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  • When a patient comes to our New Jersey spine surgery practice for treatment, we carefully assess their condition, diagnose them and devise a treatment plan to provide relief and improved mobility and function. For some patients this means conservative treatments including medication, exercise, massage, or a combination of those protocols, while others will require surgery to correct a specific injury or illness. Our goal is always to improve their quality of life. A new study published in the May edition of the Journal of Neurosurgery has suggested that in addition to meticulous clinical care, spine surgery patients may benefit from greater attention to their expectations and other cognitive factors.


    The study was a collaboration between researchers from the Sunnybrook Health Sciences Centre in Toronto, Canada, the DeltaQuest Foundation in Concord, Massachusetts, and Tufts University School of Medicine in Boston. They team decided to investigate how misalignment between physicians’ clinical expectations and patients’ quality of life expectations could affect outcomes. According to co-author Joel Finkelstein, M.D., M.Sc., the Feldberg Chair in Spinal Research at the University of Toronto, “Clinicians measure the outcomes of their treatment by the standardized PROMs or Patient Reported Outcome Measures. These are classified into generic and disease specific scoring systems. The nature of the evaluation is from the patient’s perspective, which is the important outcome.” He went on to say, “It has been my experience (as well as others) that the observed and expected outcome, self-reported patient and objective measures, do not always align. This can affect patient satisfaction.”


    Cognitive appraisal – assessing how happy a patient is – has not been a key focus for surgeons in the past, but Finkelstein believes that his study shows that it should be. “The use of the PROMs assumes invariance in how a patient perceives their health-related quality of life. If there is a change in what constitutes a person’s quality of life, then they would use the outcome measure differently or answer it differently. This is not because of a change in the physical health status for which the treatment was directed, but because of how a patient appraises their quality of life. This is cognitive appraisal. Measuring cognitive appraisal in our opinion is the next frontier in how we assess outcomes and predict outcomes by understanding what is going on in the brain.”


    In other words, the more a patient’s perception of their abilities and function change, the more their assessment of their surgical outcomes improves.  The group studied 122 adults who had undergone spinal decompression and/or fusion surgery for degenerative spinal conditions. They assessed their expectations for pain relief, the ability to perform household chores and to exercise or enjoy recreational activities without pain, preventing future disability and sleeping comfort. They found better outcomes in patients who expected to be able to exercise or do recreational activities, or who were expecting symptom relief. Focusing on the positive made all the difference.


    Speaking of their findings, Dr. Finkelstein said, “If we can identify cognitive factors which lead to poorer outcome prior to treatment, then addressing these may help with maximizing the benefits of surgery. If we identify changes in cognitive appraisal during the trajectory of recovery, we may be able to account for observed vs expected mismatches in outcome.”


    Helping our patients understand what to expect from surgery and move forward with optimism is part of what we do at our New Jersey spine specialty practice. To learn how we can help you, contact our office today and set up a time to come in for a consultation.

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