title: Early postoperative fear of movement predicts pain, disability, and physical health six months after spinal surgery for degenerative conditions.
abstract: BACKGROUND
  The fear-avoidance model offers a promising framework for understanding the development of chronic postoperative pain and disability. However, limited research has examined this model in patients undergoing spinal surgery.
  
  
  OBJECTIVE
  To determine whether preoperative and early postoperative fear of movement predicts pain, disability, and physical health at 6 months following spinal surgery for degenerative conditions, after controlling for depressive symptoms and other potential confounding variables.
  
  
  METHODS
  A prospective cohort study conducted at an academic outpatient clinic.
  
  
  METHODS
  One hundred forty-one patients undergoing surgery for lumbar or cervical degenerative conditions.
  
  
  METHODS
  Self-reported pain and disability were measured with the Brief Pain Inventory and the Oswestry Disability Index/Neck Disability Index, respectively. The physical composite scale of the 12-Item Short-Form Health Survey (SF-12) measured physical health.
  
  
  METHODS
  Data collection occurred preoperatively and at 6 weeks and 6 months following surgery. Fear of movement was measured with the Tampa Scale for Kinesiophobia and depression with the Prime-MD PHQ-9.
  
  
  RESULTS
  One hundred and twenty patients (85% follow-up) completed the 6-month postoperative assessment. Multivariable mixed-method linear regression analyses found that early postoperative fear of movement (6 weeks) predicted pain intensity, pain interference, disability, and physical health at 6-month follow-up (p<.05). Preoperative and early postoperative depression predicted pain interference, disability, and physical health.
  
  
  CONCLUSIONS
  Results provide support for the fear-avoidance model in a postsurgical spine population. Early postoperative screening for fear of movement and depressive symptoms that do not acutely improve following surgical intervention appears warranted. Cognitive and behavioral strategies may be beneficial for postsurgical patients with high fear of movement and/or depressive symptoms.
authors.affiliation: Department of Orthopaedic Surgery & Rehabilitation, Vanderbilt University, School of Medicine, Medical Center East - South Tower, Suite 4200, Nashville, TN 37232, USA. Electronic address: kristin.archer@vanderbilt.edu.
authors.forename: Kristin R
authors.initials: KR
authors.lastname: Archer
authors.affiliation: Department of Psychology, Washington DC VA Medical Center, 50 Irving St, NW, Washington, DC 20422, USA.
authors.forename: Caryn L
authors.initials: CL
authors.lastname: Seebach
authors.affiliation: Department of Orthopaedic Surgery & Rehabilitation, Vanderbilt University, School of Medicine, Medical Center East - South Tower, Suite 4200, Nashville, TN 37232, USA.
authors.forename: Shannon L
authors.initials: SL
authors.lastname: Mathis
authors.affiliation: Department of Orthopaedic Surgery, Johns Hopkins Medicine, 601 N. Carolina St, Baltimore, MD 21287, USA.
authors.forename: Lee H
authors.initials: LH
authors.lastname: Riley
authors.affiliation: Department of Physical Medicine and Rehabilitation, Johns Hopkins Medicine, 600 N. Wolfe St, Baltimore, MD 21287, USA.
authors.forename: Stephen T
authors.initials: ST
authors.lastname: Wegener
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002574:Cervical Vertebrae / Q000601:surgery; D003863:Depression; D004185:Disability Evaluation; D006233:Persons with Disabilities / Q000523:psychology; D005239:Fear / Q000523:psychology*; D005260:Female; D006304:Health Status; D006801:Humans; D008159:Lumbar Vertebrae / Q000601:surgery; D008297:Male; D008875:Middle Aged; D009068:Movement; D015999:Multivariate Analysis; D017063:Outcome Assessment, Health Care; D010147:Pain Measurement; D010149:Postoperative Pain / Q000523:psychology*; D010698:Phobic Disorders / Q000523:psychology; D011184:Postoperative Period; D011446:Prospective Studies; D013122:Spinal Diseases / Q000503:physiopathology / Q000523:psychology* / Q000601:surgery*; D055815:Young Adult
keywords: Depression; Fear of movement; Postoperative pain; Rehabilitation; Spine surgery