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Patient Activation Mediates the Association Between Psychosocial Risk Factors and Spine Surgery Results

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Abstract

Although spine surgery (SS) and spinal cord stimulators (SCSs) can provide significant relief for patients with intractable pain, their effectiveness is variable. Previously, a number of pre-operative psychosocial risk factors have predicted suboptimal outcomes of these procedures. However, recent research has found that “patient activation”—the extent to which patients are engaged and active in their own health care—can predict positive surgical results. The purpose of the current investigation was to determine whether patient activation helps explain associations between established psychosocial risk factors and suboptimal outcomes. Candidates for SS and SCS (n = 1254; 56.3% women, mean age 50.4 years) consented to participate in an outcome study prior to their pre-surgical psychological evaluation. Of those, 46.3% returned self-report measures an average of 180 days (SD = 79.1) post-surgery. Bootstrapped mediation analyses indicated that patient activation mediates numerous associations between psychosocial risk factors and suboptimal outcomes. That is, patients’ involvement in obtaining information, decision making, and their resilience can explain why some patients do not experience adverse surgical results when pre-surgical psychosocial risk factors are present. Pre-surgical psychological evaluations should include examination of patient strengths in addition to psychosocial risk factors, so that treatments can be appropriately individualized and the most effective surgical results obtained.

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References

  • Austin, J. E., & Rini, C. (2013). Bone marrow and stem cell transplant. Washington, DC: American Psychological Association.

    Book  Google Scholar 

  • Ben-Porath, Y. S. (2012). Interpreting the MMPI-2-RF (1 ed.). Minneapolis, MN: University of Minnesota Press.

    Google Scholar 

  • Ben-Porath, Y. S., & Tellegen, A. (2008/2011). The Minnesota multiphasic personality inventory-2 restructured form (MMPI-2-RF): Manual for administration, scoring, and interpretation. Minneapolis, MN: University of Minnesota Press.

  • Block, A. R. (2013). Spine surgery. In A. R. Block & D. B. Sarwer (Eds.), Presurgical psychological screening: Understanding patients, improving outcomes (pp. 43–60). Washington, DC: APA Press.

    Chapter  Google Scholar 

  • Block, A. R., & Ben-Porath, Y. S. (2018). MMPI-2-RF user’s guide for the spine surgery and spinal cord stimulator candidate interpretive reports. Minneapolis, MN: University of Minnesota Press.

    Google Scholar 

  • Block, A. R., Ben-Porath, Y. S., & Marek, R. J. (2013). Psychological risk factors for poor outcome of spine surgery and spinal cord stimulator implant: A review of the literature and their assessment with the MMPI-2-RF. The Clinical Neuropsychologist, 27(1), 81–107. https://doi.org/10.1080/13854046.2012.721007.

    Article  PubMed  Google Scholar 

  • Block, A. R., Marek, R. J., Ben-Porath, Y. S., & Kukal, D. (2017). Associations between pre-implant psychosocial factors and spinal cord stimulation outcome: Evaluation using the MMPI-2-RF. Assessment, 24(1), 60–70. https://doi.org/10.1177/1073191115601518.

    Article  PubMed  Google Scholar 

  • Block, A. R., Marek, R. J., Ben-Porath, Y. S., & Ohnmeiss, D. D. (2014). Associations between minnesota multiphasic personality inventory-2-restructured form (MMPI-2-RF) scores, workers’ compensation status, and spine surgery outcome. Journal of Applied Biobehavioral Research, 19(4), 248–267.

    Article  Google Scholar 

  • Block, A. R., & Sarwer, D. B. (2013). Introduction. In A. R. Block & D. B. Sarwer (Eds.), Presurgical psychological screening: Understanding patients, improving outcomes (1st ed., pp. 3–24). Washington, DC: American Psychological Association.

    Chapter  Google Scholar 

  • Cano, A. (2004). Pain catastrophizing and social support in married individuals with chronic pain: The moderating role of pain duration. Pain, 110(3), 656–664.

    Article  PubMed  PubMed Central  Google Scholar 

  • Enders, C. K., & Bandalos, D. L. (2001). The relative performance of full information maximum likelihood estimation for missing data in structural equation models. Structural Equation Modeling, 8(3), 430–457.

    Article  Google Scholar 

  • Fairbank, J. C., Couper, J., Davies, J. B., & O’Brien, J. P. (1980). The Oswestry low back pain disability questionnaire. Physiotherapy, 66(8), 271–273.

    CAS  PubMed  Google Scholar 

  • Fairbank, J. C., & Pynsent, P. B. (2000). The Oswestry Disability Index. Spine (Phila Pa 1976), 25(22), 2940–2952 (discussion 2952).

    Article  CAS  Google Scholar 

  • Fisher, K., & Johnston, M. (1997). Validation of the Oswestry low back pain disability questionnaire, its sensitivity as a measure of change following treatment and its relationship with other aspects of the chronic pain experience. Physiotherapy Theory and Practice, 13(1), 67–80.

    Article  Google Scholar 

  • Hayes, A. (2013). Introduction to mediation, moderation, and conditional process analysis. A regression-based approach. New York: Guilford. ISBN 1609182308.

    Google Scholar 

  • Hemphill, J. F. (2003). Interpreting the magnitudes of correlation coefficients. American Psychologist, 58(1), 78–80. https://doi.org/10.1037/0003-066X.58.1.78.

    Article  PubMed  Google Scholar 

  • Hibbard, J. H., Mahoney, E. R., Stockard, J., & Tusler, M. (2005). Development and testing of a short form of the patient activation measure. Health Services Research, 40(6p1), 1918–1930.

    Article  PubMed  PubMed Central  Google Scholar 

  • Hibbard, J. H., Stockard, J., Mahoney, E. R., & Tusler, M. (2004). Development of the Patient Activation Measure (PAM): Conceptualizing and measuring activation in patients and consumers. Health Services Research, 39(4p1), 1005–1026.

    Article  PubMed  PubMed Central  Google Scholar 

  • Marek, R. J., Block, A. R., & Ben-Porath, Y. S. (2015). The Minnesota multiphasic personality inventory-2-restructured form (MMPI-2-RF): Incremental validity in predicting early postoperative outcomes in spine surgery candidates. Psychological Assessment, 27(1), 114–124. https://doi.org/10.1037/pas0000035.

    Article  PubMed  Google Scholar 

  • Marek, R. J., Block, A. R., & Ben-Porath, Y. S. (2017). Validation of a psychological screening algorithm for predicting spine surgery outcomes. Assessment. https://doi.org/10.1177/1073191117719512.

    Article  PubMed  Google Scholar 

  • McCracken, L. M., & Vowles, K. E. (2014). Acceptance and commitment therapy and mindfulness for chronic pain: Model, process, and progress. American Psychologist, 69(2), 178.

    Article  PubMed  Google Scholar 

  • Mirza, S. K., Deyo, R. A., Heagerty, P. J., Turner, J. A., Martin, B. I., & Comstock, B. A. (2013). One-year outcomes of surgical versus nonsurgical treatments for discogenic back pain: A community-based prospective cohort study. The Spine Journal, 13(11), 1421–1433.

    Article  PubMed  PubMed Central  Google Scholar 

  • Preacher, K. J., Rucker, D. D., & Hayes, A. F. (2007). Addressing moderated mediation hypotheses: Theory, methods, and prescriptions. Multivariate Behavioral Research, 42(1), 185–227.

    Article  PubMed  Google Scholar 

  • Remmers, C., Hibbard, J., Mosen, D. M., Wagenfield, M., Hoye, R. E., & Jones, C. (2009). Is patient activation associated with future health outcomes and healthcare utilization among patients with diabetes? The Journal of Ambulatory Care Management, 32(4), 320–327.

    Article  PubMed  Google Scholar 

  • Skolasky, R. L., Mackenzie, E. J., Wegener, S. T., & Riley, L. H. 3rd (2008). Patient activation and adherence to physical therapy in persons undergoing spine surgery. Spine, 33(21), E784–E791. https://doi.org/10.1097/BRS.0b013e31818027f1.

    Article  PubMed  PubMed Central  Google Scholar 

  • Skolasky, R. L., Mackenzie, E. J., Wegener, S. T., & Riley, L. H. 3rd (2011). Patient activation and functional recovery in persons undergoing spine surgery. J Bone Joint Surg Am, 93(18), 1665–1671. https://doi.org/10.2106/JBJS.J.00855.

    Article  PubMed  Google Scholar 

  • Sogg, S., Lauretti, J., & West-Smith, L. (2016). Recommendations for the pre-surgical psychosocial evaluation of bariatric surgery patients. Surgery for Obesity and Related Diseases. https://doi.org/10.1016/j.soard.2016.02.008.

    Article  PubMed  Google Scholar 

  • Sturgeon, J. A., & Zautra, A. J. (2010). Resilience: A new paradigm for adaptation to chronic pain. Current Pain and Headache Reports, 14(2), 105–112.

    Article  PubMed  PubMed Central  Google Scholar 

  • Tellegen, A., & Ben-Porath, Y. S. (2008/2011). The Minnesota multiphasic personality inventory-2 restructured form (MMPI-2-RF): Technical manual. Minneapolis. Minneapolis, MN: University of Minnesota Press.

  • Weinstein, J. N., Tosteson, T. D., Lurie, J. D., Tosteson, A. N., Hanscom, B., Skinner, J. S., … Deyo, R. A. (2006). Surgical vs nonoperative treatment for lumbar disk herniation: The Spine Patient Outcomes Research Trial (SPORT): A randomized trial. JAMA, 296(20), 2441–2450.

    Article  CAS  PubMed  PubMed Central  Google Scholar 

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Funding

This study was partially funded through a grant from the University of Minnesota Press to the first author, Andrew Block.

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Authors and Affiliations

  1. Texas Back Institute, Plano, TX, 75093, USA

    Andrew R. Block

  2. College of Human Sciences and Humanities, University of Houston – Clear Lake, Houston, TX, 77008, USA

    Ryan J. Marek

  3. Department of Psychological Sciences, Kent State University, Kent, OH, 44242, USA

    Yossef S. Ben-Porath

Authors
  1. Andrew R. Block
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  2. Ryan J. Marek
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  3. Yossef S. Ben-Porath
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Corresponding author

Correspondence to Andrew R. Block.

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Conflict of interest

Yossef Ben-Porath is a paid consultant to the MMPI-2-RF publisher, the University of Minnesota and Distributor, Pearson. As co-author of the MMPI-2-RF, he receives royalties on sales of the test. Andrew R. Block and Ryan J. Marek declare that they have no conflict of interest.

Ethical Approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

Human and Animal Rights

This article does not contain any studies with animals performed by any of the authors.

Informed Consent

Informed consent was obtained from all individual participants included in the study.

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Block, A.R., Marek, R.J. & Ben-Porath, Y.S. Patient Activation Mediates the Association Between Psychosocial Risk Factors and Spine Surgery Results. J Clin Psychol Med Settings 26, 123–130 (2019). https://doi.org/10.1007/s10880-018-9571-x

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  • DOI: https://doi.org/10.1007/s10880-018-9571-x

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