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

Publication date: Available online 27 November 2018

Source: The Spine Journal

Author(s): Janni Strøm, Claus Vinther Nielsen, Lene Bastrup Jørgensen, Niels Trolle Andersen, Malene Laursen

Abstract

Background

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.

Purpose

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.

Study design

A single-center, two-arm, randomized controlled trial

Patient sample

One hundred fourteen consecutive patients scheduled for instrumented lumbar spine fusion due to degenerative disc disease or spondylolisthesis.

Outcome measures

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 2 days 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) 2 days and 3 and 6 months after surgery.

Method

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.

Results

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≥0.37). 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 sub-scale 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.

Conclusion

Providing patients with access to w-SPIINA in addition to a standard information regimen had no additional effect on HADS and patient-reported outcomes1 day before, 2 days, 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.

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