Negative beliefs and psychological disturbance in spine surgery patients: a cause or consequence of a poor treatment outcome?

Havakeshian, S.; Mannion, A. F.

doi:10.1007/s00586-013-2822-5

Cited by 63Musculoskeletal pain and rehabilitationSpine and Intervertebral Disc PathologyCervical and Thoracic Myelopathy

Negative beliefs and psychological disturbance in spine surgery patients: a cause or consequence of a poor treatment outcome?

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Havakeshian, S., Mannion, A. F.·2013·European Spine Journal

DOI 10.1007/s00586-013-2822-5PMC PMC3843780

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Abstract

Purpose Chronic musculoskeletal pain is often associated with psychological distress and maladaptive beliefs and these are sometimes reported to have a negative impact on surgical outcome. The influence of a surgical intervention, and in particular its outcome, on the course of change in psychological status is poorly documented. In this prospective study, we sought to examine the dynamic interplay between psychological factors and outcome in patients undergoing decompression surgery for spinal stenosis/herniated disc.Methods Before and 12 months after surgery, 159 patients (100 men, 59 women; 65 ± 11 years) completed a questionnaire booklet containing questions on socio-demographics, medical history, pain characteristics (intensity, frequency, use of medication), psychological disturbance [ZUNG Depression Scale and Modified Somatic Perception Questionnaire (MSPQ)], catastrophising (sub-scale of the Coping Strategies Questionnaire) and disability (Roland and Morris questionnaire) and the Fear Avoidance Beliefs Questionnaire about physical activity (FABQ-PA). The global outcome of surgery was assessed at 12 months using a five-point Likert scale and dichotomised as "good" (operation helped/helped a lot; coded 1) and "poor" (operation helped only little/did not help/made things worse; coded 0).Results Valid questionnaire data were available for 148 patients at 12 months' follow-up: 113 (76.4 %) reported a good outcome and 35 (23.6 %) a poor outcome. In univariate analyses, the following baseline variables each significantly (p < 0.05) predicted a good 12-month global outcome: no involvement in a disability claim, and lower LBP frequency, average LBP in the last week, average score on all pain scales, FABQ-PA and catastrophising. In multiple logistic regression, only lower FABQ-PA scores [OR 0.877 (95 %CI 0.809-0.949), p = 0.001] and lower LBP frequency at baseline [OR 0.340 (1.249-1.783), p < 0.0001] significantly predicted a good outcome at 12 months. A second "explanatory" logistic regression model revealed that a good outcome at 12 months was significantly associated with improvements (from baseline to 12 months) in average score on all the pain intensity scales [OR 1.6879 (1.187-2.398)], general health [OR 1.246 (1.004-1.545)], psychological disturbance [OR 1.073 (1.006-1.144)] and Roland Morris Disability [OR 1.243 (1.074-1.439)].Conclusion In a multivariable prospective (predictive) model, FABQ-PA was the only baseline psychological factor that significantly predicted outcome. Future studies should assess whether pre-operative cognitive-behavioural therapy in patients with maladaptive beliefs improves treatment outcome. Psychological disturbance did not significantly predict outcome, but it improved post-operatively in patients with a good outcome and worsened in those with a poor outcome. Rather than being a risk factor for poor outcome, in this group it appeared to be more a consequence of long-standing, unremitting pain that improved when symptoms resolved after successful surgery.

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Robust literature supports preoperative psychological distress and fear of movement as significant risk factors for poorer post-surgical outcomes.
“Robust literature supports preoperative psychological distress and fear of movement as significant risk factors for poorer post-surgical outcomes, 30,[43][44][45][46]”
From A Conceptual Model for Spine Surgery Recovery: A Qualitative Study of Patients’ Expectations, Experiences, and Satisfaction (2023) · cites this paper as [30]
The Discussion reports that preoperative fear-avoidance beliefs significantly predicted poor surgical outcome and that many previous studies found a similar association. It also says many, but not all, studies linked preoperative psychological distress to poor outcomes; this study found no predictive power for distress (Discussion; Conclusion). The claim therefore overstates the support for both factors as significant risk factors. (LLM, conf=0.90)
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Negative beliefs and psychological disturbance in spine surgery patients: a cause or consequence of a poor treatment outcome? Havakeshian S, Mannion AF. Eur Spine J December 2013, Volume 22, Issue 12, pp 2827-2835
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Authors: Havakeshian, S., & Mannion, A. F.
Affiliations: Schulthess-Klinik (CH)
Corresponding author: Mannion, A. F.
ORCID: Mannion, A. F.
Venue: European Spine Journal
Publisher: Springer Science and Business Media LLC
Published: 2013-05-23
Volume: 22
Issue: 12
Pages: 2827-2835
ISSN: 0940-6719 (ISSN-L)
1432-0932
DOI: 10.1007/s00586-013-2822-5
PMC: PMC3843780
OpenAlex: W1996879446
Cited by: 63
References: 55
Citations by year: 2026: 2 · 2025: 3 · 2024: 4 · 2023: 9 · 2022: 7 · 2021: 5 · 2020: 4 · 2019: 3 · 2018: 6 · 2017: 4 · 2016: 9 · 2015: 4 · 2014: 2 · 2013: 1
FWCI: 3.92
Type: journal article
Language: en
Open access: bronze
doi.org
Licence: www.springer.com/tdm (tdm)
Locations: European Spine Journal (publishedVersion)
Europe PMC (PubMed Central) (publishedVersion)
PubMed Central (publishedVersion)
PubMed (publishedVersion)
Funders: National Science Foundation
Schweizerischer Nationalfonds zur Förderung der Wissenschaftlichen Forschung (57123)
Universität Zürich
Topics: Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
Health Sciences › Medicine › Pathology and Forensic Medicine › Spine and Intervertebral Disc Pathology
Health Sciences › Medicine › Surgery › Cervical and Thoracic Myelopathy
Keywords: spinal surgery, spinal stenosis, disc herniation, fear-avoidance beliefs, psychological distress, pain catastrophizing, low back pain, surgical outcomes, psychological factors, chronic musculoskeletal pain
MeSH terms: Aged, Disability Evaluation, Fear, Female, Follow-Up Studies, Humans, Intervertebral Disc Displacement, Male, Pain Measurement, Postoperative Period, Prospective Studies, Surveys and Questionnaires, Risk Factors, Multivariate Analysis, Treatment Outcome, Low Back Pain, Decompression, Surgical, Catastrophization

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Negative beliefs and psychological disturbance in spine surgery patients: a cause or consequence of a poor treatment outcome?

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