Use of Patient Health Questionnaire–2 scoring to predict patient satisfaction and return to work up to 1 year after lumbar fusion: a 2-year analysis from the Michigan Spine Surgery Improvement Collaborative

2019 ◽  
Vol 31 (6) ◽  
pp. 794-801 ◽  
Author(s):  
Hesham Mostafa Zakaria ◽  
Tarek R. Mansour ◽  
Edvin Telemi ◽  
Karam Asmaro ◽  
Mohamed Macki ◽  
...  
Keyword(s):  
Multivariate Analysis ◽  
Patient Satisfaction ◽  
Return To Work ◽  
Spine Surgery ◽  
Lumbar Fusion ◽  
Estimating Equation ◽  
Patient Health Questionnaire ◽  
Health Questionnaire ◽  
Patient Health ◽  
Prospective Longitudinal

OBJECTIVEThe Michigan Spine Surgery Improvement Collaborative (MSSIC) is a prospective, longitudinal, multicenter, quality-improvement collaborative. Using MSSIC, the authors sought to identify the relationship between a positive Patient Health Questionnaire–2 (PHQ-2) screening, which is predictive of depression, and patient satisfaction, return to work, and achieving Oswestry Disability Index (ODI) minimal clinically important difference (MCID) scores up to 2 years after lumbar fusion.METHODSData from a total of 8585 lumbar fusion patients were analyzed. Patient satisfaction was measured by the North American Spine Society patient satisfaction index. A positive PHQ-2 score is one that is ≥ 3, which has an 82.9% sensitivity and 90.0% specificity in detecting major depressive disorder. Generalized estimating equation models were constructed; variables tested include age, sex, race, past medical history, severity of surgery, and preoperative opioid usage.RESULTSMultivariate analysis was performed. Patients with a positive PHQ-2 score (i.e., ≥ 3) were less likely to be satisfied after lumbar fusion at 90 days (relative risk [RR] 0.93, p < 0.001), 1 year (RR 0.92, p = 0.001), and 2 years (RR 0.92, p = 0.028). A positive PHQ-2 score was also associated with decreased likelihood of returning to work at 90 days (RR 0.76, p < 0.001), 1 year (RR 0.85, p = 0.001), and 2 years (RR 0.82, p = 0.031). A positive PHQ-2 score was predictive of failure to achieve an ODI MCID at 90 days (RR 1.07, p = 0.005) but not at 1 year or 2 years after lumbar fusion.CONCLUSIONSA multivariate analysis based on information from a large, multicenter, prospective database on lumbar fusion patients was performed. The authors found that a positive score (≥ 3) on the PHQ-2, which is a simple and accurate screening tool for depression, predicts an inability to return to work and worse satisfaction up to 2 years after lumbar fusion. Depression is a treatable condition, and so in the same way that patients are medically optimized before surgery to decrease postoperative morbidity, perhaps patients should have preoperative psychiatric optimization to improve postoperative functional outcomes.

scholarly journals The Association Between PHQ-2 Screening and Patient Satisfaction and Return to Work Up To 2-Years After Lumbar Fusion: Analysis From the Michigan Spine Surgery Improvement Collaborative (MSSIC)

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Hesham M Zakaria ◽  
Tarek R Mansour ◽  
Edvin Telemi ◽  
Rachel J Hunt ◽  
Karam P Asmaro ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Return To Work ◽  
Spine Surgery ◽  
Lumbar Fusion ◽  
Radicular Pain ◽  
Satisfaction Index ◽  
Returning To Work ◽  
Axial Pain ◽  
Fusion Analysis ◽  
Prospective Longitudinal

Abstract INTRODUCTION The Michigan Spine Surgery Improvement Collaborative (MSSIC) is a prospective, longitudinal, multicenter, quality improvement collaborative. Using MSSIC, we sought to identify the relationship between a positive PHQ-2, which is predictive of depression, and patient satisfaction, return to work, and achieving ODI MCID up to 2-yr after lumbar fusion. METHODS A total of 8585 lumbar fusion patients were analyzed. Patient satisfaction was measured by the NASS patient satisfaction index. A positive PHQ-2 score is =3, which has a 82.9% sensitivity and 90.0% specificity in detecting major depressive disorder. Generalized estimating equations (GEE) models were constructed; variables tested include age, gender, race, PMH, preoperative diagnosis (disc herniation, spondylolisthesis, etc), preoperative symptoms (axial pain, radicular pain, etc), severity of surgery, and preoperative opioid usage. RESULTS Patients with a positive PHQ-2 score were less likely to be satisfied after lumbar fusion at 90-d (OR 0.93, P < .001), 1-yr (OR 0.92, P = .001), and 2-yr (OR 0.92, P = .028). A positive PHQ-2 was also associated with decreased likelihood of returning to work at 90-d (OR 0.76, P < .001), 1-yr (OR 0.85, P = .001), and at 2-yr (OR 0.82, P = .031). A positive PHQ-2 was predictive of failure to achieve ODI MCID at 90-d (OR 1.07, P = .005) but not at 1-yr or 2-yr after lumbar fusion. CONCLUSION A multivariate analysis from a large, multicenter, prospective database on lumbar fusion patients was performed. We find that PHQ-2, which is a simple and accurate screening tool for depression, is associated with an inability to return to work and worse satisfaction up to 2-yr after lumbar fusion. Depression is a treatable condition, and so in the same way that patients are medically optimized before surgery to decrease postoperative morbidity, then perhaps patients should have preoperative psychiatric optimization to improve postoperative functional outcomes.

scholarly journals The Association Between Chronicity of Preoperative Opioid Usage Between Patient Satisfaction, Return to Work, and Achieving ODI MCID up to 2 Years After Lumbar Fusion: Analysis From the Michigan Spine Surgery Improvement Collaborative (MSSIC)

Neurosurgery ◽  
2019 ◽  
Vol 66 (Supplement_1) ◽  
Author(s):  
Hesham M Zakaria ◽  
Tarek R Mansour ◽  
Edvin Telemi ◽  
Karam P Asmaro ◽  
Theresa A Elder ◽  
...  
Keyword(s):  
Patient Satisfaction ◽  
Return To Work ◽  
Spine Surgery ◽  
Lumbar Fusion ◽  
Favorable Outcome ◽  
Satisfaction Index ◽  
Fusion Analysis ◽  
Opioid Users ◽  
The Relationship ◽  
Prospective Database

Abstract INTRODUCTION The Michigan Spine Surgery Improvement Collaborative (MSSIC) is a multicenter quality improvement collaborative. Using the MSSIC database, we sought to identify the relationship between preoperative opioid usage and patient satisfaction, return to work, and achieving ODI MCID up to 2-yr after lumbar fusion. METHODS A total of 8693 lumbar fusion patients were analyzed. Patient satisfaction was measured by the NASS patient satisfaction index. Generalized estimating equations (GEE) models were constructed; variables tested include age, gender, race, PMH, and number of surgical levels. Preoperative opioid chronicity was defined as opioid naïve (no opioid usage), new opioid users (<6 wk), recent opioid users (6 wk-3 mo), frequent opioid users (3 mo-6 mo), and chronic opioid users (>6 mo). Comparisons were made to opioid naïve patients. RESULTS Chronic opioid users were less likely to be satisfied with their procedure at 90-d (OR 0.95, P < .001), 1-yr (OR 0.90, P < .001), and 2-yr (OR 0.87, P < .001) after surgery. New opioid users were more likely to achieve ODI MCID at 90-d (OR 1.25, P < .001), 1-yr (OR 1.15, P < .001), and 2-yr (OR 1.22, P < .002) postoperatively. Recent opioid users were more likely to achieve ODI MCID at 2 yr (OR 1.26, P < .001). Chronic opioid users were less likely to achieve ODI MCID at 90-d (OR 0.89, P < .001), 1-yr (OR 0.87, P = .002), and 2-yr (OR 0.82, P = .004). Chronic opioid users were also less likely to return to work at 90-d (OR 0.83, P < .001). CONCLUSION A multivariate analysis on preoperative opioid usage from a large, multicenter, prospective database on lumbar fusion patients was performed. We found that, as compared to opioid naïve patients, 2-yr postoperatively new opioid users (<6 wk) were more likely to have a favorable outcome, while chronic opioid users (>6 mo) were less likely to have a favorable outcome. Thus, preoperative opioid counseling is imperative to improve outcomes in spine surgery.

scholarly journals The Perioperative Symptom Severity of Higher Patient Health Questionnaire-9 Scores Between Genders in Single-Level Lumbar Fusion

10.14444/8007 ◽  
2021 ◽  
Vol 15 (1) ◽  
pp. 62-73
Author(s):  
James M. Parrish ◽  
Nathaniel W. Jenkins ◽  
Dustin H. Massel ◽  
Augustus J. Rush ◽  
Manasi S. Parrish ◽  
...  
Keyword(s):  
Symptom Severity ◽  
Lumbar Fusion ◽  
Patient Health Questionnaire ◽  
Health Questionnaire ◽  
Single Level ◽  
Patient Health

A Validation of Patient Health Questionnaire-9 for Cervical Spine Surgery

Spine ◽  
2020 ◽  
Vol 45 (23) ◽  
pp. 1668-1675
Author(s):  
James M. Parrish ◽  
Nathaniel W. Jenkins ◽  
Michael T. Nolte ◽  
Dustin H. Massel ◽  
Nadia M. Hrynewycz ◽  
...  
Keyword(s):  
Cervical Spine ◽  
Spine Surgery ◽  
Patient Health Questionnaire ◽  
Health Questionnaire ◽  
Cervical Spine Surgery ◽  
Patient Health

The Association of Preoperative Opioid Usage With Patient-Reported Outcomes, Adverse Events, and Return to Work After Lumbar Fusion: Analysis From the Michigan Spine Surgery Improvement Collaborative (MSSIC)

Neurosurgery ◽  
2019 ◽  
Vol 87 (1) ◽  
pp. 142-149 ◽  
Author(s):  
Hesham Mostafa Zakaria ◽  
Tarek R Mansour ◽  
Edvin Telemi ◽  
Karam Asmaro ◽  
Michael Bazydlo ◽  
...  
Keyword(s):  
Adverse Events ◽  
Return To Work ◽  
Spine Surgery ◽  
Lumbar Fusion ◽  
Estimating Equation ◽  
Opioid Use ◽  
Short Term ◽  
Spine Registry ◽  
Patient Reported ◽  
Opioid Users

Abstract BACKGROUND It is important to delineate the relationship between opioid use and spine surgery outcomes. OBJECTIVE To determine the association between preoperative opioid usage and postoperative adverse events, patient satisfaction, return to work, and improvement in Oswestry Disability Index (ODI) in patients undergoing lumbar fusion procedures by using 2-yr data from a prospective spine registry. METHODS Preoperative opioid chronicity from 8693 lumbar fusion patients was defined as opioid-naïve (no usage), new users (&lt;6 wk), short-term users (6 wk-3 mo), intermediate-term users (3-6 mo), and chronic users (&gt;6 mo). Multivariate generalized estimating equation models were constructed. RESULTS All comparisons were to opioid-naïve patients. Chronic opioid users showed less satisfaction with their procedure at 90 d (Relative Risk (RR) 0.95, P = .001), 1 yr (RR 0.89, P = .001), and 2 yr (RR 0.89, P = .005). New opioid users were more likely to show improvement in ODI at 90 d (RR 1.25, P &lt; .001), 1 yr (RR 1.17, P &lt; .001), and 2 yr (RR 1.19, P = .002). Short-term opioid users were more likely to show ODI improvement at 90 d (RR 1.25, P &lt; .001). Chronic opioid users were less likely to show ODI improvement at 90 d (RR 0.90, P = .004), 1 yr (RR 0.85, P &lt; .001), and 2 yr (RR 0.80, P = .003). Chronic opioid users were less likely to return to work at 90 d (RR 0.80, P &lt; .001). CONCLUSION In lumbar fusion patients and when compared to opioid-naïve patients, new opioid users were more likely and chronic opioid users less likely to have improved ODI scores 2 yr after surgery. Chronic opioid users are less likely to be satisfied with their procedure 2 yr after surgery and less likely to return to work at 90 d. Preoperative opioid counseling is advised.

Somatoforme Symptome, Angst und Depression bei Migranten aus der Türkei, aus Osteuropa und aus der ehemaligen Sowjetunion

2010 ◽  
Vol 58 (3) ◽  
pp. 165-171 ◽  
Author(s):  
Ricarda Mewes ◽  
Winfried Rief ◽  
Alexandra Martin ◽  
Heide Glaesmer ◽  
Elmar Brähler
Keyword(s):  
Psychische Gesundheit ◽  
Patient Health Questionnaire ◽  
Health Questionnaire ◽  
Epidemiologische Studien ◽  
Patient Health

Hintergrund: Gegenüberstellende epidemiologische Studien zur psychischen Gesundheit bei verschiedenen Migrantengruppen in Deutschland fehlen weitgehend. Sie sind jedoch von großer Wichtigkeit, um den Therapiebedarf für diese Gruppen zu bestimmen und Angebote entsprechend auszurichten. Die vorliegende Studie möchte die Ausprägung einer depressiven, somatoformen und angstbezogenen Symptomatik bei osteuropäischen, türkischen und Migranten aus der ehemaligen Sowjetunion in der Allgemeinbevölkerung miteinander vergleichen und untersuchen, ob es Unterschiede in der Bereitschaft gibt, für verschiedene Beschwerden einen Arzt aufzusuchen. Methode: 43 osteuropäische Migranten (beide Eltern in Polen, Rumänien, Slowakischer Republik, Tschechischer Republik oder Ungarn geboren), 49 Migranten aus der ehemaligen Sowjetunion (beide Eltern in Russland, Ukraine, Weißrussland oder Kasachstan geboren; Russlanddeutsche Personen fallen auch in diese Gruppe) und 42 Personen mit türkischem Migrationshintergrund wurden mit dem Patient-Health-Questionnaire auf depressive, somatoforme und angstbezogene Symptome untersucht und mit einem Fragebogen zu ihrer Bereitschaft befragt, für verschiedene Beschwerden einen Arzt aufzusuchen. Die Gruppen wurden mit Varianzanalysen unter Kontrolle möglicher konfundierender Variablen miteinander verglichen. Ergebnisse: Unter Kontrolle von Geschlecht, Alter, Partnerschaft und Erwerbstätigkeit zeigten sich keine signifikanten Unterschiede in depressiver, somatoformer und ängstlicher Symptomatik zwischen den drei Gruppen. Unter Kontrolle für Alter und Geschlecht zeigten sich ebenfalls keine Unterschiede in der Bereitschaft, für verschiedene Beschwerden einen Arzt aufzusuchen. Frauen berichteten mehr somatoforme Beschwerden als Männer und zeigten eine höhere Bereitschaft, einen Arzt zu konsultieren. Diskussion: Es lassen sich keine kulturellen Einflüsse in Bezug auf die psychische Gesundheit und den Umgang mit verschiedenen Beschwerden bei diesen eher gut integrierten Migranten feststellen. Weitere Studien zu dieser Fragestellung mit größeren Stichproben und unter Einbezug schlechter Deutsch sprechender Migranten wären wünschenswert.

Beurteilung depressiver und somatischer Symptome mittels des PHQ-9 und PHQ-15 bei ambulanten vietnamesischen und deutschen Patientinnen

2016 ◽  
Vol 64 (1) ◽  
pp. 25-36 ◽  
Author(s):  
Eric Hahn ◽  
Ronald Burian ◽  
Annegret Dreher ◽  
Georg Schomerus ◽  
Michael Dettling ◽  
...  
Keyword(s):  
Patient Health Questionnaire ◽  
Health Questionnaire ◽  
Fand Sich ◽  
Patient Health ◽  
Somatische Symptome ◽  
Vergleichende Untersuchungen

Zusammenfassung. Studien in der Allgemeinbevölkerung zeigen uneinheitliche Ergebnisse bezüglich häufigerer Somatisierung bei Migranten. Vergleichende Untersuchungen fanden bei depressiven Patienten ostasiatischer Herkunft geringere Angaben von psychologischen Symptomen und häufigere somatische Beschwerden, als bei Patienten westlicher Herkunft. Aufgrund einer geringen Inanspruchnahme psychiatrischer Versorgungsangebote in Deutschland, insbesondere durch vietnamesische Migranten der ersten Generation, existieren bisher keine Studien zu einer psychischen und somatischen Symptomausprägung bei Patienten vietnamesischer Herkunft im Vergleich zu deutschen Patienten ohne Migrationshintergrund. Im Kontext kultursensibler Diagnostik von Migranten in Deutschland wurde als ausreichend messäquivalentes Selbstbeurteilungsinstrument insbesondere der Patient Health Questionnaire bzw. der Gesundheitsfragebogen für Patienten als ein valides und einfach verwendbares Instrument für eine Erfassung von Symptomen und Schweregraden häufiger psychischer Störungen, wie der Depression empfohlen. Im Rahmen der vorliegenden Untersuchung wurden bei 66 vietnamesischen Patientinnen der ersten Generation und 83 deutschen Patientinnen während des erstmaligen psychiatrischen Kontaktes psychische Symptome einer Depression mittels des PHQ-9 und somatische Symptome mittels des PHQ-15 in der jeweiligen Muttersprache erfasst. Für beide Gruppen fand sich für beide Instrumente eine zufriedenstellende interne Konsistenz. Ein möglicher Zusammenhang zwischen der Herkunft und dem Schweregrad der Ausprägung psychischer depressiver und somatischer Symptome bei diagnostizierter depressiver Episode erfolgte mittels einer multivariaten Analyse. Für die Selbstbeurteilung mittels des PHQ-9 fanden sich keine Gruppenunterschiede hinsichtlich des Gesamtsummenwertes und des Schweregrades psychischer depressiver Symptome. Dagegen berichteten vietnamesische Patientinnen in der Selbstwahrnehmung anhand des PHQ-15 von einem insgesamt höheren Schweregrad von somatischen Symptomen. Insbesondere waren bei depressiven vietnamesischen Patientinnen die Mittelwerte der Einzelitems Kopfschmerzen, Glieder- und Gelenkschmerzen, Schmerzen im Brustbereich sowie Schwindel und Ohnmachtsanfälle gegenüber deutschen Patientinnen deutlich erhöht. Entgegen der Untersuchungshypothese und früherer Studien ging die häufigere Selbstbeurteilung oder Aufmerksamkeit auf somatische Symptome bei vietnamesischen Patientinnen nicht mit einer verminderten Eigenwahrnehmung von psychischen Symptomen einer depressiven Episode anhand des PHQ-9 einher.

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