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Healthcare 2016, 4(1), 11;

Demoralization, Patient Activation, and the Outcome of Spine Surgery

Texas Back Institute, Plano, TX 75093, USA
Academic Editor: Robert J. Gatchel
Received: 25 November 2015 / Revised: 6 January 2016 / Accepted: 12 January 2016 / Published: 19 January 2016
(This article belongs to the Special Issue Low Back Pain: Recent Advances And Perspectives)
Full-Text   |   PDF [178 KB, uploaded 19 January 2016]


It is now well established that psychosocial factors can adversely impact the outcome of spine surgery. This article discusses in detail one such recently-identified “risk” factor: demoralization. Several studies conducted by the author indicate that demoralization, an emotional construct distinct from depression, is associated with poorer pain reduction, less functional improvement and decreased satisfaction among spine surgery patients. However, there are indications that the adverse impact of risk factors such as demoralization can be mitigated by psychosocial “maximizing” factors—characteristics that propel the patient towards positive surgical results. One of these maximizing factors, patient activation, is discussed in depth. The patient activation measure (PAM), an inventory assessing the extent to which patients are active and engaged in their health care, is associated not only with improved spine surgery results, but with better outcomes across a broad range of medical conditions. Other maximizing factors are discussed in this article. The author concludes that the past research focus on psychosocial risk factors has limited the value of presurgical psychological screening, and that future research, as well as clinical assessment, should recognize that the importance of evaluating patients’ strengths as well as their vulnerabilities. View Full-Text
Keywords: presurgical psychological screening; spine surgery; demoralization; patient activation; MMPI-2-RF; maximizing factors presurgical psychological screening; spine surgery; demoralization; patient activation; MMPI-2-RF; maximizing factors
This is an open access article distributed under the Creative Commons Attribution License which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited. (CC BY 4.0).

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Block, A.R. Demoralization, Patient Activation, and the Outcome of Spine Surgery. Healthcare 2016, 4, 11.

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