Somatic Perception Questionnaire Research Articles

The Association Between Mental Disorders and Postoperative Outcomes of Scoliosis Surgery: A Systematic Review and Meta-analysis.

Mental disorders may adversely impact postoperative recovery in scoliosis surgery. However, study findings have been inconsistent and a systematic synthesis is lacking. We searched PubMed, Embase, PsycINFO, and Cochrane Library for studies examining associations between preoperative mental disorders, assessed by various scales, such as the Patient Health Questionnaire (PHQ), the Modified Somatic Perception Questionnaire (MSPQ), and the State-Trait Anxiety Inventory (STAI), and postoperative outcomes, such as pain, disability, quality of life, and satisfaction, in scoliosis surgery. Random-effects meta-analyses pooled standardized mean differences (SMDs) in postoperative outcomes between patients with and without mental disorders. Twelve observational studies were included for the systematic review, and 5 studies were included in the meta-analysis. The meta-analysis demonstrated significantly worse postoperative outcomes in patients with mental disorders compared to those without (SMD -1.96, 95% confidence interval [CI] -3.08 to -0.84, P < 0.001). Significant heterogeneity was present (I2 = 76%). Review of included studies found mental disorders linked to higher preoperative pain/disability and lower quality of life/satisfaction, as well as worse postoperative scores on these outcomes. Moderating factors identified included mental disorder severity, treatment specifics, and patient demographics. Preoperative mental disorders, especially depression and anxiety, are associated with significantly worse postoperative pain, disability, quality of life, and satisfaction in scoliosis surgery. This association may be mediated by psychological factors, such as catastrophizing, self-criticism, and kinesiophobia, and biological factors, such as inflammation, neuroendocrine changes, and central sensitization. Routine psychological screening and interventions for high-risk patients may improve postoperative outcomes but not necessarily surgical effectiveness. Further research is warranted to confirm these findings and elucidate optimal treatment approaches.

The effects of psychological distress after surgery in patients undergoing lumbar spinal fusion

BackgroundThe aim of this study was to evaluate the psychological distress pre-operatively, at 3, 6, and 12 months in patients who underwent lumbar spine fusion surgery.MethodsA total of 440 patients received instrumented lumbar spine fusion were enrolled. Psychological distress was evaluated using the Modified Somatic Perception Questionnaire (MSPQ) and the Modified Zung Depressive Index (ZDI). The results of lumbar fusion surgery were evaluated using the Oswestry Disability Index (ODI), the Japanese Orthopedic Association (JOA-29), and the visual analog scale (VAS).ResultsPsychological distress was reported among 23% of patients and 7, 5.5, and 4.0% of the patients preoperatively, at 3, 6, and 12 months after lumbar surgery, respectively. The mean MSPQ score decreased from 8.78 (before surgery) to 4.30, 3.52, and 3.43 at 3, 6 and 12 months in after surgery, respectively, in patients with psychological distress patients (p < 0.001). The mean ZDI score decreased from 17.78 to 12.48, 10.35, and 9.61 (p < 0.001). The mean ODI score decreased from 22.91 to 11.78, 10.13, and 9.96 (P < 0.001). The mean JOA score increased from 13.65 to 22.30, 23.43, and 23.61 (P < 0.001). The mean low back pain (LBP) VAS score decreased from 4.48 to 1.96, 1.52, and 1.51 (P < 0.001); moreover, the mean leg pain (LP) VAS score decreased from 5.30 to 1.30, 1.04, and 1.03 (P < 0.001).ConclusionsPatients with psychological distress may experience surgical intervention benefits equal to those of ordinary patients. Moreover, reduced pain and disability after surgical intervention may also alleviate psychological distress. Hence, we highly recommend that patients with psychological distress undergo surgical intervention as normal patients do, but appropriate screening measures and interventions are necessary.

Spine Surgeon Assessments of Patient Psychological Distress are Inaccurate and Bias Treatment Recommendations.

Prospective cohort study. This study determined (1) the surgeon accuracy of psychological assessment in patients in spine clinic, (2) the impact of psychological distress on surgical recommendation, and (3) the correlation between patient-reported disability and psychological distress. Psychological distress is common among patients presenting for spine surgery. Surgeon estimations of patients' distress may influence treatment recommendations, but little is known as to whether these assessments accurately mirror patient-perceived psychological distress. A sample of new patients was recruited from an academic spine center. Prior to their initial consultation, patients completed the Modified Somatic Perception Questionnaire and Zung Depression Index to assess mental and physical manifestations of distress, which generated a Distress and Risk Assessment Method (DRAM) score of N (normal), R (at risk), or D (distressed). The Oswestry Disability Index and Neck Disability Index scores were also collected. Surgeons provided their estimates of the DRAM score after the visit and indicated their surgery recommendation. Of 296 patients, 40.5% reported some level of psychological distress (DRAM=R) and 15.9% had a high level of distress (DRAM=D). All three surgeons' ability to accurately assess the participant DRAM score was poor, with an overall kappa of 0.13 (0.08-0.18), biased toward underestimating the patient's true level of psychological distress. Patients rated as normal (N) by the surgeon were 3.78 times more likely to be recommended for surgery compared to those assessed as distressed (D) ( P =0.007). Patients with higher DRAM scores had higher Oswestry Disability Index ( P =0.008) and Neck Disability Index ( P =0.005) scores compared to those with lower DRAM scores. Spine surgeons have limited ability to detect psychological profiles in patients, with a tendency to underestimate levels of distress. The finding that these inaccurate assessments influence surgical recommendations underscores the importance of limiting surgeon bias in the decision-making process. Diagnostic Level 2.

Psychological Profile and Social Behaviors of Patients with Hyperacusis.

Increased noise sensitivity refers to the abnormal subjective response to external sounds, with a prevalence of between 8% and 15.2% in the adult population as suggested by epidemiological studies. The basic neural mechanism of hyperacusis still remains obscure, so therapies for this often-devastating symptom remain elusive. The aim of this study was to assess psychological profiles in patients with presbycusis without tinnitus in a perspective case-control design. All subjects were initially submitted to audiological evaluation (tympanometry, recordings of the acoustic reflex thresholds, pure tone audiometry) and subsequently were administered the following questionnaires: the hyperacusis questionnaire (HQ), the brief symptom inventory (BSI), and the modified somatic perception questionnaire (MSPQ). Patients with hyperacusis reported a total score and subscales (attentional, social, and emotional) of the HQ significantly higher than controls. They also reported higher scores of the MSPQ and significantly higher mean values with concern to the somatization, obsessive-compulsive, interpersonal sensitivity, depression, and anxiety subscales of the BSI. These results show that psychological distress, as expressed by higher level of somatic attention, somatization, anxiety, and depression, is a significant factor to consider for a complete diagnosis and effective treatment of hyperacusis. For a correct diagnosis of patients seeking help for hyperacusis, their psychological distress should also be assessed, regardless of their hearing abilities. Further studies are required to investigate the pathological mechanisms that are involved in the onset of hyperacusis in patients with normal hearing and those with sensorineural hearing loss.

Role of psychological distress screening in predicting the outcomes of epidural steroid injection in chronic low back pain

BackgroundThere is a paucity of studies investigating relationship between psychological distress and effectiveness of epidural steroid injection in patients with chronic lower back pain (CLBP). AimsThis prospective cohort study assessed whether the outcome can be predicted in CLBP patients undergoing epidural injection by pre-treatment psychological stress stratification using objective screening methods. Methods96 patients with CLBP were recruited to this prospective cohort study. Preoperative level of psychological distress was measured using Modified Zung Index (MZI) and Modified Somatic Perception Questionnaire (MSPQ); pain with Visual Analogue Score (VAS) and McGill Pain Questionnaire (MPQ) and back pain related disability with Oswestry Disability Index (ODI). Fluoroscopic caudal epidural steroid injection comprising 80 mg methylprednisolone and 8 mg of lignocaine was performed. Scores were repeated at 6, 12, and 26 weeks. Successful outcome was Minimal Clinically Important Change (MCIC) in any given measure. ResultsThere were 60 (62.5%) not-distressed patients, 3(3.1%) purely somatising, 15(15.6%) depressed and 18(18.8%) with mixed distress. Preoperative VAS was 82.4, MPQ 18.2 and ODI 51.6. Average VAS and MPQ improved significantly at 6 and 26 weeks. Average magnitude of change of VAS and ODI did not differ between distressed and not-distressed. MPQ improved significantly more in the distressed. MZI was negatively associated with VAS MCIC at 6 weeks and 6 months but it failed to predict the outcome independently. MSPQ was the only individual predictor of MPQ-MCIC at any time; MSPQ≥8 could predict MPQ-MCIC at 6 months with 53%-sensitivity and 78%-specificity. None of psychological measures used showed a significant predictive value of ODI at any follow-up point ConclusionsPsychological distress may predict response only in certain outcome measures in patients suffering from nonspecific CLBP. If the interest lied primarily in pain and functional improvement, the psychological distress failed to discriminate the results at 6 months.

Validity of the Somatic Complaints Scales of the MMPI-2-RF in an Outpatient Chronic Pain Clinic.

Chronic pain has become a significant medical issue. The Minnesota Multiphasic Personality Inventory-2-Restructured Form (MMPI-2-RF) is a broadband psychological test that has been validated for use across various medical settings and can aid in the assessment and treatment planning of chronic pain. In the current investigation, it was hypothesized that the somatic complaints scales of the MMPI-2-RF would demonstrate good convergent validity from a structured psychodiagnostic interview and other measures of pain and somatization, and lack gender bias. Patients (n = 200) who produced valid MMPI-2-RFs in an outpatient chronic pain clinic were included in the study. Patients were also administered the Modified Somatic Perception Questionnaire (MSPQ), Pain Disability Index (PDI), and the Structured Clinical Interview for DSM-IV-TR (SCID). Zero-order and partial correlations (controlling for gender) were calculated between MMPI-2-RF scale scores and other criteria. Stepdown hierarchical regression analyses were used to detect bias. By and large, higher scale scores on the somatic/cognitive scales of the MMPI-2-RF were modestly or substantially correlated with MSPQ scores, PDI scores, and SCID Somatization symptom count, even after controlling for gender. Regression analyses suggested that the MMPI-2-RF scale scores were not biased as a function of gender. These findings support the validity of specific MMPI-2-RF scales to help identify somatization and psychosocial functioning among patients with chronic pain. Identification of somatization early within the course of treatment of chronic pain may help focus treatment targets, including referrals for psychological interventions such as cognitive behavior therapy for chronic pain.

The Modified Somatic Perception Questionnaire: Operating characteristics in non-pain forensic samples

The objective of the current archival study was to investigate the ability of the Modified Somatic Perception Questionnaire (MSPQ) to discriminate between noncredible and credible neurocognitive dysfunction in a large mixed non-pain forensic sample comprised of personal injury litigants and disability claimants. Participants included 149 adults who underwent comprehensive neuropsychological examination. Criterion groups were formed, i.e., Credible Group (CG), or Noncredible Group (NCG) based upon their performance on stand-alone performance validity tests (PVT) including the Word Memory Test (WMT), and/or Test of Memory Malingering (TOMM), and Victoria Symptom Validity Test (VSVT). After excluding examinees with evidence of somatization participants in the NCG scored significantly higher on the MSPQ compared to participants in the CG. Scores on the MSPQ were not only related to cognitive performance validity but also amplified by the co-existence of somatization. There were no significant effects of gender, age, or race on MSPQ scores. We conclude that the MSPQ demonstrates external validity as a self-report measure of symptom validity that is sensitive to somatic and autonomic complaints in non-pain forensic samples. Future research is needed to develop MSPQ cutscores with external validity pertinent to other non-pain populations.

Exploring predictors of first appointment attendance at a pain management service.

Individual characteristics such as gender, employment and age have been shown to predict attendance at pain management services (PMS). The characteristics of those who drop out of pain management programmes have also been explored, but as yet no studies have analysed the characteristics of those who do not attend the service following referral. To explore the characteristics and predictors of those who attend and those who do not attend their first appointment with a PMS. Predictive factors in the two groups - attenders (n = 425) and non-attenders (n = 69) - were explored using logistic regression. Non-attendance was significantly predicted by the patient being a smoker and the appointment being in the morning. Non-attenders also scored higher on the Modified Somatic Perception Questionnaire, indicating higher levels of somatic pain. Predictors of non-attendance were different from those for individuals who drop out of pain services. Implications and recommendations are made for PMS.

Translation, Cross-cultural Adaptation and Reliability of Brazilian portuguese version of the DRAM Questionnaire for Psychometric Evaluation in Low Back Pain.

Objective Based on studies regarding pain physiology and its relation to emotional distress conditions, psychological evaluation became essential to determine the most favorable patient profiles to distinct therapeutic approaches. The Distress Risk Assessment Method (DRAM) has been developed as a screening instrument for patients with lumbar pain, classifying them in subgroups as normal, at risk, distressed somatic and distressed depressive, based on the two components of DRAM scores (Modified Somatic Perception Questionnaire [MSPQ] and Zung questionnaires). The objective of the present study is to translate and culturally adapt the DRAM to the Brazilian Portuguese language, and to determine the reliability of the final version. Methods As proposed by the International Quality of Life Assessment (IQOLA) method, a Brazilian Portuguese version of the DRAM has been applied to a sample of 85 individuals from 3 participant centers. Results The results confirmed the reliability and reproducibility of the DRAM in its Brazilian Portuguese final version: Cronbach alpha of 0.815 (MSPQ) and 0.794 (Zung) and intraclass correlation coefficient (ICC) of 0.688 (MSPQ) and 0.659 (Zung). Conclusion The presented DRAM version in Brazilian Portuguese is reliable and is available to clinical practice use.

Utility of Anxiety/Depression Domain of EQ-5D to Define Psychological Distress in Spine Surgery

Prospective patient-reported outcomes (PROs) registries are central to emerging evidence-driven reform models. These registries entail significant operator and responder burden to capture PROs data. It is important to limit the number of PROs administered. We sought to determine whether the anxiety/depression domain of EQ-5D could be used to define preoperative psychological distress in patients undergoing elective spine surgery. Patients undergoing elective spine surgery and enrolled into a prospective registry were analyzed. The 12-Item Short-Form Health Survey Mental Component Summary, Zung depression scale, Modified Somatic Perception Questionnaire, and EQ-5D were completed. The anxiety/depression domain of EQ-5D was used to define psychological distress; responses were captured as 1) not anxious or depressed, 2) moderately anxious or depressed, or 3) extremely anxious or depressed. Univariate correlation and proportional odds logistic regression analyses were conducted. Of 2470 included patients undergoing elective spine surgery, 45% (n= 1109) reported no psychological distress, 47% (n= 1168) reported moderate psychological distress, and 8% (n= 193) reported extreme psychological distress on EQ-5D. Psychological distress on EQ-5D had positive correlation with Zung depression scale (P < 0.0001, r= 0.620) and Modified Somatic Perception Questionnaire (P < 0.0001, r= 0.450) and negative correlation with 12-Item Short-Form Health Survey Mental Component Summary (P < 0.0001, r=-0.662). In proportional odds logistic regression models, EQ-5D psychological distress had significant correlations with 12-Item Short-Form Health Survey Mental Component Summary (P < 0.0001, C-index= 0.831), Zung depression scale (P < 0.0001, C-index= 0.802), and Modified Somatic Perception Questionnaire (P < 0.0001, C-index= 0.711). The anxiety/depression domain of EQ-5D could be used to categorize preoperative psychological distress. Spine registries could use this information to potentially limit the number of validated PROs administered.

Relationship between osteoarthritis of the knee and life-stressing events among Nigerians with knee osteoarthritis

Osteoarthritis (OA) of the knee is one of the most frequent musculoskeletal disorders that physicians do attend to in healthcare facilities. Knee OA is associated with psychological and medical challenges like depression, life-stressing events and pain. This study was carried out to determine the relationship between knee OA and life-stressing events among adults Nigerians with knee OA. Participants with knee OA were recruited consecutively from selected hospitals in Kano State, Nigeria. Western Ontario Macmaster Universities Index of Osteoarthritis (WOMAC), the Modified Somatic Perception Questionnaire and Social Readjustment Rating Scale Questionnaire were administered on the participants to access their pain, somatic complaints and lie-stressing events. Test of normality was carried out using Shapiro Wilk test and showed that the data was not normally distributed. The data was further subjected to descriptive statistics of mean, standard deviation, Spearman Rho and linear regression. A total number of 108 OA of the knee individuals consented and participated in the study of which 62.04% (67) were females while 37.96% (41) were males. The mean WOMAC scores for the whole group was 15.8 (SD=10.6) and there were significant differences in WOMAC score, SES and Somatic perception between male and female. There was positive significant relationship between SRS and emotional function (r=0.331) among male participants. Although, there was no significant association between WOMAC and life stressing events among female participants, but there were positive significant relationships between emotional function and pain (r=0.376), emotional function and stiffness (r=0.328), somatic perception and pain (r=0.286), somatic perception and emotional function (r=0.588) as well as SRS and emotional function (r=0.257). This study shows that there was relationship between somatic perception, life-stressing event and OA of the knee among adult Nigerians with knee osteoarthritis. There were also differences in knee OA, SES and somatic perception between male and female participants. Keywords: Osteoarthritis, life stressing, somatic, perception, knee

Examination of the Modified Somatic Perception Questionnaire (MSPQ) in a large sample of credible and noncredible patients referred for neuropsychological testing

Objective: The current study evaluated MSPQ sensitivity to noncredible PVT performance in the context of external incentive, and examined MSPQ false positive rates in noncompensation-seeking neuropsychology patients; and investigated effects of ethnicity/culture, gender, and somatoform diagnosis on MSPQ scores, and relationships with PVT and MMPI-2-RF data. Method: MSPQ scores were compared in credible (n = 110) and noncredible (n = 153) neuropsychology referrals. Results: Noncredible patients scored higher than credible patients. When the credible group was divided into those with somatoform orientation (n = 39) versus those without (n = 71), the credible nonsomatoform group scored lower than the other two groups, who did not differ from each other. MSPQ elevations were found in ethnic minorities, and in individuals who learned English as a second language or concurrently with another language. MSPQ elevations were also associated with chronic systemic diseases, neurologic illness, and substance abuse. Women scored higher than men, but men and women were equally represented among those patients scoring beyond cut-offs. MSPQ scores were minimally related to PVT data but were more strongly correlated with MMPI-2-RF scales, particularly over-report validity scales, RC1, and Somatic/Cognitive scales, with more widespread relationships observed in noncredible patients. Conclusions: A cut-off of 18 resulted in few false positives in credible nonsomatoform patients, and appears appropriate for identifying physical symptom over-report (due to malingering or somatoform orientations), with associated sensitivity of 29%. However, clinicians are cautioned regarding using the MSPQ in patients with systemic, neurologic, and substance abuse conditions, and in ethnic minorities and non-monolingual English-speakers.

Waddell non-organic signs: new evidence suggests somatic amplification among outpatient chronic pain patients

Background ContextWaddell et al. identified a set of eight non-organic signs in 1980. There has been controversy about their meaning, particularly with respect to their use as validity indicators. PurposeThe current study examined the Waddell signs in relation to measures of somatic amplification or over-reporting in a sample of outpatient chronic pain patients. We examined the degree to which these signs were associated with measures of over-reporting. Study Design/SettingThis study examined scores on the Waddell signs in relation to over-reporting indicators in an outpatient chronic pain sample. Patient SampleWe examined 230 chronic pain patients treated at a multidisciplinary pain clinic. The majority of these patients presented with primary back or spinal injuries. Outcome MeasuresThe outcome measures used in the study were Waddell signs, Modified Somatic Perception Questionnaire, Pain Disability Index, and the Minnesota Multiphasic Personality Inventory-2 Restructured Form. MethodsWe examined Waddell signs using multivariate analysis of variance (MANOVA) and analysis of variance (ANOVA), receiver operating characteristic analysis, classification accuracy, and relative risk ratios. ResultsMultivariate analysis of variance and ANOVA showed a significant association between Waddell signs and somatic amplification. Classification analyses showed increased odds of somatic amplification at a Waddell score of 2 or 3. ConclusionsOur results found significant evidence of an association between Waddell signs and somatic over-reporting. Elevated scores on the Waddell signs (particularly scores higher than 2 and 3) were associated with increased odds of exhibiting somatic over-reporting.

Classification characteristics of a chronic low back pain population using a combined McKenzie and patho-anatomical assessment

BackgroundPhysiotherapists use musculo-skeletal classification systems for patient assessment. Since its early development, the McKenzie lumbar spine assessment (MK) has been incorporated into examination algorithms and combined with a series of patho-anatomical diagnostic tests. No previous studies have used a MK and a combined examination (MK-C) to provide a detailed profile of patients, report and compare the classification characteristics of a chronic low back pain (CLBP) population. ObjectiveTo report the classification characteristics of a CLBP population using MK and MK-C examinations, and conduct inter-classification comparison of the MK-C for demographics, the Oswestry Disability Index (ODI), Roland Morris Disability Index (RM), Modified Somatic Perceptions Questionnaire (MSPQ), symptom duration and intensity. MethodA prospective cross-sectional study conducted in a spinal clinic by a MK trained physiotherapist. ResultsResults were obtained in 150 patients. Using MK, 31% (n = 47) of participants were classified as inconclusive. Following MK-C only 6% of participants remained inconclusive (n = 9). The most frequent MK-C classification was facet joint syndrome (FJS) (49%). Participants with FJS were significantly older than those classified as discogenic (p < 0.001; CI 3.96 ̶ 19.74), or mixed (p < 0.001; CI 5.98 ̶ 36.41). Participants classified as discogenic had significantly higher RM (p = 0.022) and MSPQ (p = 0.005) scores than FJS. ConclusionResults indicated that 94% of CLBP patients could be classified using a MK-C. The most common presentation in CLBP was facet joint syndrome. Age, RM and MSPQ appeared to be distinguishing characteristics of this population. Future studies should be conducted to establish the validity and reliability of the MK-C.

Impact of preoperative depression on 2-year clinical outcomes following adult spinal deformity surgery: the importance of risk stratification based on type of psychological distress.

OBJECTIVE The objective of this study was to isolate whether the effect of a baseline clinical history of depression on outcome is independent of associated physical disability and to evaluate which mental health screening tool has the most utility in determining 2-year clinical outcomes after adult spinal deformity (ASD) surgery. METHODS Consecutively enrolled patients with ASD in a prospective, multicenter ASD database who underwent surgical intervention with a minimum 2-year follow-up were retrospectively reviewed. A subset of patients who completed the Distress and Risk Assessment Method (DRAM) was also analyzed. The effects of categorical baseline depression and DRAM classification on the Oswestry Disability Index (ODI), SF-36, and Scoliosis Research Society questionnaire (SRS-22r) were assessed using univariate and multivariate linear regression analyses. The probability of achieving ≥ 1 minimal clinically important difference (MCID) on the ODI based on the DRAM's Modified Somatic Perceptions Questionnaire (MSPQ) score was estimated. RESULTS Of 267 patients, 66 (24.7%) had self-reported preoperative depression. Patients with baseline depression had significantly more preoperative back pain, greater BMI and Charlson Comorbidity Indices, higher ODIs, and lower SRS-22r and SF-36 Physical/Mental Component Summary (PCS/MCS) scores compared with those without self-reported baseline depression. They also had more severe regional and global sagittal malalignment. After adjusting for these differences, preoperative depression did not impact 2-year ODI, PCS/MCS, or SRS-22r totals (p > 0.05). Compared with those in the "normal" DRAM category, "distressed somatics" (n = 11) had higher ODI (+23.5 points), lower PCS (-10.9), SRS-22r activity (-0.9), and SRS-22r total (-0.8) scores (p ≤ 0.01), while "distressed depressives" (n = 25) had lower PCS (-8.4) and SRS-22r total (-0.5) scores (p < 0.05). After adjusting for important covariates, each additional point on the baseline MSPQ was associated with a 0.8-point increase in 2-year ODI (p = 0.03). The probability of improving by at least 1 MCID in 2-year ODI ranged from 77% to 21% for MSPQ scores 0-20, respectively. CONCLUSIONS A baseline clinical history of depression does not correlate with worse 2-year outcomes after ASD surgery after adjusting for baseline differences in comorbidities, health-related quality of life, and spinal deformity severity. Conversely, DRAM improved risk stratification of patient subgroups predisposed to achieving suboptimal surgical outcomes. The DRAM's MSPQ was more predictive than MCS and SRS mental domain for 2-year outcomes and may be a valuable tool for surgical screening.

Psychological Distress can be Determined before Lumbar Surgeries with a Clinically Applicable, Easy-to-use Tool: the Short form of the DRAM

Introduction The Distress and Risk Assessment Method (DRAM) is a tool for measuring the psychological risk factors in low back pain patients. In our previous study, the DRAM scale, its categories as well as its components (Zung Depression Scale (ZDS) and Modified Somatic Perception Questionnaire (MSPQ)) proved to be significant predictors for global treatment outcome in routine lumbar degenerative surgeries. On the other hand, the original DRAM has to be calculated from 45 items making that a long and clinically impractical tool. The aim of the study was to develop and validate a short form of the DRAM (sDRAM) and to determine the prognostic power of the new version in terms of the global treatment outcome. Material and Methods Classic Test Theory were applied for item reduction after the exploratory factor analysis of ZDS and MSPQ on the dataset of a large ( N = 1837) cohort of surgically treated low back pain patients. Internal consistency and the correlation of the shortened DRAM (sDRAM) with the original scale were analyzed. After that, a two-step cluster analysis of sDRAM was applied to determine the cut-off scores. The prognostic value of the scale and its categories was tested on a prospective cohort of routine lumbar degenerative surgeries ( N = 445) where global treatment outcome was assessed two years after the surgery by a Likert scale. Results The sDRAM consisted of five ZDS items (1, 6, 7, 12, 18) and three MSPQ items (3, 9, 11) preserving the original item-distribution ratio. sDRAM scale (range: 0–24) was highly correlated with the DRAM scale (range: 0–99) (r=0.88). Cluster analysis of the patients showed a four-cluster structure in the cohort similarly to the original questionnaire. Cut-off scores (sZDS &gt; 6, sMSPQ &gt; 2) were used to formulate the sDRAM categories (Normal, At risk, Distressed). The sDRAM scale showed a significant association with the global treatment outcome in a logistic regression model ( p &lt; 0.001, B=0.258, OR=1.3) and in ROC analysis (AUC=0.744, p &lt; 0.001) and it was similar to the original DRAM ( p &lt; 0.001, B=0.066, OR=1.07 as well as AUC=0.72, p &lt; 0.001). Risk for poor outcome was significantly associated with the suggested categories of sDRAM (6%, 20%, 39% of poor outcome in “Normal,” “At Risk” and “Distressed” subgroups, Chi-square=38.9, df=2, p &lt; 0.001). Conclusion A shorter, clinically applicable method for the assessment of DRAM has been developed. The sDRAM consists of 8 items and correlates with the original questionnaire. sDRAM and its categories proved to be significantly associated with global treatment outcome. The tool can be used for preoperative risk assessment and reduction strategies, however, further validation is needed to show its utility in different, wider patient-groups.

Reliability and Validity of the Farsi Version of the Somatosensory Amplification Scale.

Background:The somatosensory amplification scale (SSAS) is a 10-item self-report instrument designed to assess a tendency to experience normal somatic and visceral sensations as intense, noxious, and disturbing.Objectives:The present study investigated the reliability and validity of the SSAS, developed by Barsky et al. (1988), in the Iranian population.Materials and Methods:The study was carried out on 240 patients with functional gastrointestinal disorders and 30 healthy persons selected by convenience sampling from 2013 to 2014. The patients completed the SSAS, the somatization subscale of the symptom checklist-90-revised (SCL-90-R som), and the modified somatic perception questionnaire (MSPQ), whereas the healthy persons completed just the SSAS.Results:Exploratory factor analysis indicated that the one-factor solution, accounting for 29.42% of the variance, explained that the SSAS items were represented by one global dimension. The SSAS had acceptable internal consistency (α = 0.78) and good test-retest reliability (r = 0.80). The item-to-scale correlations varied from 0.17 to 0.55. Item 2 had the lowest item-total score correlation (r = 0.17), and the α coefficient for the SSAS exceeded when this item was deleted. The convergent validity of the SSAS with somatization was shown with a significant correlation between the SSAS, SCL-90-R som (r = 0.36), and MSPQ scores (r = 0.52). Discriminant validity analysis showed no significant difference in the SSAS between the patient and control groups (P > 0.05) and non-specificity of the SSAS for patients.Conclusions:In sum, the SSAS has acceptable reliability and validity for the Iranian population and the scale measures the same the original scale, namely somatosensory amplification.

Surgical Site Infection after Primary Degenerative Lumbar Spine Surgeries and Its Effect on Long-Term Outcome

Introduction Surgical site infection (SSI) is one of the most serious complications after spinal surgery. Predisposing factors as well as the long-term consequences of the SSI treated according to the current guidelines are less reported. Aims of the study were to analyze the risk factors for SSI in patients requiring routine lumbar surgery because of disc degeneration cohort and to determine the impact of SSI on long-term outcome. Reliability of the results was tested using a prospectively recruited validation cohort. Materials and Methods A total of 1,030 patients ( N = 1,030) were included in the study. All patients underwent one or two-level decompression or instrumented lumbar fusion. Patients completed self-reported health status measurement questionnaires—Oswestry Disability Index (ODI), Core Outcome Measurement Index (COMI), Zung Depression Scale (ZDS), and Modified Somatic Perception Questionnaire (MSPQ)—and visual analog scale for pain at baseline and 2 years after the surgery. SSI was defined according to the latest Centers for Disease Control and Prevention (CDC) guideline and treated according to the current recommendation of the National Orthopedic and Infectious Diseases Societies. Effect of baseline characteristics, comorbidities, pain history, and surgical data on the occurrence of SSI was determined in uni- and multivariate logistic regression models. The performance of the final multivariate regression model was assessed by measuring its discriminative ability (c-index) in ROC analysis. Five-point Likert scale on self-reported outcome was classified into two categories (“good” and “poor” result) and influence of SSI on outcome was also analyzed. SPSS 20.0 statistical program package was used for analyses where p &lt; 0.05 was considered significant. Results The incidence of SSI in the test cohort was found 3.5% and 3.9% in the validation cohort. The significant ( p &lt; 0.001) multivariate regression model predictive for the occurrence of SSI contained the patient's age, body mass index (BMI), and the presence of some comorbidities, such as diabetes, ischemic heart disease, arrhythmia, liver disease, and autoimmune disease. The c-index of the model was 0.71, showing good discriminative ability and it was confirmed by the data of the independent validation cohort (c = 0.72). There was no significant difference in changes of mean scores of pain and outcome questionnaires comparing patients with and without SSI (pain: p = 0.42, ODI: p = 0.79, COMI: p = 0.79). The self-reported overall outcome of the index procedure was not influenced by the occurrence of SSI (chi-square = 3.35, df = 1, p = 0.067). Conclusions No significant difference was found in the incidence of SSI in one- and two-level noninstrumented and instrumented lumbar degenerative surgeries. Predisposing factors for SSI were older age, higher BMI, and the presence of certain comorbidities. Analyzing the long-term outcome of surgical treatment, no significant difference was found if the SSI was treated according to the recent guidelines. Our predictive model for SSI was validated on an independent prospective cohort.

A Cluster-Based Method for the Preoperative Identification of Lumbar Degenerative Patients having Higher Risk for Poor Global Outcome

Introduction Surgery for lumbar disc degeneration has been shown to yield poor results in 10 to 45% of the patients. Evidence-based clinical tools for preoperative risk estimation would be very important to identify the “at-risk” patients. Several factors referring on the patients' symptoms, psychosocial issues, and medical history were previously published as significant individual risk factors on outcome, but there is low number of reports on integrative models with advanced statistics. The aim of this study was to identify significant outcome predictors and clinically different subgroups in patients surgically treated because of lumbar degenerative disc disease. Patients and Methods A total of 750 consecutive patients indicated for one- or two-level lumbar decompression/microdiscectomy or fusion surgery (TLIF) were recruited into the study. Patients with previous lumbar surgery or nondisc degeneration-related phenotype were not included into the analysis. Patients completed a questionnaire booklet containing the Oswestry disability index (ODI), visual analogue scales on low back (LBP), and leg pain (LP), Zung depression scale (ZDS), and the Modified Somatic Perception Questionnaire (MSPQ) before the surgery and 2 years after the surgery. Five-point Likert scale on self-reported outcome of the surgery was classified into two categories (“good” and “poor” outcome) and effect of preoperative parameters on that was determined applying uni- and multivariate logistic regression models. Two-step agglomerative cluster analysis was used to determine the best fit cluster structure of the cohort entering the significant outcome predictors into the model. Multivariate analysis of variance (MANOVA) and Fischer test were used to analyze the clinical clusters and their canonical discriminant functions. Chi-square tests were applied to investigate the clinical outcome in the different clusters. Results Four different preoperative parameters; number of spinal levels treated, severity of low back pain, duration of pain, and distress (calculated from ZDS and MSPQ scores) were proved to be significant predictors on surgical outcome in the final multivariate regression model ( p &lt; 0.001). The four parameters identified four different subgroups in patients with good cluster quality. Clinical outcome was significantly different in the four preoperative patient-clusters (poor outcome in 5.1, 12.4, 20.9, and 25.6% of subjects, chi-square = 29.3, df = 3, p &lt; 0.001). Conclusion Preoperative parameters of the patients with lumbar disc degeneration have got significant influence on the midterm surgical outcome. Outcome predictors determine different patient clusters with different risk for poor outcome. Advanced statistical approaches are advised to use in the future for patient stratification and risk estimation.

Association between symptom duration and intensity, disability, range of motion and modified pain perceptions amongst chronic low back pain patients

Background: Chronic low back pain (CLBP) is a multi-factorial condition which remains a costly health issue. However, our understanding of the association between commonly used outcome measurements (OM) and symptom behaviour is limited for this low back pain subgroup. Previous research has reported moderate to weak correlations between symptom behaviour, range of motion (ROM), and modified pain perceptions in general low back pain populations. However, longer symptom duration and resulting psychological factors in the CLBP population support the hypothesis that different associations exist between self-reported OM and ROM than in the general population. Purpose: To investigate the association between pain intensity on the visual analogue scale (VAS), range of motion, symptom duration (months), the Oswestry disability Index (ODI), the Roland Morris disability questionnaire (RM) and the Modified Somatic Perception Questionnaire (MSPQ) at baseline in a CLBP population. Methods: A cross-sectional study was conducted with CLBP patients (>12weeks with or without leg pain) (n=147) recruited from a hospital CLBP clinic. Participants completed the VAS, ODI, RM and MSPQ, and a physiotherapist measured ROM of the lumbar spine using a standard tape measure protocol. Data was analysed using SPSS statistical analysis software (version 20) (SPSS inc., Chicago, IL). Independent sample analysis was conducted to assess for significant differences (p<0.05) between genders, and Pearson product-moment correlation coefficients were calculated to identify potential correlations between all baseline OM. Results: Across all the OM, only lumbar extension ROM differed significantly between genders (u=1897, p=0.024). Correlation analysis showed that the disability OM of ODI and RM were not correlated. Weak correlations were reported between the RM and MSPQ scores (r(145) = 0.39, p<0.001), the VAS and ODI (r(145) = 0.39, p <0.001), and lumbar rotation to the right and symptom duration (r(145) = 0.18, p=0.031). Conclusion: The assumption that increased self-reported pain intensity may be associated with limited spinal movement and elevated modified somatic pain perceptions in CLBP patients was not supported by this study. Neither did this study indicate strong associations between psychological factors and self-reported disability. Except for right rotation, symptom duration was also not associated with any ROM, pain, disability, or modified somatic pain perception measures. Pain intensity was weakly correlated with disability on the ODI, and the MSPQ was weakly correlated with the RM score, which supports similar findings in previous research. The results suggest that pain levels do not dictate patient disability status, and that strong associations between psychological factors and self-reported disability are not substantiated. Implications: Absence of strong association between the OM highlights that clinicians should view multiple OM in the context of the patient presentation, rather than in isolation. The ODI may be a more reliable indicator of pain related functional status than the RM. Whereas the RM may be more appropriate when used in conjunction with the MSPQ.