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Psychosocial stress factors among patients with lumbar disc herniation, scheduled for disc surgery in comparison with patients scheduled for arthroscopic knee surgery
Örebro University, School of Health and Medical Sciences. (Center for Health and Medical Psychology, CHAMP)
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2007 (English)In: European spine journal, ISSN 0940-6719, E-ISSN 1432-0932, Vol. 16, no 7, 961-970 p.Article in journal (Refereed) Published
Abstract [en]

Returning to work after disc surgery appears to be more heavily influenced by psychological aspects of work than by MR-identified morphological alterations. It is still not known whether psychosocial factors of importance for outcome after disc surgery are present preoperatively or develop in the postoperative phase. The aim of this study was to investigate the presence of work-related stress, life satisfaction and demanding life events, among patients undergoing first-time surgery for lumbar disc herniation in comparison with patients scheduled for arthroscopic knee surgery. Sixty-nine patients with disc herniation and 162 patients awaiting arthroscopy were included in the study, during the time period March 2003 to May 2005. Sixty-two percent of the disc patients had been on sick leave for an average of 7.8 months and 14 percent of the knee patients had been on sick leave for an average of 4.2 months. The psychosocial factors were investigated preoperatively using a questionnaire, which was a combination of the questionnaire of quality of work competence (QWC), life satisfaction (LiSat9) and life events as a modification of the social readjustment scale. There were no significant differences between the two groups in terms of work-related stress or the occurrence of demanding life events. The disc patients were significantly less satisfied with functions highly inter-related to pain and discomfort, such as present work situation, leisure-time, activities of daily living (ADL) function and sleep. Patients with disc herniation on sick leave were significantly less satisfied with their present work situation than knee patients on sick leave; this sub-group of patients with disc herniation also reported significantly higher expectations in relation to future job satisfaction than knee patients. The results indicate that psychosocial stress is not more pronounced preoperatively in this selected group of disc patients, without co-morbidity waiting for first-time disc surgery, than among knee patients awaiting arthroscopy. It was notable that the disc patients had high expectations in terms of improved job satisfaction after treatment by surgery.

Place, publisher, year, edition, pages
2007. Vol. 16, no 7, 961-970 p.
Keyword [en]
stress, lumbar disc herniation
National Category
Medical and Health Sciences
Research subject
Clinical Psychology; Medicine
Identifiers
URN: urn:nbn:se:oru:diva-6776DOI: 10.1007/s00586-007-0319-9OAI: oai:DiVA.org:oru-6776DiVA: diva2:217220
Available from: 2009-05-13 Created: 2009-05-13 Last updated: 2015-03-10Bibliographically approved
In thesis
1. Psychosocial factors in patients with lumbar disc herniation: enhancing postoperative outcome by the identifiction of predictive factors and optimised physiotherapy
Open this publication in new window or tab >>Psychosocial factors in patients with lumbar disc herniation: enhancing postoperative outcome by the identifiction of predictive factors and optimised physiotherapy
2008 (English)Doctoral thesis, comprehensive summary (Other academic)
Abstract [en]

Psychosocial factors have been advanced as an explanation for the development of chronic disability in 20 to 30% of patients treated by lumbar disc surgery.

Aims: The overall aim of this thesis was to study the role of psychosocial factors in patients undergoing first-time lumbar disc surgery in relation to the outcome of both surgery and subsequent physiotherapy.

Methods: Sixty-nine patients with lumbar disc herniation undergoing first-time disc surgery participated in the studies; in addition, Study I included 162 knee patients for comparison. Psychosocial factors were assessed preoperatively, as was the activation of the physiological stress response system. Pain, disabil-ity and quality of life were assessed before, and 3 and 12 months after surgery. Coping and kinesiophobia were analysed before and one year after surgery. The results of two different postoperative training programmes were compared.

Results: There were no differences between disc and knee patients regarding the presence of psychosocial stress factors preoperatively (Study I). Disc patients with low diurnal cortisol variability had lower physical function, perceived fewer possibilities to influence their pain and were more prone to catastrophise than patients with high diurnal cortisol variability (Study II). The results of clinic-based physiotherapy and home training did not differ regarding postoperative disability and pain 3 months after surgery. The home-based group had less pain and higher quality of life in comparison to the clinic-based group 12 months after surgery (Study III). Patients’ expectations of returning to work could best predict pain, disability, quality of life and sick leave one year after surgery (Study IV). Psychosocial factors were only weakly asso-ciated to pain, disability, quality of life and sick leave preoperatively. However, these associations were stronger in patients with residual pain one year after surgery.

Conclusion: Psychosocial factors and, in particular, patients’ expectations regarding outcome are associated with the results of lumbar disc surgery. Assessing psychosocial factors preoperatively and developing an active home training programme after surgery could create options leading to better results for these patients.

Place, publisher, year, edition, pages
Örebro: Örebro universitet, 2008. 85 p.
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 22
Keyword
Lumbar disc herniation, surgery, psychosocial factors, physio-therapy, expectations
National Category
Medical and Health Sciences
Research subject
Medicine
Identifiers
urn:nbn:se:oru:diva-2516 (URN)978-91-7668-633-1 (ISBN)
Public defence
2008-11-21, Aulan, ingång 21, Centrallasarettet, Västerås, 13:15 (English)
Opponent
Supervisors
Available from: 2008-10-15 Created: 2008-10-15 Last updated: 2011-05-17Bibliographically approved

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Johansson, Ann-ChristinLinton, Steven J.
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