Department of Orthopaedic Surgery, Tufts Medical Center.
Tufts University School of Medicine.
Spine (Phila Pa 1976). 2023 Jul 1;48(13):908-913. doi: 10.1097/BRS.0000000000004567. Epub 2022 Dec 28.
Prospective cohort study.
This study determined (1) the surgeon accuracy of psychological assessment in patients in spine clinic, (2) the impact of psychological distress on surgical recommendation, and (3) the correlation between patient-reported disability and psychological distress.
Psychological distress is common among patients presenting for spine surgery. Surgeon estimations of patients' distress may influence treatment recommendations, but little is known as to whether these assessments accurately mirror patient-perceived psychological distress.
A sample of new patients was recruited from an academic spine center. Prior to their initial consultation, patients completed the Modified Somatic Perception Questionnaire and Zung Depression Index to assess mental and physical manifestations of distress, which generated a Distress and Risk Assessment Method (DRAM) score of N (normal), R (at risk), or D (distressed). The Oswestry Disability Index and Neck Disability Index scores were also collected. Surgeons provided their estimates of the DRAM score after the visit and indicated their surgery recommendation.
Of 296 patients, 40.5% reported some level of psychological distress (DRAM=R) and 15.9% had a high level of distress (DRAM=D). All three surgeons' ability to accurately assess the participant DRAM score was poor, with an overall kappa of 0.13 (0.08-0.18), biased toward underestimating the patient's true level of psychological distress. Patients rated as normal (N) by the surgeon were 3.78 times more likely to be recommended for surgery compared to those assessed as distressed (D) ( P =0.007). Patients with higher DRAM scores had higher Oswestry Disability Index ( P =0.008) and Neck Disability Index ( P =0.005) scores compared to those with lower DRAM scores.
Spine surgeons have limited ability to detect psychological profiles in patients, with a tendency to underestimate levels of distress. The finding that these inaccurate assessments influence surgical recommendations underscores the importance of limiting surgeon bias in the decision-making process.
Diagnostic Level 2.
前瞻性队列研究。
本研究旨在确定：(1)脊柱门诊患者的外科医生心理评估准确性；(2)心理困扰对手术建议的影响；以及(3)患者报告的残疾与心理困扰之间的相关性。
心理困扰在接受脊柱手术的患者中很常见。外科医生对患者痛苦的评估可能会影响治疗建议，但尚不清楚这些评估是否准确反映了患者感知到的心理痛苦。
从一所学术脊柱中心招募了新患者样本。在他们的首次就诊之前，患者完成了改良躯体知觉问卷和 Zung 抑郁指数，以评估精神和身体痛苦的表现，这产生了一个痛苦和风险评估方法（DRAM）评分 N（正常）、R（有风险）或 D（痛苦）。还收集了 Oswestry 残疾指数和颈部残疾指数评分。外科医生在就诊后提供他们对 DRAM 评分的估计，并表明他们的手术建议。
在 296 名患者中，40.5%报告存在某种程度的心理困扰（DRAM=R），15.9%存在高度困扰（DRAM=D）。三位外科医生准确评估患者 DRAM 评分的能力均较差，总体kappa 值为 0.13（0.08-0.18），偏向于低估患者真实的心理困扰程度。被外科医生评估为正常（N）的患者接受手术的可能性是被评估为痛苦（D）的患者的 3.78 倍（P=0.007）。与 DRAM 评分较低的患者相比，DRAM 评分较高的患者的 Oswestry 残疾指数（P=0.008）和颈部残疾指数（P=0.005）评分更高。
脊柱外科医生检测患者心理特征的能力有限，且存在低估痛苦水平的倾向。这些不准确的评估会影响手术建议，这强调了在决策过程中限制外科医生偏见的重要性。
诊断 2 级。
