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 Table of Contents  
ORIGINAL ARTICLE
Year : 2019  |  Volume : 9  |  Issue : 2  |  Page : 147-150

Quality of life evaluation of patients undergoing lumbar surgery: A cross-sectional study in West of Iran


1 Department of Neurosurgery, Hamadan University of Medical Sciences, Hamadan, Iran
2 Department of Operating Room, School of Para Medicine, Hamadan University of Medical Sciences, Hamadan, Iran

Date of Web Publication8-May-2019

Correspondence Address:
Mashhood Aghajanloo
Besat Hospital, Hamadan University of Medical Sciences, Hamadan
Iran
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/AIHB.AIHB_88_18

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  Abstract 


Introduction: The different studies assessed quality of life (QOL) in patients with spinal cord injury with different research tools and showed that QOL scores less are considered in national and international studies and in different cultures. Therefore, the aim of this study was to assess the QOL of patients undergoing lumbar spinal surgery in Hamadan Province, West of Iran. Materials and Methods: This retrospective cross-sectional study was performed of 300 patients underwent elective lumbar laminectomy (partial or complete) or fusion between 2012 and 2015, at a single tertiary care centre for non-traumatic and non-neoplastic indications in Hamadan, Iran. We used the Iranian version of the brief questionnaire of the World Health Organisation on QOL (WHOQOL-BREF). Stata software version 12 (StataCorp, College Station, TX, USA) was used to perform all the analytical operations. Results: In regard of psychological health (P = 0.21), social relationships (P = 0.64) and environment health (P = 0.85), patients underwent fusion surgery were obtained higher score and in regard of physical health patients underwent partial laminectomy were obtained higher score (P = 0.09). However, only in physical health domain differences between three groups was relatively significant. Mean QOL scores in each WHOQOL-BRIEF domains according to patients pain duration are presented, as shown in physical health (P = 0.06) and psychological health (P = 0.04) domains, patients with pain duration <1 year were reported higher scores. Conclusion: The results of the present study can be used in the post-operative patient information and aid the surgeon and the patient in a shared decision-making process.

Keywords: Cross sectional, lumbar surgery, quality of life


How to cite this article:
Aghajanloo M, Esmaeili F, Bathaei T, Piriaei A, Tavakoli E. Quality of life evaluation of patients undergoing lumbar surgery: A cross-sectional study in West of Iran. Adv Hum Biol 2019;9:147-50

How to cite this URL:
Aghajanloo M, Esmaeili F, Bathaei T, Piriaei A, Tavakoli E. Quality of life evaluation of patients undergoing lumbar surgery: A cross-sectional study in West of Iran. Adv Hum Biol [serial online] 2019 [cited 2020 Jul 7];9:147-50. Available from: http://www.aihbonline.com/text.asp?2019/9/2/147/257823




  Introduction Top


The studies have shown that 80% of the people experience an episode of low back pain throughout their lives. The low back pain is happening in 50% of chronic musculoskeletal diseases.[1] These diseases are the primary cause of workplace absenteeism and the second leading cause of adhesion to social security programs.[2] The degenerative spine conditions and the number of surgical patients may be increased in the aging population.[3] The low back pain continuing for >3 months is confined to as chronic low back pain and has an increased association with psychological and physiological.[4]

The idea of the quality of life (QOL) is subjective, multidimensional and consist both positive and negative factors.[5] The neuropathic pain affects the social and psychological health of low back pain patients.[6] The low back pain can decrease extremely the QOL of the patient during their lives.[7]

A study by Taylor et al. reported that older age and longer symptom duration was associated with worse patient outcomes.[8]

Sigmundsson et al. in 2012 in Sweden showed that patients with duration of leg pain exceeding 2 years and with increasing age had statistically significantly lower QOL.[9]

Farzanegan et al. in 2011 in Iran reported that scores of physical and mental health in patients significantly improved after 6 and 12 months of lumbar discectomy.[10]

The different studies assessed QOL in patients with spinal cord injury with different research tools and showed that QOL scores less are considered in national and international studies and in different cultures.[11] Therefore, the aim of this study was to assess the QOL of patients undergoing lumbar spinal surgery in Hamadan Province, West of Iran.


  Materials and Methods Top


Study setting and patients

This retrospective cross-sectional study was performed on 300 patients who underwent elective lumbar laminectomy (partial or complete) or fusion between 2012 and 2015, at a single tertiary care centre for non-traumatic and non-neoplastic indications in Besat Hospital. Besat Hospital is located in Hamadan city which is the capital of Hamadan province. Hamadan province with an area of 19,493 km2 in extent is located in West of Iran and had a population of 1758,268 people; according to the national census held in 2011 by Statistical Centre of Iran (https://www.amar.org.ir/english). Non-probability sampling (convenience sampling) was used for choosing participations.

Eligibility criteria

The inclusion criteria were an age between 20 and 65 years; pass at least 6 months of surgery and willingness to participate in the study.

Measurement tool

We used the Iranian version of the brief questionnaire of the World Health Organisation on QOL (WHOQOL-BREF), which has translated to Persian by Nedjat et al. to measure their QOL. This instrument comprises 26 items, which measure the following four domains: physical health (7 items), psychological health (6 items), social relationships (3 items) and environmental health (8 items). Two other items ( first two questions) are evaluated health condition and QOL in general. Each item is scored from 1 to 5 and consequently the scores transformed linearly to a 0–100 scale.

Statistical methods

Descriptive analysis was used including frequency tables and central and dispersion tendency indices to describe and summarise data and the bivariate Student's t- test, and the analysis of variance to compare the means of QOL between groups of patients according to their age group, gender, type of surgery and pain duration. A level of 0.05 was considered significant for all statistical tests. Stata software version 12 (StataCorp, College Station, TX, USA) was used to perform all the analytical operations.


  Results Top


A total of 300 patients were included in the study and filled out the WHOQOL-BREF questionnaire in this study. 56.67% (n = 170) were men, and 48.67% (n = 146) of them were in 40–60-year age group. In 42% of patients pain duration before surgery were 1 year, and in nearly 20% of them, pain duration was above 5 years. Number of level (s) operated in more than half of patients (51.33%) was one level and in nearly 10% of them were three levels. In 35% (n = 105) of patient, herniation level was belong to L4–L5 and L5– S1 discs, on in only 5 patients (1.67%), herniation was occurred in L3–L4 discs. Majority of the patients (64.33%) were underwent partial laminectomy, while in 32% of them fusion technic were used and 3.67% were underwent full laminectomy. Recurrent was occurred in 15.67% (n = 45) of patients [Table 1].
Table 1: Clinical and demographic characteristics of investigated participants

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[Table 2] shows the mean perception of QOL domains including physical health, psychological health, social relationships and environment health. As shown social relationships had higher score (78.96 ± and physical health had lower score (62.60 ± 10.93).
Table 2: Brief questionnaire of the World Health Organization on quality of life domains for investigated patients

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Mean QOL scores in each WHOQOL-BREF domains according to patients' age group are shown in [Table 3]. The highest means for physical health (P = 0.006) and psychological health (P = 0.006) were observed in 20–40-year age group. For all domains, the lowest scores were observed in old patients with over 60 years of age. There was not statistically significant different in social relationships and environment health domains between groups (P > 0.05).
Table 3: Mean quality of life scores in each brief questionnaire of the World Health Organisation on quality of life domains according to patients age group

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In regard of psychological health (P = 0.21), social relationships (P = 0.64) and environment health (P = 0.85), patients underwent fusion surgery were obtained higher score and in regard of physical health patients underwent partial laminectomy were obtained higher score (P = 0.09). But only in physical health domain, differences between three groups were relatively significant [Table 3].

As shown in [Table 4], there was no statistically significant difference for mean QOL scores in WHOQOL-BREF domains between males and females (P > 0.05).
Table 4: Mean quality of life scores in each brief questionnaire of the World Health Organisation on quality of life domains by gender

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Mean QOL scores in each WHOQOL-BREF domains according to patients pain duration are presented in [Table 5], as shown in physical health (P = 0.06) and psychological health (P = 0.04) domains, patients with pain duration <1 year were reported higher scores.
Table 5: Mean quality of life scores in each brief questionnaire of the World Health Organisation on quality of life domains according to patients pain duration

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  Discussion Top


Our study showed that psychological health, social relationships and environment health, patients underwent fusion surgery were obtained higher score and in regard of physical health patients underwent partial laminectomy were obtained higher score. Furthermore, this study reported that in physical health and psychological health domains, patients with pain duration <1 year were reported higher scores, and for all domains, the lowest scores were observed in old patients with over 60 years of age.

Taylor et al. reported that older age and longer symptom duration were associated with worse patient outcomes. This result is in line our study. Furthermore, patients who had a fusion procedure were more likely to report a great QOL improvement. In our study, patients underwent fusion surgery were obtained higher score in domains of psychological health, social relationships and environment health.[8]

Sigmundsson et al. in 2012 in Sweden showed that patients with duration of leg pain exceeding 2 years and with increasing age had statistically significantly lower QOL. Furthermore, there was no statistically significant difference for mean QOL scores in WHOQOL-BRIEF domains between males and females. These results were similar to the present study.[9] Recent studies have shown symptoms duration was a main prognostic factor. Ng et al. in 2007 reported that patients with the symptoms duration of <3 years to have a better prognosis than those with a longer duration of symptoms.[12] Long-term pain and loss of function in the elderly patients can be difficult to treat. Furthermore, duration of symptoms is an effect factor by giving appropriate information to patients, doctors and healthcare policymakers for earlier diagnosis and intervention.

A study by Treede et al. was conducted to determine factors associated with patient outcomes 1 year after spinal surgery. They showed in follow-up 236 included patients, two-thirds of patients (65%) reported much better functioning, 64% had a great QOL improvement and 68% had satisfaction about their treatment outcome.[4]

There are some limitations in the present study: (a) some admitted patients may have lost being included; there was a time of high waiting for performing of surgery and (b) The QOL scores in this study were evaluated by using WHOQOL-BREF questionnaire, while other questionnaires of QOL may report different findings.


  Conclusion Top


Our study showed that psychological health, social relationships and environment health, patients underwent fusion surgery were obtained higher score and in regard of physical health, patients underwent partial laminectomy were obtained higher score. Furthermore, this study reported that in physical health and psychological health domains, patients with pain duration <1 year were reported higher scores, and for all domains, the lowest scores were observed in old patients with over 60 years of age. The results of the present study can be used in the post-operative patient information and aid the surgeon and the patient in a shared decision-making process.

Acknowledgement

We gratefully acknowledge the kind support of the participants for their precious collaboration in this study as well as staffs of Besat Hospital.

Financial support and sponsorship

Nil.

Conflicts of interest

There are no conflicts of interest.



 
  References Top

1.
Hoogendoorn WE, van Poppel MN, Bongers PM, Koes BW, Bouter LM. Physical load during work and leisure time as risk factors for back pain. Scand J Work Environ Health 1999;25:387-403.  Back to cited text no. 1
    
2.
Beurskens AJ, de Vet HC, Köke AJ, van der Heijden GJ, Knipschild PG. Measuring the functional status of patients with low back pain. Assessment of the quality of four disease-specific questionnaires. Spine (Phila Pa 1976) 1995;20:1017-28.  Back to cited text no. 2
    
3.
Mokhtar SA, McCombe PF, Williamson OD, Morgan MK, White GJ, Sears WR, et al. Health-related quality of life: A comparison of outcomes after lumbar fusion for degenerative spondylolisthesis with large joint replacement surgery and population norms. Spine J 2010;10:306-12.  Back to cited text no. 3
    
4.
Treede RD, Jensen TS, Campbell JN, Cruccu G, Dostrovsky JO, Griffin JW, et al. Neuropathic pain: Redefinition and a grading system for clinical and research purposes. Neurology 2008;70:1630-5.  Back to cited text no. 4
    
5.
Fleck MP, Louzada S, Xavier M, Chachamovich E, Vieira G, Santos L, et al. Application of the portuguese version of the instrument for the assessment of quality of life of the World Health Organization (WHOQOL-100). Rev Saude Publica 1999;33:198-205.  Back to cited text no. 5
    
6.
Hiyama A, Watanabe M, Katoh H, Sato M, Sakai D, Mochida J, et al. Evaluation of quality of life and neuropathic pain in patients with low back pain using the Japanese orthopedic association back pain evaluation questionnaire. Eur Spine J 2015;24:503-12.  Back to cited text no. 6
    
7.
Richard WH. Youmans Neurological surgery. United States. Saunders; 2004.  Back to cited text no. 7
    
8.
Taylor VM, Deyo RA, Ciol M, Farrar EL, Lawrence MS, Shonnard NH, et al. Patient-oriented outcomes from low back surgery: A community-based study. Spine (Phila Pa 1976) 2000;25:2445-52.  Back to cited text no. 8
    
9.
Sigmundsson FG, Kang XP, Jönsson B, Strömqvist B. Prognostic factors in lumbar spinal stenosis surgery. Acta Orthop 2012;83:536-42.  Back to cited text no. 9
    
10.
Farzanegan G, Alghasi M, Safari S. Quality-of-life evaluation of patients undergoing lumbar discectomy using short form 36. Anesth Pain Med 2011;1:73-6.  Back to cited text no. 10
    
11.
Siscão MP, Pereira C, Arnal RL, Foss M, Marino LH. Spinal cord trauma: Characterization in a public hospital. Arq Ciênc Saúde 2007;14:145-7.  Back to cited text no. 11
    
12.
Ng LC, Tafazal S, Sell P. The effect of duration of symptoms on standard outcome measures in the surgical treatment of spinal stenosis. Eur Spine J 2007;16:199-206.  Back to cited text no. 12
    



 
 
    Tables

  [Table 1], [Table 2], [Table 3], [Table 4], [Table 5]



 

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