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European Spine Journal

, Volume 16, Issue 6, pp 777–786 | Cite as

Predictors of multidimensional outcome after spinal surgery

  • A. F. MannionEmail author
  • A.  Elfering
  • R. Staerkle
  • A.  Junge
  • D.  Grob
  • J.  Dvorak
  • N.  Jacobshagen
  • N. K. Semmer
  • N. Boos
Original Article

Abstract

The variables identified as predictors of surgical outcome often differ depending on the specific outcome variable chosen to designate “success”. A short set of multidimensional core outcome measures was recently developed, in which each of the following domains was addressed with a single question and then combined in an index: pain, function, symptom-specific well-being, general well-being (quality of life), disability (work and social). The present study examined the factors that predicted surgical outcome as measured using the multidimensional core measures. 163 spinal surgery patients (mixed indications) completed questionnaires before and 6 months after surgery enquiring about demographics, medical/clinical history, fear-avoidance beliefs (FABQ), depression (Zung self-rated depression), and the core measures domains. Multiple regression analyses were used to identify predictor variables for each core domain and for the multidimensional combined core-set index. The combination of baseline symptoms, medical variables (pain duration, previous spine operations, number of levels treated, operative procedure) and psychosocial factors (FABQ and Zung depression) explained 34% of the variance in the core measures index (P < 0.001). With regard to the individual domain items, the medical variables were better in predicting the items “pain” and “symptom-specific well-being” (R 2 = 6–7%) than in predicting “function”, “general well-being” or “disability” (each R 2 < 4%). The inverse pattern was shown for the psychosocial predictors, which accounted for in each case approximately 20% variance in “function”, “general well-being” and “disability” but only 12–14% variance in “pain” and “symptom-specific well-being”. Further to previous studies establishing the sensitivity to change of the core-set, we have shown that a large proportion of the variance in its scores after surgery could be predicted by “well-known” medical and psychosocial predictor variables. This substantiates the recommendation for its further use in registry systems, quality management projects, and clinical trials.

Keywords

Predictors Multidimensional Core outcome measures Spinal surgery Psychology 

References

  1. 1.
    Block AR, Ohnmeiss DD, Guyer RD, Rashbaum RF, Hochschuler SH (2001) The use of presurgical psychological screening to predict the outcome of spine surgery. Spine J 1(4):274–282PubMedCrossRefGoogle Scholar
  2. 2.
    Bombardier C (2000) Outcome assessments in the evaluation of treatment of spinal disorders: introduction. Spine 25(24):3097–3099PubMedCrossRefGoogle Scholar
  3. 3.
    Bortz J, Doering N (2002) Forschungsmethoden und evaluation, 3rd edn. Springer, Berlin Heidelberg New YorkGoogle Scholar
  4. 4.
    Carragee EJ (2001) Psychological screening in the surgical treatment of lumbar disc herniation. Clin J Pain 17(3):215–219PubMedCrossRefGoogle Scholar
  5. 5.
    Carragee EJ, Han MY, Suen PW, Kim D (2003) Clinical outcomes after lumbar discectomy for sciatica: the effects of fragment type and anular competence. J Bone Joint Surg Am 85-A(1):102–108PubMedGoogle Scholar
  6. 6.
    CIPS - Collegium Internationale Psychiatriae Scalarum (Hrsg) (1986) Internationale Skalen für die Psychiatrie, 3rd edn. Beltz, WeinheimGoogle Scholar
  7. 7.
    Deyo RA, Battie M, Beurskens AJHM, Bombardier C, Croft P, Koes B, Malmivaara A, Roland M, Von Korff M, Waddell G (1998) Outcome measures for low back pain research. A proposal for standardized use. Spine 23(18):2003–2013PubMedCrossRefGoogle Scholar
  8. 8.
    Dionne CE, Von Korff M, Koepsell TD, Deyo RA, Barlow WE, Checkoway H (1999) A comparison of pain, functional limitations, and work status indices as outcome measures in back pain research. Spine 24(22):2339–2345PubMedCrossRefGoogle Scholar
  9. 9.
    Hagg O, Fritzell P, Ekselius L, Nordwall A (2003) Predictors of outcome in fusion surgery for chronic low back pain. A report from the Swedish Lumbar Spine Study. Eur Spine J 12(1):22–33PubMedGoogle Scholar
  10. 10.
    Howe J, Frymoyer JW (1985) The effects of questionnaire design on the determination of end results in lumbar spinal surgery. Spine 10(9):804–805PubMedCrossRefGoogle Scholar
  11. 11.
    Junge A, Dvorak J, Ahrens S (1995) Predictors of bad and good outcomes of lumbar disc surgery. A prospective clinical study with recommendations for screening to avoid bad outcomes. Spine 20(4):460–468PubMedCrossRefGoogle Scholar
  12. 12.
    Kasl SV, Jones BA (2003) An epidemiological perspective on research design, measurement, and surveillance strategies. In: Handbook of occupational health psychology. APA, Washington, pp 379–398CrossRefGoogle Scholar
  13. 13.
    Kim J, Lonner JH, Nelson CL, Lotke PA (2004) Response bias: effect on outcomes evaluation by mail surveys after total knee arthroplasty. J Bone Joint Surg Am 86-A(1):15–21PubMedGoogle Scholar
  14. 14.
    Main CJ, Waddell G (1984) The detection of psychological abnormality in chronic low back pain using four simple scales. Curr Concepts Pain 2:10–15Google Scholar
  15. 15.
    Mannion AF, Elfering A (2006) Predictors of surgical outcome and their assessment. Eur Spine J 15(Suppl 1):S93–S108PubMedCrossRefGoogle Scholar
  16. 16.
    Mannion AF, Elfering A, Staerkle R, Junge A, Grob D, Semmer NK, Jacobshagen N, Dvorak J, Boos N (2005) Outcome assessment in low back pain: how low can you go? Eur Spine J 14(10):1014–1026PubMedCrossRefGoogle Scholar
  17. 17.
    Mannion AF, Junge A, Taimela S, Muntener M, Lorenzo K, Dvorak J (2001) Active therapy for chronic low back pain: part 3. Factors influencing self-rated disability and its change following therapy. Spine 26(8):920–929PubMedCrossRefGoogle Scholar
  18. 18.
    Mannion AF, Muntener M, Taimela S, Dvorak J (1999) A randomised clinical trial of three active therapies for chronic low back pain. Spine 24(23):2435–2448PubMedCrossRefGoogle Scholar
  19. 19.
    Ng LC, Sell P (2004) Predictive value of the duration of sciatica for lumbar discectomy. A prospective cohort study. J Bone Joint Surg Br 86(4):546–549PubMedGoogle Scholar
  20. 20.
    Norquist BM, Goldberg BA, Matsen FA 3rd (2000) Challenges in evaluating patients lost to follow-up in clinical studies of rotator cuff tears. J Bone Joint Surg Am 82(6):838–842PubMedGoogle Scholar
  21. 21.
    Nygaard OP, Kloster R, Solberg T (2000) Duration of leg pain as a predictor of outcome after surgery for lumbar disc herniation: a prospective cohort study with 1-year follow up. J Neurosurg Spine 92(2):131–134CrossRefGoogle Scholar
  22. 22.
    Pellise F, Alvarez L, Escudero O, Pont A, Ferrer M (2003) Metric characteristics of the six-question “core set” in the evaluation of back pain. Eur Spine J 12(Supp 1):S12–S13Google Scholar
  23. 23.
    Pellise F, Ferrer M, Escudero O, Alvarez L, Pont A, Alonso J, Deyo R (2005) Reliability and responsiveness of a “minimum core-set” in the evaluation of patients with chronic low back pain. Eur Spine J 14(Supp 1):S18Google Scholar
  24. 24.
    Rothoerl RD, Woertgen C, Brawanski A (2002) When should conservative treatment for lumbar disc herniation be ceased and surgery considered? Neurosurg Rev 25(3):162–165PubMedCrossRefGoogle Scholar
  25. 25.
    Schade V, Semmer N, Main CJ, Hora J, Boos N (1999) The impact of clinical, morphological, psychosocial and work-related factors on the outcome of lumbar discectomy. Pain 80(1–2):239–249PubMedCrossRefGoogle Scholar
  26. 26.
    Staerkle R, Mannion AF, Elfering A, Junge A, Semmer NK, Jacobshagen N, Grob D, Dvorak J, Boos N (2004) Longitudinal validation of the fear-avoidance beliefs questionnaire (FABQ) in a Swiss–German sample of low back pain patients. Eur Spine J 13(4):332–340PubMedCrossRefGoogle Scholar
  27. 27.
    Stromqvist B (2002) Evidence-based lumbar spine surgery. The role of national registration. Acta Orthop Scand Suppl 73(305):34–39Google Scholar
  28. 28.
    Tandon V, Campbell F, Ross ER (1999) Posterior lumbar interbody fusion. Association between disability and psychological disturbance in noncompensation patients. Spine 24(17):1833–1838PubMedCrossRefGoogle Scholar
  29. 29.
    Trief PM, Grant W, Fredrickson B (2000) A prospective study of psychological predictors of lumbar surgery outcome. Spine 25(20):2616–2621PubMedCrossRefGoogle Scholar
  30. 30.
    Waddell G, Morris EW, Di Paola MP, Bircher M, Finlayson D (1986) A concept of illness tested as an improved basis for surgical decisions in low-back disorders. Spine 11(7):712–719PubMedCrossRefGoogle Scholar
  31. 31.
    Waddell G, Newton M, Henderson I, Somerville D, Main CJ (1993) A Fear-Avoidance Beliefs Questionnaire (FABQ) and the role of fear-avoidance beliefs in chronic low back pain and disability. Pain 52(2):157–168PubMedCrossRefGoogle Scholar
  32. 32.
    Woertgen C, Holzschuh M, Rothoerl RD, Brawanski A (1997) Does the choice of outcome scale influence prognostic factors for lumbar disc surgery? A prospective, consecutive study of 121 patients. Eur Spine J 6(3):173–180PubMedCrossRefGoogle Scholar
  33. 33.
    Woertgen C, Rothoerl RD, Breme K, Altmeppen J, Holzschuh M, Brawanski A (1999) Variability of outcome after lumbar disc surgery. Spine 24(8):807–811PubMedCrossRefGoogle Scholar
  34. 34.
    Zanoli G, Stromqvist B, Padua R, Romanini E (2000) Lessons learned searching for a HRQoL instrument to assess the results of treatment in persons with lumbar disorders. Spine 25(24):3178–3185PubMedCrossRefGoogle Scholar
  35. 35.
    Zung WW (1965) A self-rating depression scale. Arch Gen Psychiatry 12:63–70PubMedGoogle Scholar

Copyright information

© Springer-Verlag 2006

Authors and Affiliations

  • A. F. Mannion
    • 1
    Email author
  • A.  Elfering
    • 2
  • R. Staerkle
    • 3
  • A.  Junge
    • 1
  • D.  Grob
    • 1
  • J.  Dvorak
    • 1
  • N.  Jacobshagen
    • 2
  • N. K. Semmer
    • 2
  • N. Boos
    • 3
  1. 1.Schulthess KlinikZürichSwitzerland
  2. 2.Department of PsychologyUniversity of BernBernSwitzerland
  3. 3.Centre for Spinal SurgeryUniversity of ZürichZürichSwitzerland

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