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A prospective study of cognitive behavioural factors as predictors of pain, disability and quality of life one year after lumbar disc surgery
Clin Res Ctr, Dept Orthopaed Surg, Cent Hosp, Uppsala Univ, Västerås, Sweden.
Örebro University, School of Law, Psychology and Social Work.ORCID iD: 0000-0001-5359-0452
Clin Res Ctr, Dept Orthopaed Surg, Cent Hosp, Uppsala Univ, Västerås, Sweden.
Clin Res Ctr, Dept Orthopaed Surg, Cent Hosp, Uppsala Univ, Västerås, Sweden.
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2010 (English)In: Disability and Rehabilitation, ISSN 0963-8288, E-ISSN 1464-5165, Vol. 32, no 7, p. 521-529Article in journal (Refereed) Published
Abstract [en]

Purpose: The primary aim of this study was to analyse the predictive value of cognitive and behavioural factors, in relation to pain, disability and quality of life (QoL) one year after lumbar disc surgery.

Method: The study design was prospective. Fifty-nine patients scheduled for first time lumbar disc surgery were included. Pain, disability, QoL, coping, fear avoidance beliefs, expected outcome and sick leave were assessed preoperatively and 12 months after surgery. Multiple backward stepwise logistic regression analyses were performed to study the contribution of the preoperatively measured independent behavioural/cognitive factors (coping, fear avoidance beliefs and assessed chance to return to work within 3 months) to the dependent variables pain, disability and quality of life at 12 months after surgery.

Results: Low expectations on work return within 3 months after surgery was significantly predictive for residual leg pain, odds ratio (OR)¼8.2, back pain, OR¼9.7, disability, OR¼13.8 and sick leave, OR¼19.5. Low QoL, was best predicted by preoperatively high scores on fear avoidance beliefs OR¼6.6 and being a woman OR¼6.0. The regression model explained 26–40% of the variance in pain, disability, QoL and sick leave.

Conclusions: Eliciting patients’ expectations on work return after surgery could contribute to early identification of those who run the risk of developing long-term disability and sick-leave.

Place, publisher, year, edition, pages
Oxon, United Kingdom: Taylor & Francis, 2010. Vol. 32, no 7, p. 521-529
Keywords [en]
Lumbar disc surgery, expectation, prediction
National Category
Psychology Medical and Health Sciences
Research subject
Psychology; Medicine
Identifiers
URN: urn:nbn:se:oru:diva-9125DOI: 10.3109/09638280903177243ISI: 000274856200001PubMedID: 20136470Scopus ID: 2-s2.0-76649134423OAI: oai:DiVA.org:oru-9125DiVA, id: diva2:287285
Available from: 2010-01-18 Created: 2010-01-18 Last updated: 2018-09-12Bibliographically 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. p. 85
Series
Örebro Studies in Medicine, ISSN 1652-4063 ; 22
Keywords
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: 2017-10-18Bibliographically approved

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Johansson, Ann-ChristinLinton, Steven J.

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