Physiotherapy
Volume 96, Issue 3 , Pages 213-221, September 2010

The influence of psychological factors on pre-operative levels of pain intensity, disability and health-related quality of life in lumbar spinal fusion surgery patients

  • Allan D. Abbott

      Affiliations

    • Department of Physical Therapy, Karolinska University Hospital, Stockholm, Sweden
    • Department of Clinical Science, Intervention and Technology, Division of Orthopaedics, Karolinska Institute, Stockholm, Sweden
    • Corresponding Author InformationCorresponding author at: Department of Physical Therapy, Karolinska University Hospital, Huddinge, Stockholm 14186, Sweden. Tel.: +46 8 585 819 55; fax: +46 8 585 821 90.
    • ,
  • Raija Tyni-Lenné

      Affiliations

    • Department of Physical Therapy, Karolinska University Hospital, Stockholm, Sweden
    • ,
  • Rune Hedlund

      Affiliations

    • Institute for Clinical Sciences, Department for Orthopaedics, Sahlgrenska University Hospital, Gothenburg, Sweden

published online 26 March 2010.

Abstract 

Objectives

To assess the extent to which perceived pain and psychological factors explain levels of disability and health-related quality of life (HRQOL) in patients scheduled for lumbar fusion surgery, and to test the hypothesis that relationships between pain intensity, mental health, fear of movement/(re)injury, disability and HRQOL are mediated by cognitive beliefs and appraisals.

Design

Cross-sectional, correlation study.

Setting

Orthopaedic outpatient setting in a tertiary hospital.

Participants

One hundred and seven chronic back pain patients scheduled for lumbar fusion surgery.

Measures

Visual analogue scale for pain intensity, Short Form 36 mental health subscale, Tampa Scale for Kinesiophobia, Back Beliefs Questionnaire, Self-efficacy Scale, Coping Strategy Questionnaire, Oswestry Disability Index and European Quality of Life Questionnaire.

Results

The group effect of multiple mediators significantly influenced the relationships between pain intensity and mental health, fear of movement/(re)injury, functional disability and HRQOL. Pain catastrophising significantly mediated the relationship between pain intensity and mental health, control over pain significantly mediated the relationship between mental health and functional disability, self-efficacy and pain outcome expectancy significantly mediated the relationship between mental health and HRQOL, and self-efficacy also significantly mediated the relationship between pain intensity, fear of movement/(re)jury and functional disability. The model explained 28, 30, 52 and 42% of the variation in mental health, fear of movement/(re)injury, functional disability and HRQOL, respectively.

Conclusions

This study highlights the strong influence and mediation roles of psychological factors on pain, mental health, fear of movement/(re)injury, disability and HRQOL in patients scheduled for lumber fusion. Future research should focus on screening as well as pre- and post-operative interventions based on these psychological factors for the potential improvement of lumber fusion surgery outcomes.

Keywords: Spinal fusion, Disability, Quality of life, Mental disorders, Fear avoidance, Mediation

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PII: S0031-9406(10)00017-9

doi:10.1016/j.physio.2009.11.013

Physiotherapy
Volume 96, Issue 3 , Pages 213-221, September 2010

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