Block Andrew R
Texas Back Institute, Plano, TX 75093, USA.
Healthcare (Basel). 2016 Jan 19;4(1):11. doi: 10.3390/healthcare4010011.
It is now well established that psychosocial factors can adversely impact the outcome of spine surgery. This article discusses in detail one such recently-identified "risk" factor: demoralization. Several studies conducted by the author indicate that demoralization, an emotional construct distinct from depression, is associated with poorer pain reduction, less functional improvement and decreased satisfaction among spine surgery patients. However, there are indications that the adverse impact of risk factors such as demoralization can be mitigated by psychosocial "maximizing" factors-characteristics that propel the patient towards positive surgical results. One of these maximizing factors, patient activation, is discussed in depth. The patient activation measure (PAM), an inventory assessing the extent to which patients are active and engaged in their health care, is associated not only with improved spine surgery results, but with better outcomes across a broad range of medical conditions. Other maximizing factors are discussed in this article. The author concludes that the past research focus on psychosocial risk factors has limited the value of presurgical psychological screening, and that future research, as well as clinical assessment, should recognize that the importance of evaluating patients' strengths as well as their vulnerabilities.
现已充分证实，社会心理因素会对脊柱手术的结果产生不利影响。本文详细讨论了一个最近才被确认的此类“风险”因素：士气低落。作者进行的多项研究表明，士气低落是一种有别于抑郁的情绪状态，它与脊柱手术患者疼痛减轻效果较差、功能改善较少以及满意度降低有关。然而，有迹象表明，诸如士气低落等风险因素的不利影响可以通过社会心理“强化”因素来减轻，这些因素能够促使患者取得积极的手术效果。其中一个强化因素——患者能动性，将在本文中进行深入探讨。患者能动性量表（PAM）是一种评估患者在自身医疗保健中积极主动程度的量表，它不仅与脊柱手术效果的改善有关，还与广泛的医疗状况下的更好结果相关。本文还将讨论其他强化因素。作者得出结论，过去对社会心理风险因素的研究重点限制了术前心理筛查的价值，并且未来的研究以及临床评估都应认识到评估患者优势以及弱点的重要性。
