Abstract
Background Context: Patient demographic and medical indicators influence the well-being of spine surgery patients. It may, however, be worthwhile to evaluate other lifestyle and attitudinal factors. We hypothesized that such factors would explain at least as much variance in outcome as more commonly considered covariates. Purpose: To compare explained variance in outcome of lifestyle and attitudinal factors as compared to standard demographic and medical covariates. Study Design/Setting: Cross-sectional observational study of patients drawn from an active clinic and internet-based support group. Patient Sample: A heterogeneous sample of 376 patients was recruited, comprised of people with diagnoses of cervical (n = 80), lumbar (n = 228), and scoliosis (n = 68) spine disorders. Outcome Measures: Quality of Life (QOL) outcomes were measured using the Oswestry Disability Index, Neck Disability Index, Rand-36, PROMIS Pain Impact, NRS Back and Leg Pain, Scoliosis Research Society-22r, and Global Health. Methods: This study compared explained variance in QOL outcomes in demographic and medical versus lifestyle and attitudinal factors. Demographic and medical factors included age, gender, body mass index, and co-morbidities. Lifestyle factors included exercise and commuting practice. Attitudinal factors related to social connectedness: giving and receiving emotional support, feeling overwhelmed by others’ needs, helping orientation, and general helping behaviors. Regression analyses estimated explained variance. Patient groups differed in most factors evaluated, so the regression analyses were computed separately by group. R2 statistics were characterized as null, small (0.02), medium (0.15), and large (0.35) effect sizes (ES), and proportions were compared for the medical/demographic versus lifestyle/attitudinal factors by group. Results: Similar proportions of variance were explained by demographic/medical and lifestyle/attitudinal covariates across groups, with half of effect sizes being small in magnitude and 6% being medium. Lumbar patients tended to have more small effect sizes among lifestyle and attitudinal covariates than among medical/demographic covariates (z = – 1.29, p < 0.10). Similar patterns were found for both generic and disease-specific outcomes. Conclusions: Spine surgery outcome research should investigate lifestyle and attitudinal factors to enhance the personal and salutogenic relevance of the research. Time spent commuting, exercise practice, and social connectedness appear to be relevant factors. A pre-operative evaluation of overweight and smoking status, limited social connectedness, and long daily commutes could alert the surgeon to delay or avoid performing procedures on these patients to avoid poor outcomes.
Highlights
Background ContextPatient demographic and medical indicators influence the well-being of spine surgery patients
Scoliosis patients reported the longest time since surgery, with a mean of over 13 years as compared to a mean of about 2 years in the cervical and lumbar patients
Scoliosis patients had a higher number of surgeries as compared to the cervical and lumbar patients
Summary
Background ContextPatient demographic and medical indicators influence the well-being of spine surgery patients. Measurement science has extended such work to facilitate the interpretation of changes in outcomes in terms of their clinical significance [1,2,3], and has paved the way for evidence-based clinical treatment guidelines [4,5,6] As part of this evolution, studies in spine research have documented a wide range of factors that influence treatment outcome, including medical factors (e.g., co-morbidities [7]), sociodemographic factors [8] (e.g., gender, age), and behavioral factors [8,9] (workers’ compensation status [10,11]). A recent book on psychological factors related to spine surgery noted a cluster of about ten psychosocial and medical risk factors with sufficient empirical documentation to merit continued consideration [8] Such factors included psychological or personality factors (e.g., hostility, anxiety, depression, history of psychological disturbance), behavioral factors (e.g., smoking, substance abuse, worker’s compensation status, obesity), social support, and attitudinal factors (e.g., job dissatisfyaction) [8]. We believe that more research on psychosocial factors in spine outcome research is warranted, and present preliminary findings to support this recommendation
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