Depression Symptoms Are Associated with Poor Functional Status Among Operative Spinal Deformity Patients.

dc.contributor.author

Lafage, Renaud

dc.contributor.author

Ang, Bryan

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Schwab, Frank

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Kim, Han Jo

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Smith, Justin S

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Shaffrey, Christopher

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Burton, Douglas

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Ames, Christopher

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Mundis, Gregory

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Hostin, Richard

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Bess, Shay

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Klineberg, Eric

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Passias, Peter

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Lafage, Virginie

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on behalf of the International Spine Study Group (ISSG)

dc.date.accessioned

2023-06-19T18:45:17Z

dc.date.available

2023-06-19T18:45:17Z

dc.date.issued

2021-04

dc.date.updated

2023-06-19T18:45:16Z

dc.description.abstract

Study design

Retrospective review of prospective multicenter database.

Objective

The aim of this study was to investigate how preoperative mental status affects preoperative and postoperative disability and health scores in adult spinal deformity (ASD) patients.

Summary of background data

The relationship between health-related quality of life (HRQOL) and depression has previously been documented. However, the influence of depression on clinical outcomes among ASD patients is not well understood.

Methods

ASD patients with minimum 2-year follow-up were stratified based on preoperative mental health measured by Short Form 36 (SF-36) mental component score (MCS). Patients with MCS in the 25th and 75th percentile of the cohort were designated as having low and high MCS, respectively. After matching by preoperative demographics and deformity, pre- and post-HRQOL were compared between the two groups. Further analysis was performed to identify individualized questions on the SF-36 that could potentially screen for patients with low MCS.

Results

Five hundred thirteen patients were assessed (58.4 years' old, 79% women, mean MCS 45.5). Thresholds for low and high MCS cohorts were 35.0 and 57.3, respectively. After matching by preoperative alignment, low MCS patients had worse Oswestry Disability Index (ODI) (52.3 ± 17.0 vs. 35.7 ± 14.6, P < 0.001) and Scoliosis Research Society-22R scores for all domains (all P < 0.001) compared to high MCS patients. Similar results were maintained at 2-year postop, with low MCS patients having a worse ODI (35.2 ± 20.2 vs. 19.7 ± 18.6, P < 0.001) and MCS (42.4 ± 13.5 vs. 58.6 ± 7.1, P < 0.001). Despite similar preoperative Physical Component Score (PCS), low MCS patients were less likely to reach MCID for PCS (46.1% vs. 70.6%, P < 0.01) and had a lower satisfaction at 2-year follow-up (3.88 ± 1.07 vs. 4.39 ± 0.94, P < 0.001). Questions 5a, 9d, and 9f on the SF-36 were found to be independent predictors of low MCS.

Conclusion

ASD patients with low MCS are more likely to experience functional limitations before and after surgery and are less likely to be satisfied postoperatively, even when similar clinical goals are achieved. Incorporating psychological factors may assist in decision making.Level of Evidence: 3.
dc.identifier

00007632-202104010-00010

dc.identifier.issn

0362-2436

dc.identifier.issn

1528-1159

dc.identifier.uri

https://hdl.handle.net/10161/28113

dc.language

eng

dc.publisher

Ovid Technologies (Wolters Kluwer Health)

dc.relation.ispartof

Spine

dc.relation.isversionof

10.1097/brs.0000000000003886

dc.subject

International Spine Study Group (ISSG)

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Humans

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Scoliosis

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Retrospective Studies

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Follow-Up Studies

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Prospective Studies

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Depression

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Mental Health

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Quality of Life

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Databases, Factual

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Adult

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Aged

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Middle Aged

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Female

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Male

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Functional Status

dc.title

Depression Symptoms Are Associated with Poor Functional Status Among Operative Spinal Deformity Patients.

dc.type

Journal article

duke.contributor.orcid

Shaffrey, Christopher|0000-0001-9760-8386

pubs.begin-page

447

pubs.end-page

456

pubs.issue

7

pubs.organisational-group

Duke

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School of Medicine

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Clinical Science Departments

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Orthopaedic Surgery

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Neurosurgery

pubs.publication-status

Published

pubs.volume

46

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