Background

In patients who receive spine surgery, pain is relational to disability and quality of life, but exactly how this influence is mediated is not fully understood. Mediation analyses allow an understanding of a known relationship by exploring the underlying mechanism or processes by which one variable influences another.

Objectives

To determine the mediating influence of psychological, mobility, and satisfaction variables on the relationship between preoperative back pain intensity and 12-month disability and quality of life in individuals who underwent lumbar spine surgery.

Design

This mediation analysis study used data from the Quality Outcomes Database (QOD) Lumbar Spine Surgical Registry.

Methods

There were included individuals who received lumbar spine surgery for degenerative spine conditions. The exposure variable was preoperative back pain intensity. Mediator variables were depression/anxiety, mobility, and satisfaction. Outcomes included disability and quality of life. Separate multiple mediator models were conducted using the Hayes PROCESS, Model 4 with bias-corrected bootstrapping (5000 samples) to predict disability and quality of life.

Results

26,130 individuals (n = 13,740 males, mean age 60.2 [SD = 13.8) were included. We observed a significant indirect effect through the mediators (anxiety/depression, mobility and satisfaction), for both disability (b = 0.31, 95%CI = 0.26, 0.35) and quality of life (b = −0.44, 95%CI = −0.48, −0.41).

Conclusion

Our study suggests that the relationship between preoperative back pain intensity (exposure) and long-term disability and quality of life (outcomes) is partially mediated by anxiety/depression, mobility, and patient satisfaction in individuals who received lumbar spine surgery.

中文翻译：

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心理、活动能力和满意度变量介导了接受腰椎手术的个体的基线背痛强度与长期结果之间的关系

背景

在接受脊柱手术的患者中，疼痛与残疾和生活质量有关，但这种影响究竟是如何调节的尚不完全清楚。中介分析允许通过探索一个变量影响另一个变量的潜在机制或过程来理解已知关系。

目标

确定心理、活动能力和满意度变量对接受腰椎手术的个体术前背痛强度与 12 个月残疾和生活质量之间关系的中介影响。

设计

该中介分析研究使用了来自质量结果数据库 (QOD) 腰椎外科登记处的数据。

方法

其中包括因退行性脊柱疾病而接受腰椎手术的人。暴露变量是术前背痛强度。中介变量是抑郁/焦虑、流动性和满意度。结果包括残疾和生活质量。使用 Hayes PROCESS 模型 4 进行了单独的多重中介模型，并带有偏差校正的引导程序（5000 个样本），以预测残疾和生活质量。

结果

包括 26,130 个人（n = 13,740 名男性，平均年龄 60.2 [SD = 13.8）。我们观察到通过中介因素（焦虑/抑郁、行动能力和满意度）对残疾 ( b  = 0.31, 95%CI = 0.26, 0.35) 和生活质量 ( b  = -0.44, 95%CI = - )产生显着的间接影响0.48, -0.41)。

结论

我们的研究表明，术前背痛强度（暴露）与长期残疾和生活质量（结果）之间的关系部分是由接受腰椎手术的个体的焦虑/抑郁、活动能力和患者满意度介导的。