Patient positioning on the operating table and patient safety: A systematic review and meta-analysis.

AIM: To identify occurrence of harmful incidents related to patient positioning on operating table. DESIGN: Systematic review and meta-analysis. DATA SOURCES: Eight databases including Ovid, Medline, Embase, CINAHL, the Cochrane Library, Epistemonikos, Scopus, Web of Science and Google Scholar were systematically searched from the inception of the databases to August 2023. Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram depicting the flow information. REVIEW METHODS: The Cochrane Risk of Bias Tools were used to assess the risk of bias. Risk of harm with 95% confidence interval (CI) was estimated for each included study, and an overall risk was calculated using meta-analysis. RESULTS: Of the 22 included reports, two were randomized controlled trials (RCTs), five had a prospective cohort design, three had a cross-sectional design, and 12 were register-based studies. Intraoperative peripheral nerve injuries, perioperative pressure ulcers, musculoskeletal injuries, vascular injuries, postoperative pain and eye injuries were related to supine, lithotomy, Trendelenburg, prone and beach chair positioning. Overall risk of any harm was estimated as 0.2%. Studies with patients placed in prone positioning (8 study samples) had the highest risks of harm varying from 0.19 to 0.81, with an overall risk of 0.33. Meta-analysis of the two RCTs showed higher risk of chemosis with head-down positioning than with head in neutral position (overall relative risk = 1.64; 95% CI: [1.25, 2.14]). CONCLUSIONS: Harmful incidents related to patient positioning occur and consequences can be severe. The operating room teams should be aware of the harms and prevent and treat them seriously. IMPACT: This review underlines that research is sparse on patient positioning on operating table and harmful incidents. There is a need for high-quality, well-designed studies that focus on harmful incidents and prevention of harm related to patient positioning. PATIENT OR PUBLIC CONTRIBUTION: No patient or public contribution, as this is a review of previous research.

Intraoperative peripheral nerve injury related to lithotomy positioning with steep Trendelenburg in patients undergoing robotic-assisted laparoscopic surgery - A systematic review.

AIMS: To examine the incidence of intraoperative peripheral nerve injury, symptoms, risk factors, functions, and quality of life in patients undergoing robotic-assisted laparoscopic surgery to lithotomy positioning with steep Trendelenburg. DESIGN: A systematic review. DATA SOURCES: The Cochrane Library catalogue, PubMed, EMBASE, CINHAL and SveMed + databases were searched from January 2000 - February 2019. REVIEW METHODS: Titles and abstracts were screened for inclusion. Full-text assessments of each paper were conducted by two reviewers. The quality of the included papers was assessed using the Mixed Methods Appraisal Tool. Descriptive statistics and thematic analysis were used to synthesize the data. RESULTS: Eleven quantitative studies were included with three themes: (a) incidence of intraoperative peripheral nerve injury; (b) upper extremity intraoperative peripheral nerve injury related to steep Trendelenburg positioning; and (c) lower extremity intraoperative peripheral nerve injury related to lithotomy positioning. The overall incidence of intraoperative peripheral nerve injury in robotic-assisted laparoscopic urologic, gynaecologic and colorectal surgery was 0.16%-10.0% and the symptoms appeared immediately after surgical procedures. Risk factors for intraoperative peripheral injury were prolonged operative time, high American Society of Anesthesiologists scores, comorbidities and high body mass index. CONCLUSION: Intraoperative peripheral nerve injuries are rare, but occasionally serious when related to lithotomy positioning with steep Trendelenburg. Operating room nurses have a responsibility both for positioning patients and for being familiar with the technological developments that will influence the preoperative handling of patients. IMPACT: This systematic review emphasizes the need for operating room nurses together with surgical team to have knowledge about mechanisms for injury, positioning, anatomy/physiology, and evaluation of risk factors to ensure that patients are not exposed for intraoperative peripheral nerve injuries. Increased robotic-assisted laparoscopic surgery necessitates further research examining the incidence of intraoperative peripheral nerve injury related to positioning and how these affect patients' function and the quality of life.

Self-management and health related quality of life in persons with chronic obstructive pulmonary disease.

PURPOSE: Although it is well-known that persons with COPD experience lower health related quality of life (HRQoL), little is known about the importance of self-management related domains on HRQoL in persons with COPD. Therefore, the purpose of this study is to examine associations between self-management related domains and HRQoL, adjusting for sociodemographic and clinical characteristics, self-efficacy, and sense of coherence. METHODS: Cross-sectional data of 225 persons with COPD, recruited from a hospital register, were analyzed. Self-management related domains were measured using the Health education impact questionnaire (heiQ) and HRQoL was measured using the St. George's Respiratory Questionnaire (SGRQ). Multiple linear regression analysis was used. RESULTS: The final models showed significant associations between the self-management domains constructive attitudes and approaches and emotional distress and HRQoL. Dyspnea, number of comorbidities, self-efficacy, and the various self-management related domains explained 51.3 to 55.1% of the variance in HRQoL. CONCLUSIONS: The findings suggest that addressing self-management related domains, in addition to self-efficacy, dyspnea, and comorbidities, may be of importance for enhancement of HRQoL in persons with COPD.

Medication errors in home care: a qualitative focus group study.

AIMS AND OBJECTIVES: To explore registered nurses' experiences of medication errors and patient safety in home care. BACKGROUND: The focus of care for older patients has shifted from institutional care towards a model of home care. Medication errors are common in this situation and can result in patient morbidity and mortality. DESIGN: An exploratory qualitative design with focus group interviews was used. METHODS: Four focus group interviews were conducted with 20 registered nurses in home care. The data were analysed using content analysis. RESULTS: Five categories were identified as follows: lack of information, lack of competence, reporting medication errors, trade name products vs. generic name products, and improving routines. CONCLUSION: Medication errors occur frequently in home care and can threaten the safety of patients. Insufficient exchange of information and poor communication between the specialist and home-care health services, and between general practitioners and healthcare workers can lead to medication errors. A lack of competence in healthcare workers can also lead to medication errors. To prevent these, it is important that there should be up-to-date information and communication between healthcare workers during the transfer of patients from specialist to home care. Ensuring competence among healthcare workers with regard to medication is also important. In addition, there should be openness and accurate reporting of medication errors, as well as in setting routines for the preparation, alteration and administration of medicines. RELEVANCE TO CLINICAL PRACTICE: To prevent medication errors in home care, up-to-date information and communication between healthcare workers is important when patients are transferred from specialist to home care. It is also important to ensure adequate competence with regard to medication, and that there should be openness when medication errors occur, as well as in setting routines for the preparation, alteration and administration of medications.

Diabetic foot ulcer teams in Norwegian hospitals. / Diabetiske fotsårteam i norske sykehus.

BACKGROUND: The national clincial guidelines for diabetes recommend that diabetic foot ulcers be treated by interdisciplinary diabetic foot ulcer teams. This study aims to survey the extent of diabetic foot ulcer teams in the specialist health service in Norwegian hospitals and to describe their clinical composition, organisation and working routines. MATERIAL AND METHOD: The study is cross-sectional with the use of a questionnaire survey. The criteria for participating were somatic hospitals with 24-hour operations and a specialist function for patients with diabetes mellitus. A total of 41 hospitals participated of the 51 that fulfilled the criteria. RESULTS: Altogether 17 of 41 hospitals had diabetic foot ulcer teams. The teams had a broad clinical composition and followed national recommendations for surveying risk factors and treatment of diabetic foot ulcers. Nine foot ulcer teams had written routines for assessment, five used the Noklus diabetes patient records to document ulcer treatment, and ten had planned interdisciplinary meetings. Only one-quarter of the teams included both medical and surgical competence in the planned interdisciplinary collaboration. INTERPRETATION: The diabetic foot ulcer teams had broad clinical competence and followed national clinical guidelines. The teams had a short waiting time for the initial consultation, half had written guidelines, and 60 % had planned interdisciplinary meetings. Far fewer had included both medical and surgical competence in the planned interdisciplinary collaboration.

Occurrence, Characteristics, and Predictors of Pain in Patients with Chronic Obstructive Pulmonary Disease.

Few studies have provided a detailed characterization of pain in patients with chronic obstructive pulmonary disease (COPD). The aims of this cross-sectional study were to describe the occurrence, intensity, locations, and level of interference associated with pain, as well as pain relief; to identify differences in demographic, clinical, and symptom characteristics between COPD patients with and without pain; and to determine which demographic, clinical, and symptom characteristics were associated with average pain, worst pain, and pain interference. A total of 258 patients with COPD provided information on demographic characteristics; comorbidities; respiratory parameters including dyspnea; body mass index; and symptom characteristics (i.e., anxiety, depression, sleep disturbance, and fatigue). Pain was measured using the Brief Pain Inventory. Of these 258 COPD patients, 157 (61%) reported pain. Multiple linear regression analyses were performed to determine which demographic, clinical, and symptom characteristics were associated with average pain severity, worst pain severity, and mean pain interference. Lower stages of COPD were associated with higher worst pain and higher pain interference scores. Higher depression scores were associated with higher average pain and higher pain interference scores. In addition, higher number of pain locations was associated with higher average and higher worst pain severity scores. Findings from this study confirm that pain is a significant problem and highlights the need for specific pain management interventions for patients with COPD. More research is needed about specific pain characteristics and symptoms to gain an increased knowledge about the causes of pain in these patients.

Demographic and clinical characteristics associated with quality of life in patients with chronic obstructive pulmonary disease.

PURPOSE: Despite an increasing interest in the relationships among multiple symptoms and quality of life (QOL), little known about the association between anxiety, depression, and pain and both disease-specific and generic QOL in patients with chronic obstructive pulmonary disease (COPD). METHODS: In a cross-sectional study of 100 COPD patients, disease-specific QOL was measured by St. George's Respiratory Questionnaire and generic QOL by the QOL scale. Anxiety and depression were evaluated using the Hospital Anxiety and Depression Scale, and pain was assessed with a numeric rating scale. RESULTS: Of the 100 patients, 31 % reported clinically meaningful anxiety, 13 % depression, and 45 % reported the presence of pain. Younger patients (p = 0.02) and those with higher anxiety scores (p = 0.02) reported worse disease-specific QOL. Patients with lower physical function (p = 0.04) and those with higher depression scores (p < 0.001) reported worse generic QOL. Age, comorbidity, physical function, anxiety, depression, and pain explained 19.2 and 49.6 % of the variance in disease-specific and generic QOL scores, respectively. CONCLUSIONS: Findings from this study suggest that the relationships between patient characteristics and common symptoms and QOL differ when disease-specific and generic measures of QOL are evaluated. Additional research is warranted to confirm these findings in COPD patients. Clinicians need to evaluate these common symptoms when planning and implementing symptoms management interventions to improve COPD patients' QOL.

The development of an integrated care model for patients with severe or very severe chronic obstructive pulmonary disease (COPD): the COPD-Home model.

BACKGROUND: Adherence to guidelines for managing stable chronic obstructive pulmonary disease (COPD) and its exacerbations is inadequate among healthcare workers and patients. An appropriate care model would meet patient needs, enhance their coping with COPD and improve their quality of life (QOL). AIM: This study aims to present the 'COPD-Home' as an integrated care model for patients with severe or very severe COPD. MODEL: One principle of the COPD-Home model is that hospital treatment should lead to follow up in the patient's home. The model also includes education, improved coordination of levels of care, improved accessibility and a management plan. One of the main elements of the COPD-Home model is the clear role of the home-care nurse. Model development is based on earlier research and clinical experience. It comprises: (i) education provided through an education programme for patients and involved nurses, (ii) joint visits and telephone checks, (iii) a call centre for support and communication with a general practitioner and (iv) an individualised self-management plan including home monitoring and a plan for pharmacological and nonpharmacological interventions. CONCLUSION: The COPD-Home model attempts to cultivate competences and behaviours of patients and community nurses that better accord with guidelines for interventions. The next step in its development will be to evaluate its ability to assist both healthcare workers and planners to improve the management of COPD, reduce exacerbations and improve QOL and coping among patients with COPD.

Comparison of health-related quality of life between patients with chronic obstructive pulmonary disease and the general population.

BACKGROUND: Chronic obstructive pulmonary disease (COPD) is associated with lower health-related quality of life (HRQOL). Previous research has focused primarily on HRQOL in these patients, whereas few studies have compared HRQOL between patients with COPD and the general population. AIM: The aim of this study was to evaluate differences in HRQOL between patients with COPD stage 2 to COPD stage 4 waiting to begin an outpatient pulmonary rehabilitation (PR) programme and Norwegian individuals with and without other chronic conditions. METHODS: A comparative survey design was used in this study of 100 patients with COPD waiting to begin PR and 3594 individuals from the general population. The SF-36 questionnaire was used to evaluate HRQOL. RESULTS: Compared with the healthy general population, COPD patients waiting to begin PR had lower scores on all SF-36 components and on the physical and mental health summary components (p < 0.001). Scores for physical function, physical role, general health, vitality, social function, emotional role and the physical health component differed markedly between patients and the general population. Patients with COPD stage 4 had lower HRQOL than did the general population and those with COPD stage 2 and COPD stage 3. CONCLUSIONS: The burden of COPD significantly affects HRQOL in patients with COPD waiting to begin PR, and those with COPD stage 4 are most affected. Action should be taken to support especially those patients with COPD stage 4.

Anxiety and depression following pulmonary rehabilitation.

AIM: The aim of this study was to evaluate changes and predictive factors of anxiety and depression in patients with chronic obstructive pulmonary disease (COPD) before and up to 3 months after pulmonary rehabilitation (PR). METHODS: A single group longitudinal design of patients with COPD underwent a PR programme. The measurements took place at baseline (T1: N=100), immediately before (T2: N=66), immediately after (T3: N=54) and 3 months after (T4: N=43) the programme. The programme was a 6-week outpatient programme, including education, psychosocial support and training sessions. Anxiety and depression were measured by the Hospital Anxiety and Depression Scale, self-efficacy by the COPD self-efficacy scale, lung function by spirometry and exercise capacity by incremental shuttle walking test. Mixed effect model analyses were used. RESULTS: Results showed a tendency of less anxiety and depression immediately after (T3) compared with immediately before (T2) the PR programme, but the changes were not significant. Results also showed that female reported significantly more anxiety than male (p=0.019), better exercise capacity predicted significantly less depression (p=0.049), and higher self-efficacy predicted both significantly less anxiety (p=0.001) and less depression (p=0.005). CONCLUSIONS: A tendency of less anxiety and depression during the PR programme was found, but the changes were not significant. Higher level of self-efficacy and better exercise capacity are suggested to relieve anxiety and depression.

Multiple symptoms in patients with chronic obstructive pulmonary disease in Norway.

This paper examines the prevalence of multiple symptoms and the relationships between future expectations and multiple symptoms in a cross-sectional study of 100 patients with chronic obstructive pulmonary disease. A questionnaire was used to examine the patients' symptoms of breathlessness, anxiety, depression, sleeplessness, fatigue, and pain, and their outlook for the future. All patients reported breathlessness, 64% anxiety, 69% depression, 28% sleeplessness, 72% fatigue, and 45% pain. Those with anxiety reported significant depression (P < 0.001), and those with fatigue reported significant depression (P = 0.004). Patients who reported pain also reported significant sleeplessness (P = 0.022). A negative outlook for the future was reported by 42% of patients who also reported significantly more anxiety, depression, sleeplessness, fatigue, and pain (P ≤ 0.049). Multiple symptoms are common in chronic obstructive pulmonary disease, and patients with a pessimistic view of the future reported more symptoms. Those with multiple symptoms and a negative outlook toward the future may benefit from interventions to help them achieve a more positive outlook for the future, which may relieve symptom burden.

Positioning patients for robotic-assisted surgery: A qualitative study of operating room nurses' experiences.

AIM: One of the challenges of robotic-assisted surgery is related to positioning of the patient on the operating table. Technological developments place increased demands on operating room nurses' competence to prevent positioning injuries and ensuring care quality. Therefore, the aim of the present study was to describe operating room nurses' experiences when positioning the patients for robotic-assisted surgery. DESIGN: A descriptive qualitative design. METHODS: Seven operating room nurses with experience in robotic-assisted surgery were included at a university hospital. Data were obtained through individual interviews and analysed using qualitative content analysis. The Consolidated Criteria for Reporting Qualitative research COREQ checklist was used. RESULTS: We identified three categories, (a) patient positioning is challenging during robotic-assisted surgery, (b) operating room nurses take responsibility for patient positioning during robotic-assisted surgery, but teamwork is important and (c) operating room nurses aim to achieve safe patient positioning during robotic-assisted surgery.

Patient safety and falls: a qualitative study of home care nurses in Norway.

This study explored patient safety and falls, based on the experiences of home care nurses. Four focus group interviews were conducted with 20 home care nurses. The data were analyzed by content analysis. This study identified the following four themes: (i) patient safety was not viewed as primary prevention; (ii) the lack of investigation into causes of falls; (iii) the frailty of older people who can no longer live at home independently and safely; and (iv) patient autonomy versus patient safety. In this study, we showed that home care nurses felt that healthcare personnel were more concerned with the treatment of falls, rather than fall prevention. In addition, home care nurses rarely focused on falls before they occurred. The patient's autonomy was placed before patient safety. This study illustrates that home care nurses might be more aware of fall prevention in clinical practice. Additional research is recommended to shed more light on this topic.

Evaluation of self-management interventions for chronic obstructive pulmonary disease.

AIM: To evaluate the benefits of self-management interventions on the quality of life of patients with chronic obstructive pulmonary disease. BACKGROUND: Chronic obstructive pulmonary disease is one of the most widespread chronic conditions worldwide, and it is predicted to increase over the next decade. Although previous review studies have demonstrated the benefits of self-management interventions on health-care utilisation, their benefits on quality of life are still unclear. METHOD: In this systematic review, we examined four randomised controlled trials undertaken between 2000 and 2011 to evaluate the benefits of chronic obstructive pulmonary disease self-management interventions on patient quality of life. RESULTS: The main theme that emerged was that self-management interventions improved patient well-being, with three minor themes: reducing the burden on patients, improved patient activity and improved total patient health. CONCLUSION: Self-management interventions tend to improve the quality of life of patients with chronic obstructive pulmonary disease. Further randomised controlled trials are recommended to evaluate self-management interventions in chronic obstructive pulmonary disease to confirm these benefits. IMPLICATIONS FOR NURSING MANAGEMENT: Nursing management in health services is involved in caring for patients with chronic obstructive pulmonary disease and is responsible for liaising with other members of the health-care team. We recommend that nursing management be engaged in health-care services to develop and implement self-management interventions for chronic obstructive pulmonary disease patients to improve their quality of life.

Patient safety culture in home care: experiences of home-care nurses.

AIM: To explore home-care nurses' experiences of patient safety in their delivery of home care to older clients. BACKGROUND: High-risk organisations, such as the airline industry and the petroleum industry, have long been preoccupied with safety. Only recently has this also become a central theme in health care. METHOD: Four focus group interviews with 20 nurses who work in home care. A qualitative thematic analysis was performed. RESULTS: One main theme was identified: struggling with responsibility in different situations. It comprises five subthemes: poor work morale and work ethic; documentation; lack of functional leadership; competence; and lack of updated routines and guidelines. CONCLUSIONS: Patient safety culture is compromised by a lack of leadership, lack of responsibility among leadership, lack of routines, failure to update procedures, and a lack of knowledge and education among health-care workers. IMPLICATIONS FOR NURSING MANAGEMENT: Nurse managers need to be made more aware of the dilemmas faced by nurses, how they struggle with their responsibilities, how they experience powerlessness in certain situations, and the lack of support they receive in decision-making.

Student supervision using the Scrub Practitioners' List of Intraoperative Non-Technical Skills (SPLINTS-no): A qualitative study.

BACKGROUND: The importance of non-technical skills in the prevention of adverse events in the operating room is well documented through research. With the increased attention to non-technical skills, the need for structured training to support the development of such skills has emerged. The Scrub Practitioners' List of Intraoperative Non-Technical Skills (SPLINTS) is an instrument for structuring observation as well as rating and feedback of non-technical skills for operating room nurses, and it can be used for student supervision and self-reflection. SPLINTS-no is the Norwegian translation and adaptation of SPLINTS. OBJECTIVE: To explore the experiences of operating room nurse preceptors using SPLINTS-no in the supervision of operating room students' non-technical skills. DESIGN: An explorative qualitative design was used. METHODS: Data were collected using semi-structured qualitative interviews with 10 operating room nurse preceptors in a Norwegian university hospital. The data were analysed by inductive qualitative content analysis. RESULTS: The operating room nurse preceptors experienced that the use of SPLINTS-no had an impact on the quality of student supervision. They improved their supervision competencies, and the use of SPLINTS-no contributed to consistency in observation and supervision. There were also findings supporting that reflection over non-technical skills contributed to building an increased awareness of these skills. CONCLUSIONS: SPLINTS-no has an impact on clinical student supervision through an increased awareness on non-technical skills. It is well accepted by the operating room nurses as a supportive tool in the supervision of non-technical skills of student operating room nurses during clinical placement.

The Norwegian version of the chronic obstructive pulmonary disease self-efficacy scale (CSES): a validation and reliability study.

The aim of this study was to evaluate the feasibility, internal consistency and face and construct validity of the Norwegian version of the Chronic Obstructive Pulmonary Disease Self-Efficacy Scale (CSES). The CSES was translated into Norwegian according to standard procedures for forward and backward translation, and administered to 100 patients with chronic obstructive pulmonary disease (COPD) (51% men, mean age 66.1 years, range 42-82) prior to their participation in an outpatient pulmonary rehabilitation programme. The CSES-N (translated version) consists of 34 items comprising five subscales describing negative affect, intense emotional arousal, physical exertion, weather/environment and behavioural risk factors. Each scale ranges from 1 to 5, with higher scores indicating better self-efficacy. For validation purposes, we measured lung function (FEV(1) , FEV(1) % predicted) and exercise capacity (ISWT), and administered the St. George's Respiratory Questionnaire (SGRQ) and Hospital Anxiety and Depression Scale (HADS). A pilot study confirmed that the CSES-N was clear, understandable and easy to self-administer. Cronbach's alpha was 0.98 for the total score (0.80-0.96 for subscales). Results showed small to medium negative correlations between all CSES-N scales and anxiety, depression (HADS), physical activity, psychosocial impact of disease and total health status (SGRQ) (-0.20 to -0.49). Small or negligible negative correlations between different CSES-N scales and respiratory symptoms (SGRQ) (-0.03 to -0.23) were found. Any correlations among exercise capacity, lung function and different socio-demographic variables (age, gender and education) and CSES-N were also small or negligible (0.00 to 0.23). This study shows acceptable feasibility, internal consistency and face and construct validity for the CSES-N in a sample of Norwegian COPD patients.

What determines subjective health status in patients with chronic obstructive pulmonary disease: importance of symptoms in subjective health status of COPD patients.

BACKGROUND: Subjective health status is the result of an interaction between physiological and psychosocial factors in patients with chronic obstructive pulmonary disease (COPD). However, there is little understanding of multivariate explanations of subjective health status in COPD. The purpose of this study was to explore what determines subjective health status in COPD by evaluating the relationships between background variables such as age and sex, predicted FEV1%, oxygen saturation, breathlessness, anxiety and depression, exercise capacity, and physical and mental health. METHODS: This study had a cross-sectional design, and included 100 COPD patients (51% men, mean age 66.1 years). Lung function was assessed by predicted FEV1%, oxygen saturation by transcutaneous pulse oximeter, symptoms with the St George Respiratory Questionnaire and the Hospital Anxiety and Depression Scale, physical function with the Incremental Shuttle Walking Test, and subjective health status with the SF-36 health survey. Linear regression analysis was used. RESULTS: Older patients reported less breathlessness and women reported more anxiety (p < 0.050). Women, older patients, those with lower predicted FEV1%, and those with greater depression had lower physical function (p < 0.050). Patients with higher predicted FEV1%, those with more breathlessness, and those with more anxiety or depression reported lower subjective health status (p < 0.050). Symptoms explained the greatest variance in subjective health status (35%-51%). CONCLUSION: Symptoms are more important for the subjective health status of patients with COPD than demographics, physiological variables, or physical function. These findings should be considered in the treatment and care of these patients.

The pain experience and future expectations of chronic low back pain patients following spinal fusion.

AIM: In a sample of patients who underwent instrumented spinal fusions for chronic low back pain (CLBP), the purposes of this study were: to determine the amount of pain patients experienced and to determine the impact of length of time since surgery, use of pain medication and their outlook on the future on these pain intensity scores. BACKGROUND: An increasing number of people report CLBP and one of the treatments is instrumented fusion. METHOD: The study used a cross-sectional design. Visual analogue scales were used to measure pain intensity in different locations and a single item measured patients' view of the future. Data were collected in November 2001. RESULTS: The sample consisted of 101 patients (71% women) aged 26-59 years treated with instrumented fusion 1-8 years ago. As many as 87% reported pain 1-8 years after the surgery. Most patients reported pain of low-to-moderate intensity in the neck and shoulders, back and hips, feet and legs and in total pain. As many as 45% of the patients did not take pain medication and patients using more analgesics reported more pain than those using fewer analgesics (p < 0.05). Patients with a more positive outlook on the future reported significantly less pain in all of the locations that were evaluated (p < 0.01). CONCLUSION: A high percentage of patients with CLBP continue to experience pain 1-8 years after spinal fusion. A positive outlook towards the future seems to be associated with less pain in these patients. Relevance to clinical practice. Patients who continue to experience pain and have a more negative outlook on the future may benefit from psychoeducational interventions that teach them how to better cope with their pain.

Quality of life in chronic low back pain patients treated with instrumented fusion.

AIM: The aim of this study was to examine pain and quality of life in a group of preoperative chronic low back pain patients (n = 25) and a group of postoperative chronic low back pain patients (n = 101) treated with instrumented fusion 1-8 years ago. BACKGROUND: Reduced quality of life is common in chronic low back pain patients and the aim of treatment is to improve quality of life. DESIGN: In the present study, a comparative survey design was used. METHODS: The McGill Pain Questionnaire and the SF-36 Health Survey were used to examine pain and quality of life. RESULTS: The pre- and postoperative groups did not differ with regard to age, gender, education, other chronic conditions or previous spinal surgery. Compared with the preoperative group, the postoperative group reported significantly lower total, sensory, affective and evaluative pain, used less pain medication (p < 0.05) and reported better scores in all SF-36 components (p < 0.05), except for general health. The effect size was > or =0.8 for all pain components and > or =0.4 for all SF-36 components, except for general health (effect size = 0.009). With regard to long-term follow-up, patients who underwent surgery 5-8 years ago reported better physical role functioning (p < 0.05) compared with those who underwent surgery 1-2 years ago. CONCLUSION: Results showed that the postoperative group reported significantly less pain and better physical and mental health compared with the preoperative group. However, despite surgery, the postoperative group reported suffering from pain and reduced quality of life. Relevance to clinical practice. Psychosocial interventions focusing on psychosocial consequences of pain are needed to modify the pain experience and increase the quality of life in patients who have undergone this kind of surgery.