title: Depressive symptoms during rehabilitation period predict poor outcome of lumbar spinal stenosis surgery: a two-year perspective.
abstract: BACKGROUND
  Previous research has shown an association between preoperative depressive symptoms and a poorer surgery outcome in lumbar spinal stenosis (LSS). It is not known whether depressive symptoms throughout the recovery period are relevant to the outcome of surgery in LSS. In this prospective clinical study the predictive value of preoperative and postoperative depressive symptoms with respect to the surgery outcome is reported.
  
  
  METHODS
  96 patients (mean age 62 years) with symptomatic lumbar spinal stenosis underwent decompressive surgery. They completed the same set of questionnaires preoperatively and 3 months, 6 months, 1 year and 2 years postoperatively. Depressive symptoms were assessed with the 21-item Beck Depression Inventory. Physical functioning and pain were assessed with the Oswestry Disability Index, the Stucki Questionnaire, self-reported walking ability and VAS rating. Logistic regression analyses were used to examine the predictive value of preoperative and postoperative depressive symptoms regarding the surgery outcome. A "good" outcome was defined in two ways: first, by gaining a 30% improvement in relation to the preoperative disability and pain, and second, by having a score at or below the median value for disability and pain on 2-year follow-up.
  
  
  RESULTS
  Having elevated depressive symptoms particularly on 3-month follow-up was predictive of a poorer surgery outcome regarding pain and disability: when the outcome was defined as less than 30% improvement from the baseline, the OR's (with 95% confidence intervals) were 2.94 (1.06-8.12), <0.05 for Oswestry and 3.33 (1.13-9.79), <0.05 for VAS. In median split approach the OR was 4.11 (1.27-13.32), <0.05 for Oswestry. Predictive associations also emerged between having depressive symptoms on 6-month and 1-year follow-ups and a poorer outcome regarding disability. The predictive value of elevated depressive symptoms particularly with respect to 2-yeard disability was evident whether the outcome was defined as a 30% improvement compared to the preoperative status or as belonging to the better scoring half of the study population on 2-year follow-up.
  
  
  CONCLUSIONS
  Preoperative and postoperative depressive symptoms may indicate those patients at greater risk of a poorer postoperative functional ability. For these patients, further clinical evaluation should be carried out, especially during postoperative stages.
authors.affiliation: Department of Rehabilitation, Kuopio University Hospital, Kuopio, Finland. sanna.sinikallio@kuh.fi
authors.forename: Sanna
authors.initials: S
authors.lastname: Sinikallio
authors.forename: Soili M
authors.initials: SM
authors.lastname: Lehto
authors.forename: Timo
authors.initials: T
authors.lastname: Aalto
authors.forename: Olavi
authors.initials: O
authors.lastname: Airaksinen
authors.forename: Heikki
authors.initials: H
authors.lastname: Kröger
authors.forename: Heimo
authors.initials: H
authors.lastname: Viinamäki
mesh_terms: D000368:Aged; D001294:Attitude to Health; D003866:Depressive Disorder / Q000175:diagnosis / Q000209:etiology* / Q000523:psychology*; D004185:Disability Evaluation; D005260:Female; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D009483:Neuropsychological Tests; D019635:Neurosurgical Procedures / Q000523:psychology; D017063:Outcome Assessment, Health Care / Q000379:methods; D026741:Physical Therapy Modalities / Q000523:psychology; D011183:Postoperative Complications / Q000209:etiology / Q000523:psychology*; D011237:Predictive Value of Tests; D013130:Spinal Stenosis / Q000523:psychology* / Q000534:rehabilitation* / Q000601:surgery; D011795:Surveys and Questionnaires; D016896:Treatment Outcome