Outcomes and Presurgical Correlates of Lumbar Fusion in Utah Workers\u27 Compensation Patients: A Replication Study

Lumbar fusion performed among injured workers has dramatically increased over the past two decades, coinciding with the increased use of more advanced surgical technology. Despite recent changes in how this surgery is performed, few outcome studies have been conducted, particularly among workers compensation populations. In prior studies, several biopsychosocial risk factors were found to be predictors of functional outcomes of lumbar fusion. Considering the recent changes in lumbar fusion surgery, there is a need to identify how patient outcomes have changed among injured workers, and whether a biopsychosocial model continues to be predictive of outcomes. The current study aimed to address multidimensional patient outcomes associated with lumbar fusion and examine the relationship between presurgical biopsychosocial variables and outcomes by testing the predictive efficacy of a multiple variable model. Injured workers (N = 245) who underwent their first lumbar fusion between 1998 and 2007 were included in a retrospective-cohort study performed in two phases that involved coding presurgical information documented in patient medical charts in the Worker\u27s Compensation Fund of Utah computer database (Phase 1) and administering a telephone outcome survey with patients at least 2 years post-surgery (Phase 2). Of the total sample, 45% (n = 110) of patients were contacted and completed follow-up outcome surveys on several measures of patient satisfaction, quality of life, fusion status, dysfunction level, disability status, pain, and general physical and mental health functioning. Results revealed injured workers reported a solid fusion rate of 89.0%, disability rate of 28.7%, and a poor outcome rate of 57.1%. Multiple linear regression analyses demonstrated an eight variable model was a statistically significant predictor of multiple patient outcomes. Involvement of a nurse case manger, vocational rehabilitation, and litigation at the time of fusion were the most prominent predictors across outcome measures, while age and depression history showed modest prediction of outcomes. Prior back operations, number of vertebral levels fused, and type of instrumentation showed no statistically significant prediction of outcomes. Results were evaluated and compared to prior lumber fusion studies on injured worker and fusion outcome literature, in general. Specific implications for our findings and limitations associated with this study were addressed

Pain acceptance potentially mediates the relationship between pain catastrophizing and post-surgery outcomes among compensated lumbar fusion patients

Purpose: Chronic low back pain is highly prevalent and often treatment recalcitrant condition, particularly among workers’ compensation patients. There is a need to identify psychological factors that may predispose such patients to pain chronicity. The primary aim of this study was to examine whether pain acceptance potentially mediated the relationship between pain catastrophizing and post-surgical outcomes in a sample of compensated lumbar fusion patients. Patients and methods: Patients insured with the Workers Compensation Fund of Utah and who were at least 2 years post-lumbar fusion surgery completed an outcome survey. These data were obtained from a prior retrospective-cohort study that administered measures of pain catastrophizing, pain acceptance, mental and physical health, and disability. Results: Of the 101 patients who completed the outcome survey, 75.2% were male with a mean age of 42.42 years and predominantly identified as White (97.0%). The majority of the participants had a posterior lumbar interbody fusion surgery. Pain acceptance, including activity engagement and pain willingness, was significantly correlated with better physical health and mental health, and lower disability rates. Pain catastrophizing was inversely correlated with measures of pain acceptance (activity engagement r=–0.67, p Conclusion: This study demonstrated that the relationship between pain catastrophizing and negative patient outcomes was potentially mediated by pain acceptance. Understanding this mediating relationship offers insight into how pain acceptance may play a protective role in patients’ pain and disability and has potential implications for pain treatments

Dietary restraint and weight loss in relation to disinhibited eating in obese Veterans following a behavioral weight loss intervention

Ability to restrain one's dietary intake is a necessary skill for weight loss. However, dietary restraint has been shown to paradoxically increase disinhibited eating in certain populations, thereby negatively impacting weight loss and leading to worse overall health outcomes. The aim of this study was to address gaps in the literature regarding the relationships between separate facets of dietary restraint (intention; behavior) with weight loss and various types of disinhibited eating (binge eating, external eating, emotional eating) in overweight and obese adults who recently completed a weight loss intervention. A sample of mostly male Veterans with overweight and obesity (N = 88) self-reported their dietary restraint intention, restraint behavior, and current disinhibited eating following completion of an 8-week behavioral weight loss treatment. Greater dietary restraint intention was related to greater dietary restraint behavior, p < .05. Greater dietary restraint behavior was significantly related to greater recent weight loss, p < .05, while restraint intention was not, p > .05. Greater dietary restraint intention was related to greater current binge eating and external eating, while greater self-reported restraint behavior was related to less binge eating, p < .05. Thus, dietary restraint behavior appears to be adaptive for this population, whereas rigid dietary restraint intention may increase risk for disinhibited eating. To decrease disinhibited eating and improve weight loss outcomes in Veterans, interventions might specifically address rigid rule-following associated with abandonment of weight loss goals and help Veterans develop specific yet flexible eating plans. Future research should examine whether dietary restraint intention and behavior differentially predict disinhibited eating and weight loss outcomes prospectively

The State of the Evidence in the Field of Health Psychology

Acceptance and Commitment Therapy (ACT) is a form of cognitive behavior therapy that is receiving increased attention within the health psychology field. This review introduces the principles and methods of ACT as applied to health psychology and reviews the research on ACT for the many areas of heath psychology including chronic pain, substance abuse and dependence, epilepsy, diabetes, obesity, and cancer management. The results of the review indicate that research does not support ACT as an empirically supported treatment for health psychology issues, but findings from several preliminary studies indicate that ACT is showing promising results and is likely worthy of further investigation. This paper provides suggestions for future research on ACT and health psychology issues

Exploring Cultural Competence in Acceptance and Commitment Therapy Outcomes

Professional psychologists have an ethical obligation to engage in culturally competent service delivery within their research and practice. Although the American Psychological Association has published guidelines for multicultural competence within these areas, researchers continue to rely on convenience samples comprised primarily of majority population groups interspersed with individuals from various diverse populations. This leads to uncertainty regarding the generalizability and utility of existing psychological treatments. Given the growth in research and popularity of Acceptance and Commitment Therapy (ACT), this paper investigates the practice of cultural competence in ACT outcome research. A comprehensive review of published ACT outcome research revealed that ACT is being implemented and researched across a number of countries around the world, with a presumably diverse population. However, a notable percent of the outcome studies do not provide adequate descriptions of the demographic makeup of their samples, particularly related to ethnic or racial information. Studies that do report ethnic or racial information provide preliminary evidence that suggests ACT may be effective with diverse groups. The implications of these findings are discussed, including recommendations for researchers and practitioners and potential directions for future research and practice. (PsycINFO Database Record (c) 2016 APA, all rights reserved

How Well Are We Doing at Reporting Participant Characteristics in Our Research?

The American Psychological Association (APA) maintains that the integrity and validity of research findings is partially supported by reporting adequate sample demographic characteristics and methodological procedures. This paper is intended as a review of progress as the field has recognized the importance of accounting for participant diversity in psychological research. We hope that this review serves as a reminder to collect this information and include it in published manuscripts. We also suggest that editors and reviewers ask for this information on manuscripts where it has not been included

How well are we doing at reporting participant characteristics in our research?

The American Psychological Association (APA) maintains that the integrity and validity of research findings is partially supported by reporting adequate sample demographic characteristics and methodological procedures. This paper is intended as a review of progress as the field has recognized the importance of accounting for participant diversity in psychological research. We hope that this review serves as a reminder to collect this information and include it in published manuscripts. We also suggest that editors and reviewers ask for this information on manuscripts where it has not been included