Kristin R Archer1, Caryn L Seebach2, Shannon L Mathis3, Lee H Riley4, Stephen T Wegener5. 1. Department of Orthopaedic Surgery & Rehabilitation, Vanderbilt University, School of Medicine, Medical Center East - South Tower, Suite 4200, Nashville, TN 37232, USA. Electronic address: kristin.archer@vanderbilt.edu. 2. Department of Psychology, Washington DC VA Medical Center, 50 Irving St, NW, Washington, DC 20422, USA. 3. Department of Orthopaedic Surgery & Rehabilitation, Vanderbilt University, School of Medicine, Medical Center East - South Tower, Suite 4200, Nashville, TN 37232, USA. 4. Department of Orthopaedic Surgery, Johns Hopkins Medicine, 601 N. Carolina St, Baltimore, MD 21287, USA. 5. Department of Physical Medicine and Rehabilitation, Johns Hopkins Medicine, 600 N. Wolfe St, Baltimore, MD 21287, USA.
Abstract
BACKGROUND CONTEXT: The fear-avoidance model offers a promising framework for understanding the development of chronic postoperative pain and disability. However, limited research has examined this model in patients undergoing spinal surgery. PURPOSE: To determine whether preoperative and early postoperative fear of movement predicts pain, disability, and physical health at 6 months following spinal surgery for degenerative conditions, after controlling for depressive symptoms and other potential confounding variables. STUDY DESIGN/ SETTING: A prospective cohort study conducted at an academic outpatient clinic. PATIENT SAMPLE: One hundred forty-one patients undergoing surgery for lumbar or cervical degenerative conditions. OUTCOME MEASURES: Self-reported pain and disability were measured with the Brief Pain Inventory and the Oswestry Disability Index/Neck Disability Index, respectively. The physical composite scale of the 12-Item Short-Form Health Survey (SF-12) measured physical health. METHODS: Data collection occurred preoperatively and at 6 weeks and 6 months following surgery. Fear of movement was measured with the Tampa Scale for Kinesiophobia and depression with the Prime-MD PHQ-9. RESULTS: One hundred and twenty patients (85% follow-up) completed the 6-month postoperative assessment. Multivariable mixed-method linear regression analyses found that early postoperative fear of movement (6 weeks) predicted pain intensity, pain interference, disability, and physical health at 6-month follow-up (p<.05). Preoperative and early postoperative depression predicted pain interference, disability, and physical health. CONCLUSION: Results provide support for the fear-avoidance model in a postsurgical spine population. Early postoperative screening for fear of movement and depressive symptoms that do not acutely improve following surgical intervention appears warranted. Cognitive and behavioral strategies may be beneficial for postsurgical patients with high fear of movement and/or depressive symptoms.
BACKGROUND CONTEXT: The fear-avoidance model offers a promising framework for understanding the development of chronic postoperative pain and disability. However, limited research has examined this model in patients undergoing spinal surgery. PURPOSE: To determine whether preoperative and early postoperative fear of movement predicts pain, disability, and physical health at 6 months following spinal surgery for degenerative conditions, after controlling for depressive symptoms and other potential confounding variables. STUDY DESIGN/ SETTING: A prospective cohort study conducted at an academic outpatient clinic. PATIENT SAMPLE: One hundred forty-one patients undergoing surgery for lumbar or cervical degenerative conditions. OUTCOME MEASURES: Self-reported pain and disability were measured with the Brief Pain Inventory and the Oswestry Disability Index/Neck Disability Index, respectively. The physical composite scale of the 12-Item Short-Form Health Survey (SF-12) measured physical health. METHODS: Data collection occurred preoperatively and at 6 weeks and 6 months following surgery. Fear of movement was measured with the Tampa Scale for Kinesiophobia and depression with the Prime-MD PHQ-9. RESULTS: One hundred and twenty patients (85% follow-up) completed the 6-month postoperative assessment. Multivariable mixed-method linear regression analyses found that early postoperative fear of movement (6 weeks) predicted pain intensity, pain interference, disability, and physical health at 6-month follow-up (p<.05). Preoperative and early postoperative depression predicted pain interference, disability, and physical health. CONCLUSION: Results provide support for the fear-avoidance model in a postsurgical spine population. Early postoperative screening for fear of movement and depressive symptoms that do not acutely improve following surgical intervention appears warranted. Cognitive and behavioral strategies may be beneficial for postsurgical patients with high fear of movement and/or depressive symptoms.
Authors: Ian R Carroll; Jennifer M Hah; Peter L Barelka; Charlie K M Wang; Bing M Wang; Matthew J Gillespie; Rebecca McCue; Jarred W Younger; Jodie Trafton; Keith Humphreys; Stuart B Goodman; Fredrick M Dirbas; Sean C Mackey Journal: Pain Med Date: 2015-07-14 Impact factor: 3.750
Authors: Kristin R Archer; Clinton J Devin; Susan W Vanston; Tatsuki Koyama; Sharon E Phillips; Shannon L Mathis; Steven Z George; Matthew J McGirt; Dan M Spengler; Oran S Aaronson; Joseph S Cheng; Stephen T Wegener Journal: J Pain Date: 2015-10-23 Impact factor: 5.820
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Authors: Rogelio A Coronado; Dawn M Ehde; Jacquelyn S Pennings; Susan W Vanston; Tatsuki Koyama; Sharon E Phillips; Shannon L Mathis; Matthew J McGirt; Dan M Spengler; Oran S Aaronson; Joseph S Cheng; Clinton J Devin; Stephen T Wegener; Kristin R Archer Journal: Phys Ther Date: 2020-09-28
Authors: James M Parrish; Nathaniel W Jenkins; Manasi S Parrish; Elliot D K Cha; Conor P Lynch; Dustin H Massel; Nadia M Hrynewycz; Shruthi Mohan; Cara E Geoghegan; Caroline N Jadczak; Jennifer Westrick; Rebecca Van Horn; Kern Singh Journal: Eur Spine J Date: 2021-02-10 Impact factor: 2.721