Block Andrew R, Marek Ryan J, Ben-Porath Yossef S
Texas Back Institute, Plano, TX, 75093, USA.
College of Human Sciences and Humanities, University of Houston - Clear Lake, Houston, TX, 77008, USA.
J Clin Psychol Med Settings. 2019 Jun;26(2):123-130. doi: 10.1007/s10880-018-9571-x.
Although spine surgery (SS) and spinal cord stimulators (SCSs) can provide significant relief for patients with intractable pain, their effectiveness is variable. Previously, a number of pre-operative psychosocial risk factors have predicted suboptimal outcomes of these procedures. However, recent research has found that "patient activation"-the extent to which patients are engaged and active in their own health care-can predict positive surgical results. The purpose of the current investigation was to determine whether patient activation helps explain associations between established psychosocial risk factors and suboptimal outcomes. Candidates for SS and SCS (n = 1254; 56.3% women, mean age 50.4 years) consented to participate in an outcome study prior to their pre-surgical psychological evaluation. Of those, 46.3% returned self-report measures an average of 180 days (SD = 79.1) post-surgery. Bootstrapped mediation analyses indicated that patient activation mediates numerous associations between psychosocial risk factors and suboptimal outcomes. That is, patients' involvement in obtaining information, decision making, and their resilience can explain why some patients do not experience adverse surgical results when pre-surgical psychosocial risk factors are present. Pre-surgical psychological evaluations should include examination of patient strengths in addition to psychosocial risk factors, so that treatments can be appropriately individualized and the most effective surgical results obtained.
尽管脊柱手术（SS）和脊髓刺激器（SCS）可为顽固性疼痛患者提供显著缓解，但它们的效果存在差异。此前，一些术前心理社会风险因素已被预测会导致这些手术的效果欠佳。然而，最近的研究发现，“患者激活”——患者在自身医疗保健中参与和积极的程度——可以预测手术的积极结果。当前调查的目的是确定患者激活是否有助于解释既定心理社会风险因素与欠佳结果之间的关联。脊柱手术和脊髓刺激器的候选患者（n = 1254；56.3%为女性，平均年龄50.4岁）在术前心理评估之前同意参与一项结果研究。其中，46.3%的患者在术后平均180天（标准差 = 79.1）返回了自我报告测量结果。自抽样中介分析表明，患者激活介导了心理社会风险因素与欠佳结果之间的众多关联。也就是说，患者在获取信息、决策方面的参与度以及他们的恢复力可以解释为什么在存在术前心理社会风险因素的情况下，一些患者没有经历不良手术结果。术前心理评估除了心理社会风险因素外，还应包括对患者优势的检查，以便能够适当地个性化治疗并获得最有效的手术结果。
