A web-based platform to accommodate symptoms of anxiety and depression by featuring social interaction and animated information in patients undergoing lumbar spine fusion: a randomized clinical trial

• Published in: The spine journal Vol. 19; no. 5; pp. 827 - 839
• Main Authors: Strøm, Janni, Nielsen, Claus Vinther, Jørgensen, Lene Bastrup, Andersen, Niels Trolle, Laursen, Malene
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.05.2019
• Subjects: Adult; Aged; Animation; Anxiety; Anxiety - etiology; Anxiety - prevention & control; Depression; Depression - etiology; Depression - prevention & control; Female; Humans; Information; Internet; Interpersonal Relations; Intervertebral Disc Degeneration - complications; Intervertebral Disc Degeneration - psychology; Intervertebral Disc Degeneration - surgery; Lumbar spine fusion; Lumbar Vertebrae - surgery; Male; Middle Aged; Patient Education as Topic - methods; Postoperative Complications - epidemiology; Postoperative Complications - psychology; Randomized trial; Spinal Fusion - adverse effects; Spinal Fusion - psychology; Spondylolisthesis - complications; Spondylolisthesis - psychology; Spondylolisthesis - surgery; Web-based platform; Depression; Web-based platform; Animation; Anxiety; Randomized trial; Lumbar spine fusion; Information
• ISSN: 1529-9430; 1878-1632
• DOI: 10.1016/j.spinee.2018.11.011

Approximately one-third of patients undergoing spine surgery have symptoms of anxiety and depression that correlate with pain, disability, and lower health-related quality of life. The use of web-based informative strategies before surgery and principles from cognitive behavioral therapy, have been applied in other patient groups, facilitating mobility and encouraging beneficial coping behavior. To examine the effect of a web-based Spine Platform featuring Interaction and Information by Animation (w-SPIINA) on symptoms of anxiety and depression, pain, disability, and health-related quality of life. A single-center, two-arm, randomized controlled trial One hundred fourteen consecutive patients scheduled for instrumented lumbar spine fusion due to degenerative disc disease or spondylolisthesis. Primary outcome was the change in self-reported Hospital Anxiety and Depression Scale (HADS) scores from baseline to 3-month follow-up. Secondary outcomes were change in HADS 1-day before surgery 2days and 6 months after and changes in self-reported disability measured on the Oswestry disability index (ODI), quality of life (EQ-5D-5L questionnaire), and the low back pain rating scale (LBPRS) 2days and 3 and 6 months after surgery. Patients were randomized to either a control group receiving a standard information regimen or an intervention group gaining access to w-SPIINA in addition to the standard regimen. The independent charity Helsefonden contributed $45,000, the Health Research Fund of the Regional Hospital Central Jutland contributed $10,000, and the Toyota foundation contributed $10,000 to remunerate a dedicated investigator. The authors have no conflict of interest to declare. There was no statistically significant difference within the w-SPIINA group and the control group regarding changes in HADS at 3-month follow-up (p≥.37). Approximately 40% reached minimum clinically important difference (MCID) in the w-SPIINA group on the HADS at 3 months. In the control group 50% reached MCID on anxiety subscale and 35% on the depression subscale at 3 months. No statistically significant differences were found between groups with regard to the overall outcomes at any of the predefined time points. Providing patients with access to w-SPIINA in addition to a standard information regimen had no additional effect on HADS and patient-reported outcomes1day before, 2days, 3 or 6 months after surgery. However, a high compliance and degree of interaction with w-SPIINA indicates that this mode of web-based support could be applicable in this group of patients.