| Author: | Lam, Wing-kuen William |
| Title: | Decision of patients with chronic back pain for spinal surgery : an exploratory study |
| Advisors: | Loke Yuen, Alice (SN) |
| Degree: | DHSc |
| Year: | 2019 |
| Subject: | Hong Kong Polytechnic University -- Dissertations Spinal cord -- Surgery -- Decision making Spinal cord -- Diseases -- Treatment |
| Department: | Faculty of Health and Social Sciences |
| Pages: | xiii, 136 pages : color illustrations |
| Language: | English |
| Abstract: | Background: Spinal disorders cause chronic back pain and motor-sensory dysfunctions that affect the daily activities and quality of living of the sufferers. It is suggested that surgery should be done in early stage of spinal dysfunctions in hope to achieving better functional outcomes and quality of life of patients. However, patients often find it difficult to make the decision for a spinal surgery. Aims: The aims of this study are to explore the intrapersonal factors that may influence patients' decision for spinal surgery. The study is to explore (1) the health/clinical considerations relating to spinal disorders, (2) sociodemographic characteristics of patients, (3) preferences and expectations to treatment options, and (4) information needs of patients. Methods: This study consisted of two parts. First is an exploratory retrospective case-control study, and second is a survey among patients on their treatment preferences, expectations and information needs. Two parts of the study were developed according to the perspectives (surfaces) of Intrapersonal CUBE framework. The exploratory study reviewed the medical records of 122 patients who attended a spine nurse clinic in the year of 2017. Comparisons were made between the patients who opted (case) and those who did not opt (control) for spinal surgery. Potential factors influencing surgery decisions were assessed by univariate statistics and logistic regressions. Point biserial correlation was conducted to identify the continuous variables correlated with surgery decision. The patient survey was prospective and cross-sectional. Questionnaires were collected from 75 nurse clinic patients from September 2018 to May 2019. Patients' preference to treatment modalities, expectation to treatment outcomes and information needs were analyzed by univariate statistics. Logistic regression was conducted to assess the odds ratios for patient preference and expectation to surgery decision. Results: The case-control study (Part 1) showed that more unemployed patients (67%) than those who were employed (33%) who opted for surgery. Patients who opted for surgery were suffered with higher level of pain (4.75 vs. 2.60, p < 0.05) and radiated pain (4.40 vs. 2.55, p < 0.05) than patients who opted for conservative treatment. Patients who opted for surgery also showed higher disability level in terms of exercise tolerance (minutes) (21.0 vs. 69.7, p < 0.001); Oswestry Disability Index (ODI) (41.6 vs. 30.9, p < 0.05); Barthel Index (BI) (18.6 vs. 19.9, p < 0.05) and Japanese Orthopedic Association Score (JOA) (13.7 vs. 15.6, p < 0.05) than patients who chose conservation treatment. Univariate logistic regression showed that the influential factors to surgery option were: unemployment (OR 3.77, p < 0.05); primary pain descriptor (OR 4.06, p < 0.05); presence of radicular symptoms (OR 4.71, p < 0.05). Multiple logistic regression also showed that unemployment, primary pain descriptor and presence of radiated symptoms were most influential predictors for surgery option, when adjusted for radiated pain descriptor and ODI. Point biserial correlations demonstrated that exercise tolerance, primary pain score, radiated pain score, ODI, BI and JOA scores were correlated with surgery option. In this cross-sectional survey (Part 2), results showed that there were more male patients (73.5%) who opted for surgery. Patients who opted for surgery were more likely to be married (75.5%) than those opted not to have surgery (38.5%). More patients who finally opted for surgery had preference for pharmacological treatment (73.5%, p < 0.05). Results showed that all patients reported high level of MODEMS expectations scores (4.54 to 4.91) with all six treatment outcomes: (1) relief from symptoms such as pain, stiffness, swelling, numbness, weakness, instability; (2) to do more everyday household or yard activity; (3) to sleep more comfortably; (4) to go back to usual job; (5) to exercise and do more recreational activity and (6) to prevent future disability. The patients who opted not to have surgery expressed higher expectation for sleep quality than those opted for surgery (4.91 vs. 4.71). Logistic regression showed that patients had preference for pharmacological treatment were almost three times (OR=2.77, p < 0.05) more likely to accept surgery, when adjusted for preference to surgery, preference to physiotherapy and MODEMS score. A high percentage of patients (80.8% to 100%) desired for all 17 information items in making treatment decision. More patients who opted for surgery expressed information need for "the severity of my spine conditions" than those opted not to have surgery (100% vs. 88.5%, p < 0.05). Conclusion: The results of this study identified multiple factors that influencing patients' decision for surgery. The inclusion of these factors in a comprehensive assessment of patient parameters can provide clinicians a better understanding of patients' readiness for surgical treatment. Shared decision making with the implementation of decision aids is beneficial to support patients' informed decision regarding surgery. |
| Rights: | All rights reserved |
| Access: | restricted access |
Files in This Item:
| File | Description | Size | Format | |
|---|---|---|---|---|
| 991022378656803411.pdf | For All Users (off-campus access for PolyU Staff & Students only) | 2.67 MB | Adobe PDF | View/Open |
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