Rehabilitation following surgery to the low back

Abstract

It is estimated that between 10 and 45% of patients who undergo surgery to the low back continue to suffer pain. This variability cannot be explained solely on the basis of pre-surgical clinical findings. There has been little clear elucidation of the issues which may affect outcome. The study aimed to identify those patients who were most likely to benefit from surgery and those whose rehabilitation might be prolonged by evaluating the psychological, clinical and demographic factors which may influence outcome. In addition, it attempted to investigate the relationship between cardiovascular and endocrine functioning and psychological factors. Eighty nine patients were assessed on a range of pre and peri-operative measures and then various outcome measures post-operatively on four occasions up to six months following surgery. Those who reported low anxiety pre-operatively and those who believed more in their own control over their back problems improved more in several areas of quality of life. Patients of one of the surgeons improved more in several aspects and those who waited longest for their surgery fared less well. Women and those who were not wage earners appeared to be less well rehabilitated when compared to men or those in heavy or active occupations. Depression, social support and coping had little effect on outcome. There were no relationships between self reported, cardiovascular and endocrine measures of anxiety. It is concluded that psychological, demographic and clinical factors can have a far reaching impact on rehabilitation. These factors may be inherent in the patient or may possibly be associated with attitudes of the hospital staff to the patient. It is concluded that the findings have implications for future intervention studies designed to improve the rehabilitation of these patients.