title: The influence of psychological factors on pre-operative levels of pain intensity, disability and health-related quality of life in lumbar spinal fusion surgery patients.
abstract: OBJECTIVE
  To assess the extent to which perceived pain and psychological factors explain levels of disability and health-related quality of life (HRQOL) in patients scheduled for lumbar fusion surgery, and to test the hypothesis that relationships between pain intensity, mental health, fear of movement/(re)injury, disability and HRQOL are mediated by cognitive beliefs and appraisals.
  
  
  METHODS
  Cross-sectional, correlation study.
  
  
  METHODS
  Orthopaedic outpatient setting in a tertiary hospital.
  
  
  METHODS
  One hundred and seven chronic back pain patients scheduled for lumbar fusion surgery.
  
  
  METHODS
  Visual analogue scale for pain intensity, Short Form 36 mental health subscale, Tampa Scale for Kinesiophobia, Back Beliefs Questionnaire, Self-efficacy Scale, Coping Strategy Questionnaire, Oswestry Disability Index and European Quality of Life Questionnaire.
  
  
  RESULTS
  The group effect of multiple mediators significantly influenced the relationships between pain intensity and mental health, fear of movement/(re)injury, functional disability and HRQOL. Pain catastrophising significantly mediated the relationship between pain intensity and mental health, control over pain significantly mediated the relationship between mental health and functional disability, self-efficacy and pain outcome expectancy significantly mediated the relationship between mental health and HRQOL, and self-efficacy also significantly mediated the relationship between pain intensity, fear of movement/(re)jury and functional disability. The model explained 28, 30, 52 and 42% of the variation in mental health, fear of movement/(re)injury, functional disability and HRQOL, respectively.
  
  
  CONCLUSIONS
  This study highlights the strong influence and mediation roles of psychological factors on pain, mental health, fear of movement/(re)injury, disability and HRQOL in patients scheduled for lumber fusion. Future research should focus on screening as well as pre- and post-operative interventions based on these psychological factors for the potential improvement of lumber fusion surgery outcomes.
authors.affiliation: Department of Physical Therapy, Karolinska University Hospital, Stockholm, Sweden. allan.abbott@karolinska.se
authors.forename: Allan D
authors.initials: AD
authors.lastname: Abbott
authors.forename: Raija
authors.initials: R
authors.lastname: Tyni-Lenné
authors.forename: Rune
authors.initials: R
authors.lastname: Hedlund
mesh_terms: D000223:Adaptation, Psychological; D000328:Adult; D003430:Cross-Sectional Studies; D006233:Persons with Disabilities / Q000523:psychology*; D004651:Employment; D005239:Fear / Q000523:psychology; D005260:Female; D006801:Humans; D008159:Lumbar Vertebrae; D008297:Male; D008603:Mental Health; D008875:Middle Aged; D010146:Pain / Q000523:psychology*; D011788:Quality of Life / Q000523:psychology*; D020377:Self Efficacy; D013123:Spinal Fusion / Q000523:psychology*