Departments of Orthopaedic Surgery and Physical Medicine & Rehabilitation, The Johns Hopkins University School of Medicine, 601 N. Caroline Street, Suite 5244, Baltimore, MD, 21287, USA.
Department of Surgery, University of Toronto, Toronto, Canada.
BMC Musculoskelet Disord. 2024 Jul 29;25(1):595. doi: 10.1186/s12891-024-07709-2.
With the increased use of patient-reported outcomes measures (PROMs) to assess spine surgery outcomes, it is important to understand how patients interpret their health changes over time. The measurement of cognitive-appraisal processes enables the quantification of how individuals think about quality of life (QOL). This study examined how appraisal processes were associated with patients' views of their role in managing their health-patient activation.
This longitudinal cohort study from August 2019 to January 2022 included 222 adults undergoing spine surgery for cervical (n = 107) and/or lumbar (n = 148) pathology at an academic medical center. PROMs assessed disability (Neck Disability Index for cervical or Oswestry Disability Index for lumbar) and mental health (PROMIS-29 v2.0), cognitive-appraisal processes (QOLAP-SF), and patient activation (Patient Activation Measure). ANOVA models were used to examine the relationships between QOL and cognitive appraisal processes before and after surgery, overall and stratified by patient-activation stage. Effect sizes facilitated interpretation.
There were significant improvements in pain-related disability and mental health following surgery. Cognitive appraisal processes explained substantial amounts of variance, particularly with changes in mental health (45% before surgery, 75% at three months, and 63%, at 12-months after surgery). With respect to physical disability, less disability was associated with a lesser focus on negative aspects of QOL. Appraisal explained the most variance before surgery for high-activation patients. At 12-months post-surgery, however, appraisal explained the most variance for the low-activation patients. Appraisal explained similar amounts of variance in mental health at baseline and three-months post-surgery for all activation groups, but substantially more variance in the low-activation group at 12-months post-surgery. There were differences in the direction of appraisal-outcome associations by activation group in selected appraisal items/domains.
Cognitive-appraisal processes demonstrate a significant relationship with QOL among spine surgery patients. These processes explain substantial variance in pain-related disability and mental health, especially among those high in activation before surgery and those low in activation at 12-months post-surgery. Our findings suggest that patients' ways of thinking about their health may be effective targets of motivational coaching, to help them become more engaged over the recovery trajectory.
随着患者报告结局测量（PROMs）在评估脊柱手术结果中的应用日益增多，了解患者如何随时间推移感知自身健康变化变得尤为重要。认知评估过程的测量可以量化个体对生活质量（QOL）的看法。本研究探讨了评估过程如何与患者对自身健康管理角色的看法相关联，即患者激活度。
这是一项从 2019 年 8 月至 2022 年 1 月在学术医疗中心接受颈椎（n=107）和/或腰椎（n=148）病变脊柱手术的 222 名成年人的纵向队列研究。PROMs 评估了残疾（颈椎用 Neck Disability Index，腰椎用 Oswestry Disability Index）和心理健康（PROMIS-29 v2.0）、认知评估过程（QOLAP-SF）和患者激活度（Patient Activation Measure）。采用方差分析模型，根据患者激活阶段，总体上和分层后，检验手术前后 QOL 和认知评估过程之间的关系。效应大小有助于解释。
手术后疼痛相关残疾和心理健康均有显著改善。认知评估过程解释了大量的方差，尤其是心理健康的变化（手术前为 45%，术后 3 个月为 75%，术后 12 个月为 63%）。就身体残疾而言，较少的残疾与较少关注 QOL 的负面方面相关。在高激活患者中，评估在术前解释了最大的方差。然而，在术后 12 个月，评估在低激活患者中解释了最大的方差。在所有激活组中，评估在基线和术后 3 个月时对心理健康的解释方差相似，但在术后 12 个月时，在低激活组中解释了更多的方差。在某些评估项目/领域，激活组之间的评估-结果关联方向存在差异。
认知评估过程与脊柱手术患者的 QOL 显著相关。这些过程解释了疼痛相关残疾和心理健康的大量差异，尤其是在术前激活程度较高和术后 12 个月时激活程度较低的患者中。我们的研究结果表明，患者对自身健康的思考方式可能是动机辅导的有效目标，以帮助他们在康复过程中更加投入。
