| Description |
Although the prognosis of patients with a lumbar disc herniation (LDH) diagnosis is generally favorable, 20% to 30% continue reporting pain, disability, and unfavorable outcome regardless of treatment received. The Fear Avoidance Model (FAM) is one among the most known models in low back pain (LBP) to explain chronic pain and disability. However, factors in this model have been mostly examined in nonspecific LBP to describe the development of chronic symptoms. The purpose of this dissertation was to study the influence of FAM factors on patients' poor outcomes following LDH surgery. We systematically searched for studies that measured any FAM factors to prospectively assess LDH surgical outcomes. We identified 13 prospective studies that used different FAM measures to predict LDH postoperative pain, disability, or sick leave. Quality assessment of the included studies was performed and reported. Heterogeneity between studies in terms of FAM predictors, outcome measures, analyses, and in other aspects were found. While pain and depression were the most measured FAM factors, some factors were not adequately assessed. There seems to be different prognostic value between preoperative leg pain and back pain. Fear, avoidance, anxiety, and pain coping seem to have negative impact on LDH surgical outcomes. We also analyzed prospective data for LDH patients undergoing discectomy surgery to study specific FAM measures and their impact on post discectomy leg pain, back pain, and disability. Fear-avoidance, pain catastrophizing, physical activity level, functional disability, and other FAM factors were measured preoperatively. The FAM measures demonstrate significant associations with each other and with preoperative functional disability. These FAM measures also explained significant amounts of the 10- week outcomes' variances. The most influential FAM factors in our data were depression and work-related fear. Many findings in this analysis were supported by previous research. In general, FAM factors seem to have a similar impact on LDH patients (pre- and postoperatively) as on nonspecific LBP patients. LDH patients with preoperative higher levels of back pain, fear-avoidance beliefs, anxiety, pain catastrophizing, passive pain coping, and depression were more likely to have unfavorable surgical outcomes. Screening for FAM factors in LDH patients and managing them accordingly during conservative therapy, before surgery, and throughout the postoperative rehabilitation is, therefore, needed to improve outcomes and minimize health care costs. i'v |
