Гений oртопедии (Jun 2022)
The impact of coping strategies on treatment outcomes in older patients with degenerative dorsopathies
Abstract
Introduction Dissatisfaction with conservative treatments of various types of dorsopathies results in increased number of surgical interventions to eliminate the accompanying clinical manifestations. Patients' psychosocial characteristics are likely to impact treatment satisfaction, and personality traits as cognitive status, depression, anxiety and coping strategies of the patient have a role. The objective of the study was to assess the impact of the coping strategies of a patient on surgical treatment outcomes in older patients with dorsopathy. Material and methods The study included 149 patients with dorsopathy aged 60 years and over. The patients were divided into 2 groups. The first group (n = 54) consisted of patients with central stenosis of the spinal canal (M48.0) who underwent minimally invasive surgeries without stabilization. The second group included 95 patients with degenerative spondylolisthesis and unstable VMS (M43.1, M53.2). A variety of decompression and stabilization surgical technologies were employed for the patients. Results The majority of patients in the first group ( n = 46, 85 %) obtained satisfactory surgical outcome. Eight patient (15 %) had poor outcome. An inverse, moderate, statistically significant correlation was revealed between maladaptive coping strategies identified with Ways of Coping Questionnaire (distancing, avoidance), Stress Coping Questionnaire (behavioral avoidance of a problem), the Coping Strategy Indicator (avoidance) and surgical outcome. Surgical outcome was rated as satisfactory in 79 (83.2 %) cases and poor in 16 (16.8 %) patients of the second group (n = 95). Patients of the second group showed a greater number of coping strategies having a statistically significant correlation with treatment outcome. Patients with adaptive strategies resulting from decompression and stabilization operations had a more favorable outcome. Maladaptive coping strategies such as confrontation, avoidance and behavioral avoidance of the problem had a negative impact on treatment outcome. Discussion A comprehensive analysis of the questionnaire data showed that the more aggressive the intervention was with the use of fixation constructs, the greater the impact of the patient's coping strategies on the outcome of treatment observed. This relationship was not found in decompression cases with maladaptive strategies being most significant. Conclusion We can conclude about the predictive value of coping strategies based on the impact of the severity of adaptive and maladaptive coping strategies on the outcome and satisfaction with the surgical treatment of dorsopathies in older patients. This factor is essential for the preoperative stage to facilitate personalized treatment options for the complex group of patients.
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