Department of Orthopaedic Surgery, University of Utah, 590 Wakara Way, Salt Lake City, UT 84108, USA.
J Bone Joint Surg Am. 2010 Dec 15;92(18):2878-83. doi: 10.2106/JBJS.I.01036. Epub 2010 Nov 12.
Psychological distress can affect spine surgery outcomes. A majority of spinal surgeons do not use standardized questionnaires to assess for psychological distress and instead rely on their clinical impressions. The ability of spinal surgeons to properly assess patients with psychological distress has not been adequately evaluated. Our hypothesis was that the clinical impressions of spinal surgeons were not as accurate as a standardized questionnaire in assessing for psychological distress.
A prospective study was performed with eight physicians, four spinal surgeons and four nonoperative spine specialists, who evaluated 400 patients. All patients completed the Distress and Risk Assessment Method (DRAM) questionnaire for the evaluation of psychological distress. The eight physician subjects, blinded to the results of this questionnaire, performed their routine clinical evaluation and categorized the patients' psychological distress level. The results of the Distress and Risk Assessment Method questionnaire and the surgeons' assessments were compared.
In the study population of 400 patients, 64% (254 of 400) were found to have some level of psychological distress. Twenty-two percent (eighty-seven of 400) of the patients were found to have high levels of distress. Overall, the physicians' rate of sensitivity when assessing patients with high levels of distress was 28.7% (95% confidence interval: 19.5%, 39.4%) with a positive predictive value of 47.2% (95% confidence interval: 33.3%, 61.4%). Nonoperative spine specialists had a significantly higher sensitivity rate when assessing highly distressed patients (41.7% [95% confidence interval: 25.5%, 59.2%]) than surgeons (19.6% [95% confidence interval: 9.8%, 33.1%]) (p = 0.03). The sensitivity rates between experienced (greater than ten years in practice) (14.7% [95% confidence interval: 5.0%, 31.1%]) and less experienced (less than two years in practice) (29.4% [95% confidence interval: 10.3%, 56.0%]) spinal surgeons was not significant (p = 0.27).
A large percentage of patients (64%) presenting for spine evaluation have some level of psychological distress. When compared with a standardized questionnaire designed to screen for psychological distress, spinal surgeons had low sensitivity rates to detect this distress. The routine use of a standardized questionnaire to screen for psychological distress should be considered.
心理困扰可能会影响脊柱手术的结果。大多数脊柱外科医生不使用标准化问卷来评估心理困扰，而是依赖于他们的临床印象。脊柱外科医生正确评估有心理困扰的患者的能力尚未得到充分评估。我们的假设是，脊柱外科医生的临床印象在评估心理困扰方面不如标准化问卷准确。
对 8 名医生（4 名脊柱外科医生和 4 名非手术脊柱专家）进行了前瞻性研究，他们评估了 400 名患者。所有患者都完成了困扰和风险评估方法（DRAM）问卷，以评估心理困扰。8 名医生在不知道该问卷结果的情况下进行了常规临床评估，并对患者的心理困扰水平进行了分类。将困扰和风险评估方法问卷的结果与外科医生的评估进行了比较。
在 400 名患者的研究人群中，有 64%（254/400）的患者存在不同程度的心理困扰。22%（400 名患者中有 87 名）的患者有高度困扰。总体而言，医生评估有高度困扰的患者的敏感性率为 28.7%（95%置信区间：19.5%，39.4%），阳性预测值为 47.2%（95%置信区间：33.3%，61.4%）。与外科医生（19.6% [95%置信区间：9.8%，33.1%]）相比，非手术脊柱专家评估高度困扰患者的敏感性率显著更高（41.7% [95%置信区间：25.5%，59.2%]）（p = 0.03）。经验丰富（超过 10 年从业经验）（14.7% [95%置信区间：5.0%，31.1%]）和经验不足（不到 2 年从业经验）（29.4% [95%置信区间：10.3%，56.0%]）的脊柱外科医生之间的敏感性率差异无统计学意义（p = 0.27）。
很大比例的（64%）接受脊柱评估的患者存在一定程度的心理困扰。与专门用于筛查心理困扰的标准化问卷相比，脊柱外科医生在发现这种困扰方面的敏感性较低。应考虑常规使用标准化问卷筛查心理困扰。
