Relevance of Lifestyle and Attitudinal Factors to Spine Surgery Outcomes: Empirical Results on a Heterogeneous Sample

Abstract

Background Context: Patient demographic and medical indicators influence the well-being of spine surgery patients. It may, however, be worthwhile to evaluate other lifestyle and attitudinal factors. We hypothesized that such factors would explain at least as much variance in outcome as more commonly considered covariates. Purpose: To compare explained variance in outcome of lifestyle and attitudinal factors as compared to standard demographic and medical covariates. Study Design/Setting: Cross-sectional observational study of patients drawn from an active clinic and internet-based support group. Patient Sample: A heterogeneous sample of 376 patients was recruited, comprised of people with diagnoses of cervical (n = 80), lumbar (n = 228), and scoliosis (n = 68) spine disorders. Outcome Measures: Quality of Life (QOL) outcomes were measured using the Oswestry Disability Index, Neck Disability Index, Rand-36, PROMIS Pain Impact, NRS Back and Leg Pain, Scoliosis Research Society-22r, and Global Health. Methods: This study compared explained variance in QOL outcomes in demographic and medical versus lifestyle and attitudinal factors. Demographic and medical factors included age, gender, body mass index, and co-morbidities. Lifestyle factors included exercise and commuting practice. Attitudinal factors related to social connectedness: giving and receiving emotional support, feeling overwhelmed by others’ needs, helping orientation, and general helping behaviors. Regression analyses estimated explained variance. Patient groups differed in most factors evaluated, so the regression analyses were computed separately by group. R2 statistics were characterized as null, small (0.02), medium (0.15), and large (0.35) effect sizes (ES), and proportions were compared for the medical/demographic versus lifestyle/attitudinal factors by group. Results: Similar proportions of variance were explained by demographic/medical and lifestyle/attitudinal covariates across groups, with half of effect sizes being small in magnitude and 6% being medium. Lumbar patients tended to have more small effect sizes among lifestyle and attitudinal covariates than among medical/demographic covariates (z = – 1.29, p < 0.10). Similar patterns were found for both generic and disease-specific outcomes. Conclusions: Spine surgery outcome research should investigate lifestyle and attitudinal factors to enhance the personal and salutogenic relevance of the research. Time spent commuting, exercise practice, and social connectedness appear to be relevant factors. A pre-operative evaluation of overweight and smoking status, limited social connectedness, and long daily commutes could alert the surgeon to delay or avoid performing procedures on these patients to avoid poor outcomes.