57. Resilience and self-efficacy are protective psychological factors for 12-month outcomes after lumbar spine surgery

Abstract

BACKGROUND CONTEXT Psychological factors such as fear of movement negatively influence outcomes after lumbar spine surgery. Positive psychological factors like resilience and self-efficacy are considered potential protective factors that can promote recovery. PURPOSE The purpose of this study was to examine the influence of early postoperative resilience and self-efficacy on 12-month physical function, disability, pain, and physical activity after lumbar spine surgery. STUDY DESIGN/SETTING Secondary analysis of prospectively-collected data from a randomized controlled trial. PATIENT SAMPLE A total of 248 patients (mean (SD) age=62.2 (11.9) years; 51% female) who underwent laminectomy with or without fusion for a degenerative lumbar condition. OUTCOME MEASURES The primary outcomes for this study were physical function (PROMIS Physical Function), disability (Oswestry Disability Index), pain interference (PROMIS Pain Interference), back pain intensity (Numeric Rating Scale), and physical activity (acceleromoter activity counts). METHODS This was a secondary analysis of data from a multisite randomized trial comparing a postoperative cognitive-behavioral physical therapy (n=124) and education program (n=124). The primary results of the trial showed no difference in 12-month outcomes in intent-to-treat analyses. Participants completed validated outcome questionnaires at 6 weeks (baseline) and 12 months after surgery. Positive psychological factors measured at baseline were resilience (Brief Resilience Scale) and self-efficacy (Pain Self-Efficacy Questionnaire). To determine the influence of each factor independently, separate multivariable regressions (semi-partial r) were conducted for each outcome and psychological factor. Covariates in analyses included baseline outcome score, age, sex, study site, randomized group, fusion status, and fear of movement. A combined multivariable regression model was conducted for determining the most influential positive psychological factor. RESULTS In independent multivariable models, resilience was associated with 12-month physical function (r=0.19, p=0.001), disability (r=-0.14, p=0.009), pain interference (r=-0.16, p=0.006), back pain intensity (r=-0.14, p=0.02), and physical activity (r=0.12, p=0.01). Self-efficacy was associated with 12-month physical function (r=0.17, p=0.002), disability (r=-0.15, p=0.003), pain interference (r=-0.14, p = 0.01), and back pain intensity (r=-0.12, p=0.03). For both resilience and self-efficacy, higher levels were associated with higher physical function and lower disability and pain. In the combined multivariable model, only resilience was associated with 12-month physical function (r=0.12, p=0.02) and pain interference (r=-0.12, p=0.04). Both resilience (r=-0.10, p=0.05) and self-efficacy (r=-0.15, p=0.02) were associated with disability, with self-efficacy being the stronger predictor. CONCLUSIONS Early postoperative resilience and self-efficacy are consistently associated with pain-related outcomes after lumbar spine surgery, even after controlling for covariates including baseline outcome and fear of movement. When considered in a single model, resilience was the only protective factor associated with physical function and pain interference, while self-efficacy was the stronger protective factor for disability. Future work should consider how multidimensional screening tools that consider negative and positive psychological factors can enhance prognosis and treatment decision-making in patients undergoing spine surgery. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.