title: Associations among pain, disability and psychosocial factors and the predictive value of expectations on returning to work in patients who undergo lumbar disc surgery.
abstract: OBJECTIVE
  The aim of this study was to describe the associations among pain, disability and psychosocial factors preoperatively as well as 3 and 24 months later for patients who undergo first time discectomy and to analyse the predictive value of psychosocial factors on the outcome 24 months after surgery.
  
  
  METHODS
  Fifty-nine patients, 41 % women, with a mean age of 40 years and without comorbidities were included, of whom 56 responded to the 24-month follow-up; at that point, they were divided into patients with complaints (C, n = 36) and patients without complaints (NC, n = 20). Correlations among the pain intensity, disability and psychosocial factors were analysed preoperatively, 3 and 24 months after discectomy, and regression analyses of psychosocial factors on the outcome at 24 months were performed.
  
  
  RESULTS
  Psychosocial variables were weakly correlated with the pain intensity and disability preoperatively. High expectations on the return to work were predictive of both pain intensity (β = 8.0, p = 0.03) and disability (β = 9.1, p < 0.001) at 24 months. Associations between psychosocial variables and outcome variables were strengthened at the 3-month follow-up in the C group, and this association remained 24 months after surgery. Fear of movement was most strongly correlated with leg pain intensity (r (s) 0.64, p < 0.001) and the ability to decrease pain was the most correlated with disability (r (s) 0.78, p < 0.001).
  
  
  CONCLUSIONS
  Having high expectations on the return to work after surgery was the strongest predictor for a favourable outcome. Therefore, low preoperative expectations on return to work convey an important prognostic signal.
authors.affiliation: Department of Physiotherapy, School of Health, Care and Social Welfare, Mälardalen University, Box 883, SE-721 23, Västerås, Sweden. ann-christin.johansson@mdh.se.
authors.forename: Ann-Christin
authors.initials: AC
authors.lastname: Johansson
authors.affiliation: Department of Medicine, Karolinska Institutet, Solna, Sweden.
authors.forename: John
authors.initials: J
authors.lastname: Öhrvik
authors.affiliation: Department of Physiotherapy, School of Health, Care and Social Welfare, Mälardalen University, Box 883, SE-721 23, Västerås, Sweden.
authors.forename: Anne
authors.initials: A
authors.lastname: Söderlund
mesh_terms: D000293:Adolescent; D000328:Adult; D001294:Attitude to Health; D004185:Disability Evaluation; D017586:Diskectomy / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007405:Intervertebral Disc Displacement / Q000150:complications / Q000523:psychology / Q000601:surgery*; D017116:Low Back Pain / Q000175:diagnosis / Q000209:etiology / Q000523:psychology*; D008159:Lumbar Vertebrae / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D010147:Pain Measurement; D011237:Predictive Value of Tests; D057234:Preoperative Period; D011379:Prognosis; D012189:Retrospective Studies; D062707:Return to Work / Q000523:psychology*; D016896:Treatment Outcome; D055815:Young Adult
keywords: Coping strategies; Lumbar discectomy; Pain disability; Patients’ expectations; Psychosocial factors