Abstract
The Distress Risk Assessment Method (DRAM) was presented by Main, Wood and Hillis in 1992 as a simple means of assessing the risk of failure due to psychosocial factors in spine surgery. To our knowledge, it has not been used in our setting. The aim of this study was to analyse the usefulness of the Spanish translation of this instrument to predict poor outcomes. Methods: A prospective blind study was conducted including 65 patients undergoing spine surgery. We created two groups of patients based on DRAM score: not distressed (NDRAM) or distressed (DDRAM). A visual analogue scale for pain and the 12-Item Short Form Health Survey (SF-12) were used at baseline, 6 weeks and 6 months. Results: 24 patients were classified as DDRAM and 38 as NDRAM, with 3 patients not completing the questionnaires. The analysis found no significant differences in the demographic or clinical variables at baseline. At 6 weeks and 6 months, the NDRAM group showed improvements in low back pain (p < 0.001; p = 0.005), leg pain (p < 0.001; p = 0.017), physical health (p = 0.031; p = 0.003) and mental health (p = 0.137; p = 0.049). In contrast, in the DDRAM group, though leg pain score improved (p < 0.001; p = 0.002), there was no improvement at 6 weeks or 6 months in low back pain (p = 0.108; p = 0.287), physical health (p = 0.620; p = 0.263) or mental health (p = 0.185; p = 0.329). Conclusions: In our setting, the DRAM is a useful screening tool, and it has allowed the creation of a program between psychiatry and spine surgery.
Highlights
Back pain is a highly prevalent condition, with estimates suggesting that at least 84% of people suffer from this type of pain at some point in their life [1]
There is a paucity of data on the prevalence of spinal deformity, but Schwab et al indicated that the prevalence of adult spinal deformity is between 2 and 32% of the population [2]
Several studies have indicated that patients with psychosocial comorbidities, including depression, somatization and anxiety [6], have worse outcomes after spine surgery, including spinal fusion [7,8,9], laminectomy [10] and lumbar discectomy [4,5,11,12]
Summary
Back pain is a highly prevalent condition, with estimates suggesting that at least 84% of people suffer from this type of pain at some point in their life [1]. Several studies have indicated that patients with psychosocial comorbidities, including depression, somatization and anxiety [6], have worse outcomes after spine surgery, including spinal fusion [7,8,9], laminectomy [10] and lumbar discectomy [4,5,11,12]. Walker analysed the role of depression at 12 months after spinal disc surgery and concluded that patients with fewer depressive symptoms had significantly less clinical pain than those with more depressive symptoms [1]. Another study found that patients with fewer depressive symptoms and less work stress were more likely to return to work within 2 years after laminectomy surgery than patients who were more depressed [13]
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