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Spine J. 2014 May 1;14(5):837-46. doi: 10.1016/j.spinee.2013.09.052. Epub 2013 Oct 25.

Depression as a prognostic factor of lumbar spinal stenosis: a systematic review.

Author information

1
Faculty of Rehabilitation Medicine, University of Alberta, 8205 114 St, Edmonton, AB T6G 2G4, Canada.
2
Department of Public Health Sciences, School of Public Health, University of Alberta, 3-300 Edmonton Clinic Health Academy, 11405 - 87 Ave, Edmonton, AB T6G 1C9, Canada.
3
Department of Physical Therapy, 2-50 Corbett Hall, University of Alberta, Edmonton, AB T6G 2G4, Canada. Electronic address: mc.battie@ualberta.ca.

Abstract

BACKGROUND CONTEXT:

The clinical syndrome of lumbar spinal stenosis (LSS) is a commonly diagnosed lumbar condition associated with pain and disability. Psychological factors, including depression, also affect these and other health-related outcomes. Yet, the prognostic value of depression specifically in the context of LSS is unclear.

PURPOSE:

The aim of this systematic review was to examine the literature on depression as a prognostic factor of outcomes in patients with LSS.

STUDY DESIGN:

Best-evidence synthesis.

PATIENT SAMPLE:

Patients receiving the diagnosis of LSS and surgery.

METHODS:

A best-evidence synthesis was conducted, including articles published between 1980 and May 2012. Each article meeting inclusion criteria, including a longitudinal design, was critically appraised on its methodological quality by two authors independently, who then met to reach consensus. Only studies deemed scientifically admissible were included in the review.

RESULTS:

Among the 20 articles that met the inclusion criteria, 13 were judged scientifically admissible. The evidence supports an association between preoperative depression and postoperative LSS-related symptom severity (a combination of pain, numbness, weakness and balance issues) and disability. The effect size for these associations was variable, ranging from no effect to a moderate effect. For example, an increase of 5 points on a 63-point depression scale doubled the odds of being below the median in LSS-related symptom severity at follow-up. Findings on the association between preoperative depression and postoperative pain alone and walking capacity were more variable.

CONCLUSIONS:

Findings support that preoperative depression is likely a prognostic factor for postoperative LSS-related symptom severity and disability at various follow-up points. The prognostic value of depression on the outcomes of pain and walking capacity is less clear. Nonetheless, depression should be considered in the clinical care of this population.

KEYWORDS:

Best evidence synthesis; Depression; Prognostic factor; Psychosocial factors; Spinal stenosis; Systematic review

PMID:
24417814
DOI:
10.1016/j.spinee.2013.09.052
[Indexed for MEDLINE]

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