Predicting Lumbar Fusion Surgery Outcomes From Presurgical Patient Variables: The Utah Lumbar Fusion Outcome Study

Lumbar fusion surgery is a commonly used procedure to treat severe spinal pathology and associated chronic disabling low back and leg pain. Despite the common incidence of spinal fusion surgery, few studies have examined patient outcomes or predictive correlates of this procedure. The objectives of this study were to characterize Utah workers who received lumbar fusion surgery in terms of relevant presurgical and outcome variables and to identify presurgical correlates of patient outcomes. An archival prospective research design was utilized consisting of a retrospective medical chart review and a postsurgical telephone outcome survey. Subjects were 203 workers\u27 compensation patients from the state of Utah who have undergone spinal fusion surgery and who were at least 2 years postsurgery at time of follow-up. Outcomes were assessed for 144 of the 203 patients (71%). Presurgical measures _included demographic, work, compensation, disability, health, surgical, and physiological variables. Outcome measures included solid arthrosis, patient satisfaction, work disability status, functional disability due to back pain, and multidimensional health. Analysis of patient outcome data revealed that solid arthrosis was achieved in 71.9% of patients. Forty-six percent of subjects felt their back/leg pain problems were worse than what they had expected following the surgery, and 42 % felt that their quality of life had not changed or worsened as a result of lumbar fusion. Twenty-eight percent of fusion patients were work disabled at follow-up. Fusion patient mean outcome scores on multidimensional health measures reflected poorer health than comparative medical patient and nonpatient norms. The most consistent presurgical correlates across outcomes were lawyer involvement, number of prior low back operations, age at injury, and household income at time of injury. Results are compared to data from previous lumbar fusion research studies and reasons for varying findings are offered. Implications of the findings are discussed in terms of inadequate patient selection and insufficient assessment of patient outcomes in low back research studies. Limitations of the present research are discussed, including how placebo, natural history, and regression to the mean can lead to erroneous conclusions about the efficacy of lumber fusion surgery. Suggestions for improvements in low back surgery outcome research are offered

Searching for research results to inform the design of an initial professional teacher education programme for the foundation phase: A systematic review

This article reports on a systematic review conducted to inform the development of a professional teacher education programme for the foundation phase of schooling. The research question was: What do quality research studies identify as the components and/or characteristics of quality teacher education for the foundation phase programmes that allow new teachers to begin to teach for epistemological access. A search for systematic reviews on educational programmes related to foundation phase for initial teacher education was conducted for the period between 1980 and 2011. The researchers added Stage 0 as a fifth step to the traditional four-step systematic review process. Stage 0 or quasi-tertiary review allowed us to present substantive findings of the identified systematic reviews and to explore their methodological quality. From the initial 2876 hits (mostly health and medical studies), only 19 studies were related to the educational field. Only three of the 19 studies were finally accepted as eligible at Stage 0. None of the reviews directly addressed programme design but contained elements that were considered as useful when designing programmes. The present study makes it clear that there is a dearth of research on entire programmes related to initial teacher education for foundation phase teachers.IBS

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

A Brief Metacognition Questionnaire for the Elderly: Comparison with Cognitive Performance and Informant Ratings, The Cache County Study

Objective To examine the utility of a brief, metacognition questionnaire by examining its association with objective cognitive testing and informant ratings. We hypothesized that the association between self-ratings of change and both outcomes would be greater among individuals without dementia than among those with dementia. Methods Participants were 535 persons without dementia and 152 with dementia from the Cache County Memory Study who had completed a metacognition questionnaire, two administrations of the Modified Mini-Mental State Exam (3 MS) and who had data on the Informant Questionnaire of Cognitive Decline in the Elderly (IQCODE). Cronbach\u27s alpha was calculated as a measure of internal consistency of the metacognition questionnaire. Multiple regression was used to examine the relationship between metacognition and 3 MS change. Logistic regression was used to examine the relationship between metacognition and IQCODE ratings (no change vs. worse). Results Cronbach\u27s alpha was 0.75. Among individuals without dementia, metacognition significantly predicted 3 MS change (p = .027) and IQCODE ratings (OR = 4.0, 95% CI = 1.2-13.8, p = .029), suggesting consistency among measures. For those with dementia, there was a weak, inverse relationship between 3 MS change and metacognition (r = -0.16, p = .056). IQCODE ratings were not significantly associated with metacognition (p = .729). Degree of dementia severity did not modify the relationship between metacognition and either outcome (p \u3e .05). Conclusions We demonstrated adequate internal consistency and evidence for validity of a brief metacognition questionnaire. The questionnaire may provide a useful adjunct to memory and functional assessments for assessing anosognosia in elderly populations