Abstract
Introduction
The use of clinical and functional evaluation instruments for vertebral pathologies, besides determining how the situation evolves after treatment, can predict the postoperative outcome. The objective of this study is to describe the methodology to evaluate outcome in the spinal surgery.
Patients and Methods
After surgical treatment is indicated, the patients are invited to participate in the study by signing a letter of free and informed consent. The patients complete the questionnaires at the doctor's office, and are helped regarding doubts in filling them out by a person who is not involved in the surgery. All the evaluation instruments used are self-applied. The following are used: numerical rating scale of pain (NRS), SF-36 questionnaire, Fear-Avoidance Beliefs questionnaire (FABq), Beck Depression Inventory (BDI), hospital anxiety and depression scale (HAD), Oswestry Disability Index (ODI), and Neck Disability Index (NDI). The patient himself/herself answered the questionnaire, not the secretary or the surgeons. The patient fill out the questionnaire using a regular paper (paper-and-pen questionnaire) or computer software directly using the internet from their home. The surgeons give the patients feedback on the results.
Results
A total of 220 patients with lumbar spine pathologies and 32 with cervical pathologies were evaluated. Typically, when completing paper forms the data are collected, recorded, and computerized manually. The pros was that you got something answered by the patient and the cons were missing values—the patient does not answer some questions (3%), the secretary skips some questions (1%), misrecordings with the chance of error when inserting the data into the computer (range, 2–5%); and secretary's work were laborious and time consuming. When the patient answered the questionnaire directly to the computer software, the data were self-recorded by the patient using a touch-screen system at the clinic or by accessing the webpage using their own username and password. In those cases, the cons were that some patients do not know how to deal with a computer and the pros were that the data are already in the computer and in the Excel workbook and when the patient enters the office the surgeons already have the questionnaire results. The prevalence of depression according to the BDI was 28.0 and 31.2% in patients with lumbar and cervical surgical disease, and the prevalence of anxiety according to HAD-A is 40.1 and 46.9%, respectively. The mean of ODI was 46.5 and of NDI 25.4. Most of the patients, when they have been instructed about completing them, do not have any difficulty in finishing them. The mean time for the completion of all instruments is 25 to 35 minutes.
Conclusion
The use of instruments validated to evaluate patients with degenerative spinal diseases is feasible and should be encouraged among the spinal surgeons. Following the right steps, the patient is convinced of the importance of answering correctly.