Relevance of Lifestyle and Attitudinal Factors to Spine Surgery Outcomes: Empirical Results on a Heterogeneous Sample

Carolyn E. Schwartz, Brian Quaranto, Emily Samaha, Mariam Kahn-Woods, Paul Glazer
DOI: 10.4236/ss.2011.23024                

Abstract

Background Context: Patient demographic and medical indicators influence the well-being of spine surgery patients. It may, however, be worthwhile to evaluate other lifestyle and attitudinal factors. We hypothesized that such factors would explain at least as much variance in outcome as more commonly considered covariates. Purpose: To compare explained variance in outcome of lifestyle and attitudinal factors as compared to standard demographic and medical covariates. Study Design/Setting: Cross-sectional observational study of patients drawn from an active clinic and internet-based support group. Patient Sample: A heterogeneous sample of 376 patients was recruited, comprised of people with diagnoses of cervical (n = 80), lumbar (n = 228), and scoliosis (n = 68) spine disorders. Outcome Measures: Quality of Life (QOL) outcomes were measured using the Oswestry Disability Index, Neck Disability Index, Rand-36, PROMIS Pain Impact, NRS Back and Leg Pain, Scoliosis Research Society-22r, and Global Health. Methods: This study compared explained variance in QOL outcomes in demographic and medical versus lifestyle and attitudinal factors. Demographic and medical factors included age, gender, body mass index, and co-morbidities. Lifestyle factors included exercise and commuting practice. Attitudinal factors related to social connectedness: giving and receiving emotional support, feeling overwhelmed by others’ needs, helping orientation, and general helping behaviors. Regression analyses estimated explained variance. Patient groups differed in most factors evaluated, so the regression analyses were computed separately by group. R2 statistics were characterized as null, small (0.02), medium (0.15), and large (0.35) effect sizes (ES), and proportions were compared for the medical/demographic versus lifestyle/attitudinal factors by group. Results: Similar proportions of variance were explained by demographic/medical and lifestyle/attitudinal covariates across groups, with half of effect sizes being small in magnitude and 6% being medium. Lumbar patients tended to have more small effect sizes among lifestyle and attitudinal covariates than among medical/demographic covariates (z = – 1.29, p < 0.10). Similar patterns were found for both generic and disease-specific outcomes. Conclusions: Spine surgery outcome research should investigate lifestyle and attitudinal factors to enhance the personal and salutogenic relevance of the research. Time spent commuting, exercise practice, and social connectedness appear to be relevant factors. A pre-operative evaluation of overweight and smoking status, limited social connectedness, and long daily commutes could alert the surgeon to delay or avoid performing procedures on these patients to avoid poor outcomes.

Keywords

Spine Surgery Outcomes; Predictors; Behaviors; Attitudes; Lumbar; Cervical; Scoliosis

Conflicts of Interest

The authors declare no conflicts of interest.

References

[1]	J. A. Sloan, D. Cella and R. D. Hays, “Clinical Signi- Ficance of Patient-Reported Questionnaire Data: Another Step toward Consensus. (Editorial),” Journal Clinical Epidemiology, Vol. 58, No. 12, 2005, pp. 1217-1219. doi:10.1016/j.jclinepi.2005.07.009
[2]	L. Y. Carreon, et al., “Neck Disability Index, Short Form-36 Physical Component Summary, and Pain Scales for Neck and Arm Pain: The Minimum Clinically Important Difference and Substantial Clinical Benefit after Cervical Spine Fusion,” The Spine Journal, Vol. 10, No. 6, 2010, pp. 469-474. doi:10.1016/j.spinee.2010.02.007
[3]	B. R. Theodore, “Methodological Problems Associated with the Present Conceptualization of the Minimum Clinically Important Difference and Substantial Clinical Benefit,” The Spine Journal, Vol. 10, No. 6, 2010, pp. 507-509. doi:10.1016/j.spinee.2010.04.003
[4]	D. K. Resnick, “Evidence-Based Spine Surgery,” Spine, Vol. 32, Supplement 11, 2007, pp. S15-19. doi:10.1097/BRS.0b013e318053d4b4
[5]	W. C. Watters, et al., “Degenerative Lumbar Spinal Steno-Sis: An Evidence-Based Clinical Guideline for the Diagno- Sis and Treatment of Degenerative Lumbar Spinal Stenosis,” The Spine Journal, Vol. 8, No. 2, 2008, pp. 305-310.
[6]	W. C. Watters, et al., “An Evidence-Based Clinical Guide-Line for the Diagnosis and Treatment of Degenerative Lumbar Spondylolisthesis,” The Spine Journal, Vol. 9, No. 7, 2009, pp. 609-614. doi:10.1016/j.spinee.2009.03.016
[7]	J. Slover, et al., “The Impact of Comorbidities on the Change in Short-Form 36 and Oswestry Scores Following Lumbar Spine Surgery,” Spine, Vol. 31, No. 7, 2006, pp. 1974-1980. doi:10.1097/01.brs.0000229252.30903.b9
[8]	A. R. Block, et al., “The Psychology of Spine Surgery,” American Psychological Association, Washington DC, 2003. doi:10.1037/10613-000
[9]	B. Van Dorsten and E. M. Lindley, “Improving Outcomes via Behavioral Assessment of Spine Surgery Candidates,” SpineLine, January/February 2010, pp. 15-20.
[10]	I. Harris, et al., “Association between Compensation Stat-Us and Outcome after Surgery: A Meta-Analysis,” Journal of the American Medical Association, Vol. 293, No. 13, 2005, pp. 1644-1652. doi:10.1001/jama.293.13.1644
[11]	M. L. Rohling, L. M. Binder and J. Langhinrichsen -Rohling, “Money Matters: A Meta-Analytic Review of the Association between Financial Compensation and the Experience and Treatment of Chronic Pain,” Health Psychology, Vol. 14, No. 6, 1995, pp. 537-547. doi:10.1037/0278-6133.14.6.537
[12]	J. C. Fairbank and P. B. Pynsent, “The Oswestry Disability Index,” Spine, Vol. 25, No. 22 2000, pp. 2940-2952. doi:10.1097/00007632-200011150-00017
[13]	H. Vernon and S. Mior, “The Neck Disability Index: A Study of Reliability and Validity,” Journal of Manipulative Physiological Therapy, Vol. 14, 1991, pp. 405-415.
[14]	R. D. Hays, C. D. Sherbourne and R. Maze, “The RAND 36-Item Health Survey 1.0,” Health Economics, Vol. 2, No. 3, 1993, pp. 217-227. doi:10.1002/hec.4730020305
[15]	J. Ware Jr., M. Kosinski and S. D. Keller, “A 12-Item Short-Form Health Survey: Construction of Scales and Preliminary Tests of Reliability and Validity,” Medical Care, Vol. 34, No. 3, 1996, pp. 220-233. doi:10.1097/00005650-199603000-00003
[16]	K. F. Cook, M. A. Kallen and D. Amtmann, “Having a Fit: Impact of Number of Items and Distribution of Data on Traditional Criteria for Assessing IRT’s Unidimensionality Assumption,” Quality of Life Research, Vol. 18, No. 4, 2009, pp. 447-460. doi:10.1007/s11136-009-9464-4
[17]	R. A. Deyo, et al., “Outcome Measures for Low Back Pain Research. A Proposal for Standardized Use,” Spine, Vol. 23, No. 18m, 1998, pp. 2003-2013. doi:10.1097/00007632-199809150-00018
[18]	K. H. Bridwell, et al., “Is the SRS-22 Instrument Responsive to Change in Adult Scoliosis Patients Having Primary Spinal Deformity Surgery?” Spine, Vol. 32, No. 20, 2007, pp. 2220-2225. doi:10.1097/BRS.0b013e31814cf120
[19]	O. Sangha, et al., “The Self-Administered Comorbidity Questionnaire: A New Method to Assess Comorbidity for Clinical and Health Services Research,” Arthritis Rheum, Vol. 49, No. 2, 2003, pp. 156-163. doi:10.1002/art.10993
[20]	C. E. Schwartz, et al., “Helping Others Shows Differential Benefits on Health and Well-Being for Male and Female Teens,” Journal of Happiness Studies, Vol. 10, No. 4 2009, pp. 431-448. doi:10.1007/s10902-008-9098-1
[21]	J. Cohen, “A Power Primer,” Psychological Bulletin, Vol. 112, No. 1, 1992, pp. 155-159. doi:10.1037/0033-2909.112.1.155
[22]	C. Schwartz, et al., “Altruistic Social Interest Behaviors Are Associated with Better Mental Health,” Psychosomatic Medicine, Vol. 65, No. 5, 2003, pp. 778-785. doi:10.1097/01.PSY.0000079378.39062.D4
[23]	S. L. Brown, et al., “Religion and Emotional Compen- Sation: Results from a Prospective Study of Widowhood,” Personality and Social Psycholical Bulletin, Vol. 30, No. 9, 2004, pp. 1165-1174. doi:10.1177/0146167204263752