title: Decreased disability is associated with improved perceived quality of life following spinal fusion.
abstract: OBJECTIVE
  To assess the disability and relationship between functional status and health related quality of life (HRQoL) in patients in the early recovery phase following spinal fusion.
  
  
  METHODS
  This is a prospective cohort study. Since 2008 data of spinal fusion patients have been collected prospectively in two Finnish hospitals. In August 2009, complete data of 173 patients were available. The measurement tool of disability was the Oswestry Disability Index (ODI) and it was also examined in the framework of International Classification of Functioning, Disability and Health (ICF) using body functions and structures, activities and participation components.
  
  
  RESULTS
  Preoperatively the mean total ODI was 45 (SD17) and mean (95% confidence interval) change to 3 months postoperatively was -19 (-22 to -17). When the ODI was linked to the ICF, there was a 55% improvement in the body structure and functions component and a 44% improvement in both the activities and the participation components. However, 25% of the patients still had the total ODI score over 40 three months postoperatively. Preoperatively, the mean (95% CI) Physical Component Summary Score (PCS) of the Short Form 36-questionnaire (SF-36) was 27 (26 to 28) and the mean Mental Component Summary Score (MCS) of SF-36 was 47 (45 to 49). Postoperatively the improvement was 9 (95% CI: 8 to 11) in PCS and 6 (95% CI: 4 to 7) in MCS (p < 0.001).
  
  
  CONCLUSIONS
  Spinal fusion is successful in the early recovery period in terms of reduction of pain and disability. The significant changes in the ODI were seen in all three components of the ICF model. In addition, improvement in functioning was significantly related to positive change in HRQoL. Still there is a subgroup of patients having marked disability needing more intensive rehabilitation and follow-ups.
authors.affiliation: Department of Orthopaedics and Traumatology, Jyväskylä Central Hospital, Jyväskylä, Finland. pekkanen.auvinen@fimnet.fi
authors.forename: Liisa
authors.initials: L
authors.lastname: Pekkanen
authors.forename: Marko
authors.initials: M
authors.lastname: Neva
authors.forename: Hannu
authors.initials: H
authors.lastname: Kautiainen
authors.forename: Kimmo
authors.initials: K
authors.lastname: Vihtonen
authors.forename: Kati
authors.initials: K
authors.lastname: Kyrölä
authors.forename: Ilkka
authors.initials: I
authors.lastname: Marttinen
authors.forename: Marko
authors.initials: M
authors.lastname: Wahlman
authors.forename: Arja
authors.initials: A
authors.lastname: Häkkinen
mesh_terms: D000328:Adult; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000523:psychology*; D005260:Female; D005387:Finland; D006304:Health Status; D006801:Humans; D064702:International Classification of Functioning, Disability and Health; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D017060:Patient Satisfaction; D011446:Prospective Studies; D011788:Quality of Life; D012959:Socioeconomic Factors; D013123:Spinal Fusion / Q000523:psychology*; D011795:Surveys and Questionnaires; D016896:Treatment Outcome; D064232:Visual Analog Scale