Comparing Patients' and Surgeons' Expectations Of Lumbar Spine Surgery

描述(申请人提供)：腰痛是一种流行的疾病，主要困扰老年人，但影响所有年龄段的人，由于急性和非急性诊断。存在多种可能的保守疗法；然而，它们的主要缺点是推进治疗所需的时间往往延长，并伴随着持久的残疾和心理痛苦。因此，一些患者在用尽其他治疗方法后寻求手术，而一些患者在疗程早期寻求手术。对于这两组人来说，接受手术的决定都是基于个人情况、观点和对结果的预期。先前的研究表明，患者通常对整形外科手术有很高的期望。虽然雄心壮志可以激励人，但如果志向不切实际，也可能导致不良结果，并导致患者因休养时间而灰心丧气，忽视建议的生活方式改变，以避免疾病的进展。相反，如果患者缺乏参与康复和遵循停药后预防措施的动力，期望过低也可能导致不良结果。为了从手术中获得最大利益，患者和外科医生需要分享对什么是可能的、可能的和现实的理解，并共同努力实现相同的目标。这项拟议的横断面研究的主要目标是评估患者和他们的外科医生之间关于腰椎手术期望的一致性。计划进行腰椎手术的患者将根据他们是否患有急性和非急性疾病进行二分法。手术前几天，患者将完成有效的腰椎手术期望调查，测量他们的生理和心理期望。此外，在手术前，他们的外科医生将为每个患者完成外科医生版本的相同调查。主要结果将是基于一致性相关系数，根据急性组和非急性组对每对患者-外科医生之间的一致性进行比较。将使用基于GEE方法的多元回归分析来评估协变量。次要目标是组建一个教室和基于网络的课程，可以整合到现有的基础设施中，指导患者有关期望的知识。该课程在实现患者和外科医生之间更大一致性方面的有效性将在随后的随机对照试验中进行测试。这项R03研究建立在调查团队研究患者期望的广泛经验的基础上，并利用了大量的患者和既定的方法。这项研究将有助于我们独立地了解患者的期望，同时也将为未来的介入研究提供基础。最后，这项研究映射了AHRQ的比较有效性倡议，通过解决那些适应症没有准确定义的昂贵外科手术的以患者为中心的突出问题。此外，这项研究将在城市环境中进行，并将 在主要影响老年人的情况下解决医疗质量的广泛概念。

DESCRIPTION (provided by applicant): Low back pain is a prevalent medical condition afflicting primarily older adults but affecting all age groups and due to acute and non-acute diagnoses. Multiple possible conservative therapies exist; however, their major drawback is that the time required to advance therapy is often prolonged and accompanied by persistent disability and psychological suffering. Thus, some patients seek surgery after exhausting other therapies and some patients seek surgery earlier in their course. For both groups, decisions to undergo surgery are based on personal circumstances, perspectives, and expectations of outcome. Prior studies have shown that patients typically have high expectations of orthopedic surgery. Although high aspirations can be motivating, they also may predispose to poor outcomes if they are unrealistic and cause patients to become discouraged with recuperation time and ignore recommended lifestyle changes that avert progression of disease. Expectations that are too low, conversely, also may predispose to poor outcomes if patients lack motivation to participate in rehabilitation and to follow postop precautions. In order to achieve maximum benefit from surgery, patients and surgeons need to share an understanding of what is possible, probable, and realistic, and to join together and work toward the same goals. The primary objective of this proposed cross-sectional study is to assess the concordance between patients and their surgeons regarding expectations of lumbar spine surgery. Patients scheduled for lumbar surgery will be dichotomized according to whether they have acute versus non-acute conditions. Several days before surgery patients will complete the validated Lumbar Spine Surgery Expectations Survey measuring their physical and psychological expectations. Also before surgery their surgeons will complete the surgeon's version of the same survey for each patient. The main outcome will be a comparison of the concordance within each patient-surgeon pair according to acute versus non-acute groups based on the concordance correlation coefficient. Multivariate regression analysis based on the GEE method will be used to assess covariates. The secondary objective is to assemble a classroom and web-based curriculum that can be incorporated into existing infrastructures to instruct patients about expectations. The effectiveness of the curriculum in achieving greater concordance between patients and surgeons will be tested in a subsequent RCT. This R03 study builds on the investigative team's extensive experience studying patients' expectations and leverages a large volume of patients and an established methodology. This study will independently contribute to our understanding of patients' expectations and at the same time will provide the foundation for future interventional studies. Finally, this study maps to AHRQ's comparative effectiveness initiatives by addressing salient patient-centered issues for costly surgical procedures whose indications are not precisely defined. In addition, this study will be carried out in an urban setting and will address broad concepts of healthcare quality in conditions that primarily affect older adults.