Thursday, September 27, 2018 1:05 PM–2:05 PM Understanding Anxiety and Depression when Performing Spine Surgery: 121. Patient activation buffers the adverse impact of psychosocial risk factors on spine surgery and spinal cord stimulation

Abstract

BACKGROUND CONTEXT A growing body of research demonstrates that psychosocial factors can have adverse impacts on the outcome of spine surgery (SS) and spinal cord stimulation (SCS). Research using the Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) has found that problems such as demoralization, elevated somatic focus, malaise, family conflicts are associated with poorer SS and SCS results. More recently, another characteristic, “patient activation” – the extent to which patients are engaged and active in their own health care – has been found to be associated with improved spine surgery results. PURPOSE The purpose of this study is to assess whether patient activation can mitigate the adverse impacts of established psychosocial risk factors on the outcomes of SS and SCS. STUDY DESIGN/SETTING Prospective mediation design in which candidates for SS and SCS underwent a presurgical psychological evaluation including baseline psychometrics, and completed baseline outcome measures. Patients completed follow-up measures at an average of 5 months postop PATIENT SAMPLE A total of 581 patients who underwent either SS (70.7%) or SCS 29.3%. Mean age 50.2, Mean education level 13.53. 40.6% men, 50.4% women. OUTCOME MEASURES Oswestry Disability Index, Likert-Scale ratings of Pain, Negative Emotions, Satisfaction with surgery results. METHODS At baseline all patients underwent presurgical psychological evaluation, which included a diagnostic interview, review of medical records and psychometric testing including the MMPI-2-RF. Patients also completed the Patient Activation Measure (PAM). Correlations between baseline psychometric testing results and outcomes were obtained. RESULTS Results confirmed previous research demonstrating that multiple MMPI-2-RF, especially those that assess demoralization, malaise and somatic complaints, are significantly associated with poorer postop improvement in function (Oswestry score), higher levels of pain and reduced satisfaction with results. On the other hand, higher levels of patient activation (as assessed by PAM) were correlated with greater postop functional ability and greater outcome satisfaction (but did not impact reported pain level). Mediation analyses indicated that PAM scores significantly attenuated the negative impact of MMPI-2-RF factors on both functional improvement and outcome satisfaction. CONCLUSIONS Extensive research indicates that certain psychosocial factors are associated with negative outcomes of spine surgery and spinal cord stimulation. The current results indicate that patient activation—patient's involvement in obtaining information, decision making and resilience during times of stress—can mitigate such adverse effects. Presurgical psychological evaluations should include examination of patient strengths in additional to psychosocial risk factors, so that treatments can be appropriately individualized and the most effective surgical results obtained. FDA DEVICE/DRUG STATUS This abstract does not discuss or include any applicable devices or drugs.