Predictors of improved quality of life 12 months after lumbar spinal fusion surgery.

摘要

Designed to determine the effects of lumbar spinal fusion (LSF) surgery on health-related quality of life (HRQOL) and pain, this prospective repeated measures used Kolcaba's comfort theory as the framework. The physical dimension was measured by comorbities, fusion results, and activity. Social support, marital status, and responses from others measured the social dimension. Depression, affective distress, and life control represented the psychological dimension. Additional demographics included smoking, age, gender, the type of fusion, and change in employment status. Data were collected preoperatively and at 6 months and 12 months postoperatively using the MOS SF-36, the Multidimensional Pain Inventory, a social support questionnaire, which included the Inventory of Socially Supportive Behaviors and the Lubben Social Support Index, the Center for Epidemiologic Studies - Depression Scale, and chart review.; When compared to age and low back pain/sciatica benchmarks, HRQOL in this sample was significantly lower while pain was significantly higher. HRQOL and pain were found to improve in the twelve months after surgery with the most significant increase occurring within the first six months following surgery. From six to twelve months after surgery, the mental component of HRQOL and pain plateaued while the physical component of HRQOL continued to increase.; A positive change in employment status was found to be a significant predictor of HRQOL and pain. Combination fusion, a solid fusion at 12-months, and less affective distress significantly predicted improved HRQOL and pain. Improved HRQOL and pain were significantly predicted by female gender, a larger social support network, solicitous responses from others, and increased life control.; Viewing the LSF surgery patients in a holistic framework will allow for development of valid nursing interventions including consistent measurement of HRQOL and pain and support interventions that may improve the treatment and outcomes. Future research into the characteristics of those who return to work after LSF surgery, a holistic interdisciplinary nurse managed clinic for follow-up after LSF surgery, and the influence of the spiritual dimension of comfort will expand the understanding of the needs of the LSF surgery patient.