Depression as a Predictor of Quality of Life Post Lumbar Spinal Stenosis Treatment
Meeting Highlight from NASS 2014
Benjamin Kuhns, MS presented Depression Predicts Worse Quality of Life Outcomes Following Nonoperative Treatment for Lumbar Stenosis. The outcome of this important study was featured during the Annual Meeting of the North American Spine Society in San Francisco, CA.
Lumbar spinal stenosis is a common disorder that can be managed with both nonoperative treatment and surgery, as appropriate for each individual patient. Mr. Kuhns explained, “For operative treatment, preoperative depression has been shown to lead to decreased improvements in pain and disability following lumbar surgery. However, no studies as yet have investigated the impact of pretreatment depression on posttreatment outcomes following the conservative management for lumbar spinal stenosis.”
It was the authors’ hypothesis that depression is associated with worse quality of life outcomes following the medical treatment of lumbar spinal stenosis. In their study, they conducted a retrospective review of patients older than age 45 who were diagnosed with lumbar spinal stenosis between 2010 and 2013.
Nonoperative treatment included:
- Physical therapy
- Nonsteroidal anti-inflammatory drugs
Quality of life outcome measures were collected to evaluate each patient, including:
Mr. Kuhns stated, “Our statistical analysis included a mixed effects linear regression model at the four-month time points where the quality adjusted life years or PDQ was the dependent variable, and the pretreatment depression score was the independent variable.” It was explained that this model adjusted for secondary variables, including:
“When comparing depressed versus nondepressed patients at baseline, where we defined depressed patients as having a pretreatment PHQ score greater than 10, we found that depressed patients were more likely to have a lower pretreatment quality of life as judged by both the EQ-5D and the PDQ,” stated Mr. Kuhns. Furthermore, these patients were more likely to be younger, less educated, and of limited means.
Mr. Kuhns further commented:
Patients with lumbar spinal stenosis, who are severely depressed and receive nonoperative treatment, experience worse improvement in quality of life as compared to patients with slight or no depression. Mr. Kuhns explained, “This is similar to the negative predictive effects of depression on the postoperative quality of life for lumbar fusion surgery.” Therefore, there is value in the pretreatment assessment of depression because it can help determine the success of treatment.