Mannion Anne F, Junge Astrid, Elfering Achim, Dvorak Jiri, Porchet François, Grob Dieter
Spine Center, Schulthess Klinik, Zürich, Switzerland.
Spine (Phila Pa 1976). 2009 Jul 1;34(15):1590-9. doi: 10.1097/BRS.0b013e31819fcd52.
Prospective study.
The present study compared different theories on the role of expectations in a group of patients undergoing lumbar decompression surgery.
Patients' expectations of treatment are a potentially important predictor of self-rated outcome after surgery. Some studies suggest that high baseline expectations per se yield better outcomes, others maintain that the fulfillment of prior expectations is paramount, and still others assert that it is the actual improvement in symptom status that governs outcome, regardless of prior expectations.
Hundred patients took part (33 F, 67 M; mean [SD] age, 65 [11] yrs). Before surgery, they completed a booklet containing the Roland-Morris (RM) disability questionnaire, 0-10 pain graphic rating scales (back and leg separately), and Likert-scales about the degree of improvement expected in various domains. Two and 12 months after surgery, questions were answered regarding the perceived improvement for each of these domains, the RM and pain scales were completed again, and the patients rated the global outcome on a 5-point Likert-scale.
Compared with the actual improvement recorded at 12 months, prior expectations had been overly optimistic in about 40% patients for the domains leg pain, back pain, walking capacity, social life, mental well-being, and independence, and in 50% patients for everyday activities and sport. There was no significant relationship between baseline expectations and follow-up scores for back pain, leg pain, RM-disability (corrected for baseline values), or global outcome. Hierarchical multiple regression analysis revealed that "expectations being fulfilled" was the most significant predictor of global outcome.
In this patient group, expectations of surgery were overly optimistic. Having one's expectations fulfilled was most important for a good outcome. The results emphasize the importance of assessing patient-orientated outcome in routine practice, and the factors that might influence it, such that realistic expectations can be established for patients before surgery.
前瞻性研究。
本研究比较了关于期望在一组接受腰椎减压手术患者中所起作用的不同理论。
患者对治疗的期望是术后自我评定结果的一个潜在重要预测指标。一些研究表明，高基线期望本身会产生更好的结果，另一些研究则认为先前期望的实现至关重要，还有一些研究断言，决定结果的是症状状态的实际改善，而与先前期望无关。
100名患者参与研究（33名女性，67名男性；平均[标准差]年龄，65[11]岁）。手术前，他们完成了一本包含罗兰 - 莫里斯（RM）残疾问卷、0 - 10疼痛图形评分量表（分别针对背部和腿部）以及关于各领域预期改善程度的李克特量表的小册子。手术后2个月和12个月，针对这些领域的每一项，回答关于感知到的改善情况的问题，再次完成RM和疼痛量表，并且患者用5点李克特量表对总体结果进行评分。
与12个月时记录的实际改善情况相比，在腿部疼痛、背部疼痛、行走能力、社交生活、心理健康和独立性等领域，约40%的患者先前期望过于乐观，在日常活动和运动方面，50%的患者先前期望过于乐观。基线期望与背痛、腿痛、RM残疾（校正基线值后）或总体结果的随访评分之间无显著关系。分层多元回归分析显示，“期望得到满足”是总体结果的最显著预测指标。
在该患者群体中，对手术的期望过于乐观。期望得到满足对良好结果最为重要。结果强调了在常规实践中评估以患者为导向的结果以及可能影响该结果的因素的重要性，以便在手术前为患者建立现实的期望。
