Impact of poor mental health in adult spinal deformity patients with poor physical function: a retrospective analysis with a 2-year follow-up.

dc.contributor.author

Bakhsheshian, Joshua

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Scheer, Justin K

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Gum, Jeffrey L

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Hostin, Richard

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Lafage, Virginie

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Bess, Shay

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Protopsaltis, Themistocles S

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Burton, Douglas C

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Keefe, Malla Kate

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Hart, Robert A

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Mundis, Gregory M

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Shaffrey, Christopher I

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Schwab, Frank

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Smith, Justin S

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Ames, Christopher P

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International Spine Study Group

dc.date.accessioned

2023-07-09T21:52:40Z

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2023-07-09T21:52:40Z

dc.date.issued

2017-01

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2023-07-09T21:52:35Z

dc.description.abstract

OBJECTIVE Mental disease burden can have a significant impact on levels of disability and health-related quality of life (HRQOL) measures. Therefore, the authors investigated the significance of mental health status in adults with spinal deformity and poor physical function. METHODS A retrospective analysis of a prospective multicenter database of 365 adult spinal deformity (ASD) patients who had undergone surgical treatment was performed. Health-related QOL variables were examined preoperatively and at the 2-year postoperative follow-up. Patients were grouped by their 36-Item Short Form Health Survey mental component summary (MCS) and physical component summary (PCS) scores. Both groups had PCS scores ≤ 25th percentile for matched norms; however, the low mental health (LMH) group consisted of patients with an MCS score ≤ 25th percentile, and the high mental health (HMH) group included patients with an MCS score ≥ 75th percentile. RESULTS Of the 264 patients (72.3%) with a 2-year follow-up, 104 (28.5%) met the inclusion criteria for LMH and 40 patients (11.0%) met those for HMH. The LMH group had a significantly higher overall rate of comorbidities, specifically leg weakness, depression, hypertension, and self-reported neurological and psychiatric disease processes, and were more likely to be unemployed as compared with the HMH group (p < 0.05 for all). The 2 groups had similar 2-year postoperative improvements in HRQOL (p > 0.05) except for the greater improvements in the MCS and the Scoliosis Research Society-22r questionnaire (SRS-22r) mental domain (p < 0.05) in the LMH group and greater improvements in PCS and SRS-22r satisfaction and back pain domains (p < 0.05) in the HMH group. The LMH group had a higher rate of reaching a minimal clinically important difference (MCID) on the SRS-22r mental domain (p < 0.01), and the HMH group had a higher rate of reaching an MCID on the PCS and SRS-22r activity domain (p < 0.05). On multivariable logistic regression, having LMH was a significant independent predictor of failure to reach an MCID on the PCS (p < 0.05). At the 2-year postoperative follow-up, 14 LMH patients (15.1%) were categorized as HMH. Two LMH patients (2.2%), and 3 HMH patients (7.7%) transitioned to a PCS score ≥ 75th percentile for age- and sex-matched US norms (p < 0.01). CONCLUSIONS While patients with poor mental and physical health, according to their MCS and PCS scores, have higher medical comorbidity and unemployment rates, they still demonstrate significant improvements in HRQOL measurements postoperatively. Both LMH and HMH patient groups demonstrated similar improvements in most HRQOL domains, except that the LMH patients had difficulties in obtaining improvements in the PCS domain.

dc.identifier.issn

1547-5654

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1547-5646

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https://hdl.handle.net/10161/28401

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eng

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Journal of Neurosurgery Publishing Group (JNSPG)

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Journal of neurosurgery. Spine

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10.3171/2016.5.spine151428

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International Spine Study Group

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Humans

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Spinal Curvatures

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Severity of Illness Index

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Multivariate Analysis

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Likelihood Functions

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Logistic Models

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Retrospective Studies

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Follow-Up Studies

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Prospective Studies

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Mental Health

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Comorbidity

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Time Factors

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Quality of Life

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Databases, Factual

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Middle Aged

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Female

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Male

dc.title

Impact of poor mental health in adult spinal deformity patients with poor physical function: a retrospective analysis with a 2-year follow-up.

dc.type

Journal article

duke.contributor.orcid

Shaffrey, Christopher I|0000-0001-9760-8386

pubs.begin-page

116

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124

pubs.issue

1

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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

26

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