Health-related quality-of-life status in Veterans with spinal disorders
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To measure the impact of spinal disorders on health-related quality of life (HRQOL) among Veterans, to describe demographic patterns of Veterans with spinal disorders, and to quantify HRQOL scores as they relate to demographics, medical comorbidities, pain severity, and depressive symptoms.
From 2009 to 2010, 112 lumbar and 56 cervical spinal disorder patients completed SF-12, Oswestry Disability Index, visual analog pain scale, and Beck Depression Inventory surveys. Multivariate analysis identified predictors of HRQOL, disability, and depressive symptoms.
A total of 168 patients completed surveys for this study. The median age of all patients was 60. Nearly 30% of lumbar and 16% of cervical patients were aged 65 or older. Approximately 96% of patients were men. Sixty percent of patients were currently receiving or had pending disability compensation. Nearly 60% of patients were current smokers, approximately 26% reported alcoholism or intravenous drug use, and 26% self-reported post-traumatic stress disorder. The most common lumbar spine diagnoses were disk herniation (36.6%) and stenosis (34.8%), and most common cervical spine diagnoses were stenosis (50.0%) and disk herniation (23.2%). Back pain was reported by 93.8% of lumbar patients and leg pain by 83.0%. Neck pain was reported by 96.4% of cervical patients and arm pain by 69.6%. Median SF-12 physical component scores were more than two standard deviations below the US average. Ninety percent of patients had at least moderate physical disability. Sixty-four percent met criteria for depressive symptoms. Visual analog pain score was the strongest predictor of SF-12 physical (β = −1.32, P < 0.001) and mental (β = −1.63, P < 0.001) HRQOL and was the prime determinant of depressive symptoms (β = 1.52, P < 0.001) and disability index score (β = 4.39, P < 0.0001). Charlson Comorbidity Score and smoking status had no significant impact on HRQOL or disability scores. Age was negatively correlated with depressive symptoms and positively correlated with SF-12 mental component scores.
Spinal disorders have a severe impact on both physical and emotional HRQOL of Veterans and are associated with severe disability and an unusually high prevalence of depressive symptoms. Therapeutic interventions should be targeted to reduce pain, which is a prime determinant of HRQOL, disability, and depressive symptoms. Given high prevalence of multiple risk factors for poor outcomes, studies of spine surgery outcomes in Veterans are needed.
KeywordsHealth-related quality of life Veterans Spine surgery Visual analog pain score
Health-related quality of life
Physical Component Summary (of SF-12)
Mental Component Summary (of SF-12)
Visual analog pain scale
Oswestry Disability Index
Neck Disability Index
Beck Depression Inventory
National Spine Network
- 6.Luo, J., Zhang, H. T., Jiang, X. D., Xue, S., & Ke, Y. Q. (2009). Combination of bone marrow stromal cell transplantation with mobilization by granulocyte-colony stimulating factor promotes functional recovery after spinal cord transection. Acta Neurochir (Wien), 151(11), 1483–1492.CrossRefGoogle Scholar
- 8.Slover, J., Abdu, W. A., Hanscom, B., Lurie, J., & Weinstein, J. N. (2006). Can condition-specific health surveys be specific to spine disease? An analysis of the effect of comorbidities on baseline condition-specific and general health survey scores. Spine (Phila Pa 1976), 31(11), 1265–1271.CrossRefGoogle Scholar
- 18.Luo, X., Lynn George, M., Kakouras, I., Edwards, C. L., Pietrobon, R., Richardson, W., et al. (2003). Reliability, validity, and responsiveness of the short form 12-item survey (SF-12) in patients with back pain. Spine (Phila Pa 1976), 28(15), 1739–1745.Google Scholar
- 19.Walsh, T. L., Hanscom, B., Lurie, J. D., & Weinstein, J. N. (2003). Is a condition-specific instrument for patients with low back pain/leg symptoms really necessary? The responsiveness of the Oswestry disability index, MODEMS, and the SF-36. Spine (Phila Pa 1976), 28(6), 607–615.Google Scholar
- 26.Faraway, J. J. (2005). Linear models with R. New York: Chapman & Hall/CRC.Google Scholar
- 32.Sinikallio, S., Aalto, T., Lehto, S. M., Airaksinen, O., Herno, A., Kroger, H., et al. (2010). Depressive symptoms predict postoperative disability among patients with lumbar spinal stenosis: A two-year prospective study comparing two age groups. Disability and Rehabilitation, 32(6), 462–468.PubMedCrossRefGoogle Scholar
- 35.Kessler, R. C., Berglund, P., Demler, O., Jin, R., Koretz, D., Merikangas, K. R., et al. (2003). National comorbidity survey replication: The epidemiology of major depressive disorder: results from the National Comorbidity Survey Replication (NCS-R). JAMA, 289(23), 3095–3105.PubMedCrossRefGoogle Scholar