Changes in Self-Esteem in Patients with Hirayama Disease and its Association with Prognosis After Anterior Cervical Fusion Procedures

Abstract

To quantify self-esteem in patients with Hirayama disease (HD) and investigate the impact of this psychosocial factor on surgical outcomes in HD. The Rosenberg Self-Esteem Scale (RSES) was measured in 58 patients with HD before anterior cervical fusion. These patients further underwent motor unit number estimation, handgrip strength, disabilities of the arm, shoulder and hand (DASH), Beck Anxiety Inventory (BAI) and Beck Depression Index (BDI) before and 18 months after operation. Furthermore, the International Physical Activity Questionnaire (IPAQ) was administered to all patients at postoperative 18-month assessments. Compared with the general population, patients with HD showed a relatively lower RSES, and RSES was negatively associated with both postoperative DASH (r=-0.431, P<0.05) and preoperative to postoperative changes (r=-0.295, P<0.05) and positively associated with IPAQ (r=0.472, P<0.05). Similar to the difference in postoperative DASH scores, more patients with low self-esteem felt postoperative aggravated motor dysfunction than those with high/normal self-esteem (P<0.05). Postoperative BDI exerted a partial mediating effect on the relationship between RSES and DASH scores (B=-0.30, P<0.05), and postoperative BAI played a partial mediating effect on the relationship between RSES and IPAQ scores (B=0.30, P<0.05). The self-esteem of HD patients may be below the population norms. Importantly, relatively low self-esteem in HD patients may cause/worsen postoperative depression and anxiety, thereby resulting in poor self-reported surgical prognosis and an inactive lifestyle after operation. Therefore, perioperative treatment and rehabilitation efforts in HD patients, especially those with low self-esteem, should account for both physiological and psychological symptoms.