Department of Orthopaedic Surgery, Center for Musculoskeletal Research, Department of Physical Medicine and Rehabilitation, Vanderbilt University Medical Center, 1215 21st Ave South, Medical Center East-South Tower, Suite 4200, Nashville, TN 37232, USA.
Department of Orthopaedic Surgery, Vanderbilt University Medical Center, 1215 21st Ave South, Medical Center East-South Tower, Suite 4200, Nashville, TN 37232, USA.
Spine J. 2021 Jan;21(1):55-63. doi: 10.1016/j.spinee.2020.07.013. Epub 2020 Jul 28.
Positive psychosocial factors early after surgery, such as resilience and self-efficacy, may be important characteristics for informing individualized postoperative care.
To examine the association of early postoperative resilience and self-efficacy on 12-month physical function, pain interference, social participation, disability, pain intensity, and physical activity after lumbar spine surgery.
STUDY DESIGN/SETTING: Pooled secondary analysis of prospectively collected trial data from two academic medical centers.
Two hundred and forty-eight patients who underwent laminectomy with or without fusion for a degenerative lumbar condition.
Physical function, pain inference, and social participation (ability to participate in social roles and activities) were measured using the Patient Reported Outcomes Measurement Information System. The Oswestry Disability Index, Numeric Rating Scale, and accelerometer activity counts were used to measure disability, pain intensity, and physical activity, respectively.
Participants completed validated outcome questionnaires at 6 weeks (baseline) and 12 months after surgery. Baseline positive psychosocial factors included resilience (Brief Resilience Scale) and self-efficacy (Pain Self-Efficacy Questionnaire). Multivariable linear regression analyses were used to assess the associations between early postoperative psychosocial factors and 12-month outcomes adjusting for age, sex, study site, randomized group, fusion status, fear of movement (Tampa Scale for Kinesiophobia), and outcome score at baseline. This study was funded by Patient-Centered Outcomes Research Institute and Foundation for Physical Therapy Research. There are no conflicts of interest.
Resilience at 6 weeks after surgery was associated with 12-month physical function (unstandardized beta=1.85 [95% confidence interval [CI]: 0.29; 3.40]), pain interference (unstandardized beta=-1.80 [95% CI: -3.48; -0.12]), social participation (unstandardized beta=2.69 [95% CI: 0.97; 4.41]), and disability (unstandardized beta=-3.03 [95% CI: -6.04; -0.02]). Self-efficacy was associated with 12-month disability (unstandardized beta=-0.21 [95% CI: -0.37; -0.04].
Postoperative resilience and pain self-efficacy were associated with improved 12-month patient-reported outcomes after spine surgery. Future work should consider how early postoperative screening for positive psychosocial characteristics can enhance risk stratification and targeted rehabilitation management in patients undergoing spine surgery.
手术后早期的积极心理社会因素，如韧性和自我效能感，可能是为患者提供个性化术后护理的重要特征。
探讨腰椎手术后早期的韧性和自我效能感与 12 个月时的身体功能、疼痛干扰、社会参与（参与社会角色和活动的能力）、残疾、疼痛强度和身体活动的相关性。
研究设计/地点：两个学术医疗中心前瞻性收集试验数据的汇总二次分析。
248 名因退行性腰椎疾病而行椎板切除术或融合术的患者。
身体功能、疼痛推断和社会参与（参与社会角色和活动的能力）使用患者报告的结果测量信息系统进行测量。Oswestry 残疾指数、数字评分量表和加速度计活动计数分别用于测量残疾、疼痛强度和身体活动。
参与者在手术后 6 周（基线）和 12 个月时完成经过验证的结局问卷。基线时的积极心理社会因素包括韧性（简短韧性量表）和自我效能感（疼痛自我效能感问卷）。多变量线性回归分析用于评估术后早期心理社会因素与 12 个月结局之间的关联，调整年龄、性别、研究地点、随机分组、融合状态、运动恐惧（Tampa 运动恐惧量表）和基线结局评分。该研究由患者为中心的成果研究所和物理治疗研究基金会资助。无利益冲突。
术后 6 周的韧性与 12 个月的身体功能（未标准化β=1.85 [95%置信区间（CI）：0.29；3.40]）、疼痛干扰（未标准化β=-1.80 [95% CI：-3.48；-0.12]）、社会参与（未标准化β=2.69 [95% CI：0.97；4.41]）和残疾（未标准化β=-3.03 [95% CI：-6.04；-0.02]）有关。自我效能感与 12 个月的残疾有关（未标准化β=-0.21 [95% CI：-0.37；-0.04]）。
术后的韧性和疼痛自我效能感与脊柱手术后 12 个月的患者报告结局改善有关。未来的工作应考虑如何在脊柱手术后通过早期术后筛查积极的心理社会特征来增强风险分层和有针对性的康复管理。
