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European Spine Journal

, Volume 20, Issue 10, pp 1626–1634 | Cite as

Leg pain and psychological variables predict outcome 2–3 years after lumbar fusion surgery

  • Allan D. AbbottEmail author
  • Raija Tyni-Lenné
  • Rune Hedlund
Original Article

Abstract

Prediction studies testing a thorough range of psychological variables in addition to demographic, work-related and clinical variables are lacking in lumbar fusion surgery research. This prospective cohort study aimed at examining predictions of functional disability, back pain and health-related quality of life (HRQOL) 2–3 years after lumbar fusion by regressing nonlinear relations in a multivariate predictive model of pre-surgical variables. Before and 2–3 years after lumbar fusion surgery, patients completed measures investigating demographics, work-related variables, clinical variables, functional self-efficacy, outcome expectancy, fear of movement/(re)injury, mental health and pain coping. Categorical regression with optimal scaling transformation, elastic net regularization and bootstrapping were used to investigate predictor variables and address predictive model validity. The most parsimonious and stable subset of pre-surgical predictor variables explained 41.6, 36.0 and 25.6% of the variance in functional disability, back pain intensity and HRQOL 2–3 years after lumbar fusion. Pre-surgical control over pain significantly predicted functional disability and HRQOL. Pre-surgical catastrophizing and leg pain intensity significantly predicted functional disability and back pain while the pre-surgical straight leg raise significantly predicted back pain. Post-operative psychomotor therapy also significantly predicted functional disability while pre-surgical outcome expectations significantly predicted HRQOL. For the median dichotomised classification of functional disability, back pain intensity and HRQOL levels 2–3 years post-surgery, the discriminative ability of the prediction models was of good quality. The results demonstrate the importance of pre-surgical psychological factors, leg pain intensity, straight leg raise and post-operative psychomotor therapy in the predictions of functional disability, back pain and HRQOL-related outcomes.

Keywords

Disability Pain Predictors Quality of life Spinal fusion 

Notes

Acknowledgments

This study was funded by a research grant obtained from the Health Care Sciences Postgraduate School, Karolinska Institute.

Conflict of interest

None.

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Copyright information

© Springer-Verlag 2011

Authors and Affiliations

  • Allan D. Abbott
    • 1
    • 2
    Email author
  • Raija Tyni-Lenné
    • 1
    • 3
  • Rune Hedlund
    • 4
  1. 1.Department of Physical TherapyKarolinska University Hospital, HuddingeStockholmSweden
  2. 2.Division of Orthopaedics, Department of Clinical Science, Intervention and TechnologyKarolinska InstituteStockholmSweden
  3. 3.Division of Physiotherapy, Department of Neurobiology, Care Sciences and SocietyKarolinska InstituteStockholmSweden
  4. 4.Department for Orthopaedics, Institute for Clinical SciencesSahlgrenska University HospitalGothenburgSweden

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