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Low back pain disability following lumbar intervertebral fusion Wilfling, Francis Joseph

Abstract

Low back pain (LBP) disability is an extremely common and immensely expensive problem which is often refractory to surgical treatment. Though many organic, psychological and demographic factors have been suggested in the literature to contribute to this problem, the contributions of few of those factors have been established in a statistically rigorous manner. The present study sought to clarify the LBP disability problem by comprehensively and rigorously studying 100 post-lumbar-spinal-fusion subjects with the goals of finding new patient-management insights and developing a foundation on which future studies could be based. A disability index was factor-analytically derived from measures of functional impairment and was used for comparison with a large number of orthopaedic, radiological, psychological and demographic variables documented during the investigation. Of a larger number of variables documented, 239 were compared with the disability index and 58 statistically significant (p < .01) correlates of LBP disability were found. Inspection of a correlation matrix of these 58 correlates indicated that many overlaps in measurement occur between what are sometimes thought of as "purely organic" and "purely psychological" measures. To clarify what the basic dimensions underlying the correlates of LBP disability are, the correlates were factor analyzed. Seventeen orthogonal factors were derived in this factor analysis and the contribution of each of them to LBP disability was ascertained by examining the square of the correlation coefficient between the factor scores on each and the disability index. It was found that the 17 factors accounted for nearly 90% of the disability variance, and that eight of these 17 factors were significantly related to, and accounted for nearly 80% of the variance on, the disability index. Three or possibly four of the eight significant factors, or basic dimensions of LBP disability, were found to be psychological in nature. The clarification of the LBP disability problem resulting from identification of eight independent basic dimensions of LBP disability, and confirmation of the substantial role played by psychological factors, has many important ramifications. The importance of treating the whole man rather than just his back is obvious as is a probable cause for the high failure rates of surgery when used alone. Patient profiles on the eight basic dimensions of LBP disability were statistically grouped on the basis of profile similarity and four naturally occurring groups of profiles, or "Syndrome Complexes," were found. It was concluded that in each Syndrome Complex deficits occur for which a psychologist could be of help in diagnosis and treatment. Suitable techniques for diagnosis and treatment, which could be implemented on an orthopaedic ward at minimal additional cost, are presently available. These techniques are discussed using the eight basic dimensions of LBP disability as a frame of reference. Directions for future research follow rather directly from the clarification of the LBP disability problem by the present study. The specifics of planned future studies are briefly outlined.

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