were administered to all immigrants accessing an outpatient clinic or the general practitioners offices. MSPQ mean scores were significantly higher in immigrant patients than in Italian patients, after adjusting for sex and age differences. We found no differences between South Americans and Africans in MSPQ score. The tendency to express discomfort through physical symptoms appears to be related to being a foreigner who arrived in Italy through a migratory trip and also to being a person who comes from a cultural context that is very different from the one of developed countries.
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Affiliation(s)
- Nicola Luigi Bragazzi
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Giovanni Del Puente
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy
| | - Werner Maria Natta
- Department of Neuroscience, Rehabilitation, Ophthalmology, Genetics, Maternal and Child Health, Section of Psychiatry, University of Genoa, Genoa, Italy
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Beneck GJ, Popovich JM, Selkowitz DM, Azen S, Kulig K. Intensive, progressive exercise improves quality of life following lumbar microdiskectomy: a randomized controlled trial. Clin Rehabil 2014; 28:892-901. [DOI: 10.1177/0269215514525059] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/22/2023]
Abstract
Objective: The purpose of the study was to examine changes in quality of life measures in patients who have undergone an intensive exercise program following a single level microdiskectomy. Design: Randomized controlled trial with blinded examiners. Setting: The study was conducted in outpatient physical therapy clinics. Subjects: Ninety-eight participants (53 male, 45 female) who had undergone a single-level lumbar microdiskectomy allocated to receive exercise and education or education only. Interventions: A 12-week periodized exercise program of lumbar extensor strength and endurance training, and mat and upright therapeutic exercises was administered. Outcome measures: Quality of life was tested with the Short Form 36 (SF-36). Measurements were taken 4–6 weeks postsurgery and following completion of the 12-week intervention program. Since some participants selected physical therapy apart from the study, analyses were performed for both an as-randomized (two-group) design and an as-treated (three-group) design. Results: In the two-group analyses, exercise and education resulted in a greater increase in SF-36 scales, role physical (17.8 vs. 12.1) and bodily pain (13.4 vs. 8.4), and the physical component summary (13.2 vs. 8.9). In the three-group analyses, post-hoc comparisons showed exercise and education resulted in a greater increase in the SF-36 scales, physical function (10.4 vs. 5.6) and bodily pain (13.7 vs. 8.2), and the physical component summary (13.7 vs. 8.9) when compared with usual physical therapy. Conclusions: An intensive, progressive exercise program combined with education increases quality of life in patients who have recently undergone lumbar microdiskectomy.
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Affiliation(s)
- George J Beneck
- Department of Physical Therapy California State University Long Beach, Long Beach, CA, USA
| | - John M Popovich
- Center for Orthopedic Research, Michigan State University, East Lansing, MI, USA
| | - David M Selkowitz
- Department of Physical Therapy Education, Western University of Health Sciences, Pomona, CA, USA
| | - Stan Azen
- Department of Preventive Medicine, University of Southern California, Los Angeles, CA, USA
| | - Kornelia Kulig
- Division of Biokinesiology and Physical Therapy, University of Southern California, Los Angeles, CA, USA
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Li T, Han D, Liu B, Zhang X, Wang P, Qiu Y. Clinical assessment of reformed lumbar microdiscectomy. EUROPEAN JOURNAL OF ORTHOPAEDIC SURGERY AND TRAUMATOLOGY 2012; 24:23-7. [DOI: 10.1007/s00590-012-1123-8] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/14/2012] [Accepted: 10/21/2012] [Indexed: 11/28/2022]
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15
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Shamim MS. Disability, Depression and Disc Surgery: Lets be Careful with the Evidence. Anesth Pain Med 2011; 1:105-6. [PMID: 25729669 PMCID: PMC4335736 DOI: 10.5812/kowsar.22287523.2015] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/05/2011] [Revised: 08/15/2011] [Accepted: 08/20/2011] [Indexed: 10/25/2022] Open
Affiliation(s)
- Muhammad Shahzad Shamim
- Neurosurgery Department, Aga Khan University Hospital, Karachi, Pakistan
- Corresponding author: Muhammad Shahzad Shamim, Neurosurgery Department, Aga Khan University Hospital, Karachi, Pakistan. Tel: +92- 3002542530, E-mail:
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