Background

Depression, anxiety, catastrophising, and fear-avoidance beliefs are key "yellow flags" (YFs) that predict a poor outcome in back patients. Most surgeons acknowledge the importance of YFs but have difficulty assessing them due to the complexity of the instruments used for their measurement and time constraints during consultations. We performed a secondary analysis of existing questionnaire data to develop a brief tool to enable the systematic evaluation of YFs and then tested it in clinical practice.

Methods

The following questionnaire datasets were available from a total of 932 secondary/tertiary care patients (61 ± 16 years; 51% female): pain catastrophising (N = 347); ZUNG depression (N = 453); Hospital Anxiety and Depression Scale (anxiety subscale) (N = 308); fear-avoidance beliefs (N = 761). The single item that best represented the full-scale score was identified, to form the 4-item "Core Yellow Flags Index" (CYFI). 2422 patients (64 ± 16 years; 54% female) completed CYFI and a Core Outcome Measures Index (COMI) before lumbar spine surgery, and a COMI 3 and 12 months later (FU).

Results

The item–total correlation for each item with its full-length questionnaire was: 0.77 (catastrophising), 0.67 (depression), 0.69 (anxiety), 0.68 (fear-avoidance beliefs). Cronbach's α for the CYFI was 0.79. Structural equation modelling showed CYFI uniquely explained variance (p < 0.001) in COMI at both the 3- and 12-month FUs (β = 0.11 (women), 0.24 (men); and β = 0.13 (women), β = 0.14 (men), respectively).

Conclusion

The 4-item CYFI proved to be a simple, practicable tool for routinely assessing key psychological attributes in spine surgery patients and made a relevant contribution in predicting postoperative outcome. CYFI's items were similar to those in the "STarT Back screening tool" used in primary care to triage patients into treatment pathways, further substantiating its validity. Wider use of CYFI may help improve the accuracy of predictive models derived using spine registry data.

中文翻译：

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开发“核心黄旗指数”（CYFI）作为评估脊柱手术患者关键心理因素的简单工具。

背景

抑郁、焦虑、灾难化和避免恐惧的信念是预测背部患者预后不良的关键“黄旗”(YF)。大多数外科医生都承认 YF 的重要性，但由于用于测量的仪器的复杂性和会诊期间的时间限制，很难对其进行评估。我们对现有问卷数据进行了二次分析，开发了一个简短的工具来系统评估 YF，然后在临床实践中进行测试。

方法

以下问卷数据集来自总共 932 名二级/三级护理患者（61 ± 16 岁；51% 女性）：疼痛灾难化（N  = 347）；ZUNG 抑郁症（N  = 453）；医院焦虑和抑郁量表（焦虑分量表）（N  = 308）；恐惧回避信念（N  = 761）。确定最能代表全面分数的单个项目，形成 4 项目“核心黄旗指数”(CYFI)。2422 名患者（64 ± 16 岁；54% 女性）在腰椎手术前完成了 CYFI 和核心结果测量指数 (COMI)，并在 3 个月和 12 个月后完成了 COMI (FU)。

结果

每个项目与其完整问卷的项目总相关性为：0.77（灾难化）、0.67（抑郁）、0.69（焦虑）、0.68（恐惧回避信念）。CYFI 的 Cronbach α 值为 0.79。结构方程模型显示，CYFI 在 3 个月和 12 个月 FU 的 COMI 中唯一解释了方差 ( p < 0.001)（ β  = 0.11（女性）、0.24（男性）；β  = 0.13（女性）、β  = 0.14（男人），分别）。

结论

事实证明，4 项 CYFI 是一种简单、实用的工具，可用于常规评估脊柱手术患者的关键心理特征，并在预测术后结果方面做出了相关贡献。CYFI的项目与初级保健中使用的“STarT Back筛查工具”中的项目相似，用于将患者分流至治疗途径，进一步证实了其有效性。CYFI 的更广泛使用可能有助于提高使用脊柱注册数据导出的预测模型的准确性。