title: The association between preoperative mental distress and patient-reported outcome measures in patients treated surgically for cervical radiculopathy.
abstract: Previous research indicates that there might exist a link between the experience of pain and mental distress. Pain can possibly trigger anxiety and chronic pain, as well as also depression. On the other hand, anxiety and depression might also be risk factors for painful conditions and more pronounced subsequent disability and thus, the pathways may be bidirectional. Expanded knowledge of how different factors affect pain and function may help surgeons in preoperative decision-making.
  
  
  
  The aim of this study was to evaluate the impact of potential preoperative risk factors with special reference to mental distress.
  
  
  
  This is a prospective outcome study in a cohort from a multicenter randomized controlled trial comparing anterior cervical decompression and fusion with disc replacement.
  
  
  
  The sample included 151 patients with cervical radiculopathy planned for surgery.
  
  
  
  Surgical outcome was evaluated with Neck Disability Index (NDI), health related quality-of-life with European Quality of Life-5 Dimensions, and pain with visual analogue scale for arm and neck. Mental distress was preoperatively measured with the Hospital Anxiety and Depression (HAD) scale.
  
  
  
  Preoperative data regarding possible risk factors for poor outcome were analyzed in multiple linear regression models with postoperative NDI and change of NDI as dependent factors. Patients with high preoperative levels of anxiety or depression (H-HAD), indicating mental distress, were compared with patients scoring low/moderate levels (L-HAD) regarding patient-reported outcome measures (PROMs) preoperatively and at 1- and 2-year follow-up.
  
  
  
  Outcome data were available for 136 patients at the 2-year follow-up. No statistically significant difference in any outcome data could be demonstrated between the two surgical treatment groups. Mental distress was the variable most strongly associated with NDI at 2 years in the regression analysis. There were 42 patients classified as H-HAD and 94 as L-HAD. The average improvement in NDI was 16.9 in the H-HAD group and 26.3 in the L-HAD group, p=.02. The H-HAD patients showed a tendency for poorer baseline data and worse outcome overall in all PROMs at follow-up at both 1 and 2 years.
  
  
  
  Preoperative mental distress measured with HAD was associated with worse outcome overall. More research is needed to investigate whether patients with mental distress may achieve better results if other treatments are offered, either as non-surgical treatment alone or as an adjunct to surgery.
authors.affiliation: Stockholm Spine Center, Löwenströmska Sjukhuset, 194 89, Upplands Väsby, Sweden; Department of Learning, Informatics, Management and Ethics, Karolinska Institute, Tomtebodavägen 18, 171 77 Solna, Stockholm, Sweden. Electronic address: martin.skeppholm@spinecenter.se.
authors.forename: Martin
authors.initials: M
authors.lastname: Skeppholm
authors.affiliation: Stockholm Spine Center, Löwenströmska Sjukhuset, 194 89, Upplands Väsby, Sweden.
authors.forename: Roland
authors.initials: R
authors.lastname: Fransson
authors.affiliation: Stockholm Spine Center, Löwenströmska Sjukhuset, 194 89, Upplands Väsby, Sweden.
authors.forename: Margareta
authors.initials: M
authors.lastname: Hammar
authors.affiliation: Department of orthopedics, Uppsala University Hospital, 751 85 Uppsala, Sweden.
authors.forename: Claes
authors.initials: C
authors.lastname: Olerud
mesh_terms: D000328:Adult; D000368:Aged; D002574:Cervical Vertebrae / Q000601:surgery*; D019299:Decompression, Surgical / Q000009:adverse effects* / Q000523:psychology; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015337:Multicenter Studies as Topic; D000071066:Patient Reported Outcome Measures; D011183:Postoperative Complications / Q000523:psychology*; D011788:Quality of Life; D011843:Radiculopathy / Q000601:surgery*; D016032:Randomized Controlled Trials as Topic; D013123:Spinal Fusion / Q000009:adverse effects* / Q000523:psychology
keywords: Anxiety; Cervical; Depression; Outcome; Pain