title: The Influence of Pre- and Postoperative Fear Avoidance Beliefs on Postoperative Pain and Disability in Patients With Lumbar Spinal Stenosis: Analysis of the Lumbar Spinal Outcome Study (LSOS) Data.
abstract: METHODS
  Prospective multicenter cohort study.
  
  
  OBJECTIVE
  To evaluate the effect of pre- and postoperatively assessed fear avoidance beliefs (FAB) on pain and disability in patients with degenerative lumbar spinal stenosis (LSS) after decompression surgery.
  
  
  BACKGROUND
  To the present, the influence of pre- and postoperative FAB on the prognosis after surgery for LLS is still unclear.
  
  
  METHODS
  Patients of the Swiss Lumbar Stenosis Outcome Study (LSOS) with confirmed LSS undergoing first-time decompression without fusion were enrolled in this study. The main outcome of this study was minimal clinically important difference (MCID) in spinal stenosis measure symptoms (pain) and function (disability) after 12 months. To analyze the influence of pre- and postoperatively assessed FAB on pain and disability we built simple and multiple logistic regression models.
  
  
  RESULTS
  In this analysis of 234 patients undergoing decompression surgery for symptomatic degenerative LSS we found baseline FAB measured by the FAB physical activity subscale (FABQ-P) not to be associated with pain (OR 0.95; 95% CI: 0.55-1.67) and disability (OR 1.11; 95% CI: 0.64-1.92) at 12 months' follow-up. In the final multiple logistic regression models patients with high FABQ-P at 6 months (OR 0.46; 95% CI: 0.24-0.91) and high persistent FABQ-P at baseline and 6 months (OR 0.34, 95% CI: 0.16-0.73) were less likely to report a MCID for spinal stenosis measure symptoms at 12 months. Our analysis found a similar trend for disability; however, the results were not statistically significant.
  
  
  CONCLUSIONS
  In elderly patients undergoing decompression surgery for symptomatic degenerative LSS preoperative fear avoidance beliefs were not a prognostic indicator for the outcome. Patients with FAB at 6 months and persistent FAB were less likely to experience clinically relevant improvement in pain at 12 months. Studies should address the importance of persistent postoperative FAB.
  
  
  METHODS
  3.
authors: Horten Centre for Patient Oriented Research and Knowledge Transfer, University of Zurich, Zurich, Switzerland.|Department of Anesthesiology and Pain Therapy, University Hospital Maastricht, Maastricht, The Netherlands.
authors: Jakob M
authors: JM
authors: Burgstaller
authors: Horten Centre for Patient Oriented Research and Knowledge Transfer, University of Zurich, Zurich, Switzerland.|Department of General Internal Medicine, Bern University Hospital, Bern University, Bern, Switzerland.
authors: Maria M
authors: MM
authors: Wertli
authors: Horten Centre for Patient Oriented Research and Knowledge Transfer, University of Zurich, Zurich, Switzerland.
authors: Johann
authors: J
authors: Steurer
authors: Department of Anesthesiology and Pain Therapy, University Hospital Maastricht, Maastricht, The Netherlands.
authors: Alfons G H
authors: AGH
authors: Kessels
authors: Horten Centre for Patient Oriented Research and Knowledge Transfer, University of Zurich, Zurich, Switzerland.
authors: Ulrike
authors: U
authors: Held
authors: Department of Anesthesiology and Pain Therapy, University Hospital Maastricht, Maastricht, The Netherlands.
authors: Hans-Fritz
authors: HF
authors: Gramke
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D001362:Avoidance Learning; D015331:Cohort Studies; D019299:Decompression, Surgical / Q000009:adverse effects / Q000639:trends; D006233:Persons with Disabilities; D005239:Fear / Q000523:psychology*; D005260:Female; D005500:Follow-Up Studies; D007722:Health Knowledge, Attitudes, Practice; D006801:Humans; D008159:Lumbar Vertebrae / Q000473:pathology / Q000601:surgery; D008297:Male; D010147:Pain Measurement / Q000523:psychology* / Q000639:trends; D010149:Postoperative Pain / Q000175:diagnosis / Q000523:psychology*; D011300:Preoperative Care / Q000523:psychology* / Q000639:trends; D011446:Prospective Studies; D013130:Spinal Stenosis / Q000175:diagnosis / Q000523:psychology* / Q000601:surgery; D016896:Treatment Outcome