Samenvatting
BACKGROUND: Currently, evidence regarding fear avoidance beliefs as potential predictors for lumbar surgery outcomes seems insufficient and strong conclusions are not yet available.
OBJECTIVE: This systematic review aimed to evaluate the predictive value of preoperative fear avoidance beliefs for postoperative pain intensity, functional status, and health-related quality of life following surgery for lumbar degenerative disease.
STUDY DESIGN: Systematic review and best evidence synthesis.
METHODS: An extensive search was performed in PubMed/Medline, EMBASE, PsycINFO, CINAHL and the Cochrane library for articles published up until October 2021. Two independent reviewers performed the screening, data extraction, and quality assessment, with a third independent reviewer consulting to resolve any disagreement. Observational studies that included patients undergoing surgery for lumbar degenerative disease, as well as evaluated fear avoidance beliefs (i.e., pain-related fear, pain catastrophizing, pain anxiety) in relation to a surgical outcome measure (i.e., pain intensity, functional status and health-related quality of life) were included in the review. The CHARMS- and QUIPS-tools were used for data extraction and quality assessment, respectively. A best evidence synthesis was performed resulting in conclusions regarding strong, moderate, conflicting, and limited levels of evidence.
RESULTS: A total of 24 studies (n = 17,881) were included in this review. Following best evidence synthesis, 3 included studies reported no significant predictive value of preoperative pain-related fear for postoperative pain intensity resulting in moderate evidence for this relationship. Moderate evidence was also found indicating no significant predictive value of preoperative pain-related fear for postoperative functional status, as 6 out of 8 relevant studies reported this result. Only one study reported on the predictive value of preoperative pain catastrophizing for postoperative health-related quality of life, resulting in limited evidence for the absence of this predictive relationship. All other relationships were found to have conflicting evidence.
LIMITATIONS: To evaluate surgical outcome, only patient-reported outcome measures as used by spine registries were included. Thus, our findings cannot be extrapolated to all surgery outcomes following lumbar degenerative disease and should only be interpreted in relation to postoperative pain intensity, functional status, or health-related quality of life.
CONCLUSION: Best evidence synthesis showed moderate evidence indicating that preoperative pain-related fear is not a significant predictor for postoperative pain and function following surgery for lumbar degenerative disease. Additionally, limited evidence was found for a lack of predictive value of preoperative pain catastrophizing for postoperative health-related quality of life. As current evidence regarding the predictive value of preoperative fear avoidance beliefs following such a surgery is mixed, further research is required before more definitive conclusions can be made.
| Originele taal-2 | English |
|---|---|
| Pagina's (van-tot) | 441-457 |
| Aantal pagina's | 17 |
| Tijdschrift | Pain Physician |
| Volume | 25 |
| Nummer van het tijdschrift | 6 |
| Status | Published - sep 2022 |
Bibliografische nota
Funding Information:Wouter Van Bogaert, Iris Coppieters, Eva Huys-mans and Lisa Goudman are funded by the Research Foundation Flanders (FWO), Belgium. Jo Nijs is holder of a chair at the Vrije Universiteit Brussel, funded by the Berekuyl Academy, Hardewijk, The Netherlands. Jo Nijs and the Vrije Universiteit Brussel received lecturing/ teaching fees from various professional associations and educational organizations outside of the submitted work. Maarten Moens received speaker fees from Medtronic, Nevro, and Saluda outside of the submitted work. STIMULUS received independent research grants from Medtronic. There are no other conflicts of interest to declare. The funding had no influence in the study concept, study design, data collection, or any other research-related aspect that led to the preparation of this manuscript.
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© 2022, American Society of Interventional Pain Physicians. All rights reserved.
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Copyright 2022 Elsevier B.V., All rights reserved.