Pain and Quality of Life of Chinese Patients With Lumbar Spine Degenerative Diseases

Saturday, 21 July 2018

Shu-Fen Su, PhD, RN
Meng-Shan Wu, MSc, RN
Department of Nursing, National Taichung University of Science and Technology, Taichung City, Taiwan

Background:Lumbar spine degenerative disease (LDD) refers to lumbar spinal structure deterioration, which includes herniated intervertebral disc (HIVD), lumbar spinal stenosis, and spondylolisthesis. Patients with LDD may suffer from chronic low back pain, radiculopathy, intermittent claudication, and difficulty voiding, resulting in disability of daily activity, sick leave of work, and decrease of quality of life. However, relevant study of this filed is limited in Asia, especially in Taiwan.

Purpose: This study examined pain and quality of life of patients with lumbar spine degenerative diseases.

Methods: A cross-sectional sample of 48 LDD patients from the neurosurgical units of a 1500-bed hospital in Taiwan was collected. LDD patients who were diagnosed by a neurosurgeon for receiving lumbar fusion surgery were included. Congenital scoliosis and traumatic spine fracture were excluded. Before lumbar fusion surgery, all patients were evaluated using the demographic characteristics questionnaire, the Brief Pain Inventory–Short Form (BPI), and World Health Organization Quality of Life-BREF (WHOQOL-BREF) questionnaire. The demographic questionnaire assessed sex, age, work category, absence from work, body mass index, comorbidity, symptoms, pain location, diagnosis and medication. The BPI is a 10-point linear scale with 15 items evaluating pain intensity and pain interference. The WHOQOL-BREF has 28 questions and is a 5-point Likert scale to assess quality of life. In this study, the Cronbach-α of BPI and HOQOL-BREF was 0.898 and 0.849, respectively, showing good reliability. Descriptive statistics, Correlation Coefficient, Independent t-test, and One-way ANOVA were used for data analysis.

Results: The 48 participants were with 54.2% being female and with a mean age 56.10±12.85 years. Seventy-one percent were laborer, and 64.6% had pre-surgery back and legs pain. The common comorbidity was hypertension (41.7%). Most patients (79.2%) were under the most severity of LDD with a diagnosis of HIVD with spinal stenosis and spondylolisthesis. The pre-surgery mean scores for worst, average, present and least pain were 8.71±1.15, 7.15±1.34, 5.38±2.46 and 3.27±2.50, respectively. Female patients (p=.030) and patients with hypertension (p=.007) perceived higher levels of pain intensity. Patients who worked as laborers perceived lower pain intensity than housekeepers (p=.029). Patients had HIVD with spinal stenosis and spondylolisthesis perceived higher worst pain scores than those only had HIVD with spinal stenosis (p=.019). Before surgery, the mean±SD score of physical and psychological quality of life (QOL) were 9.85±2.34 and 13.81±4.35, respectively. Pain intensity was negatively related to physical (r=-.315, p<.05) and psychological (r=-.308, p<.05) quality of life. No significant differences of quality of life were found in sex, age group, work categories, pre-surgery symptoms, and severity of lumbar spine degenerations.

Conclusion: The prevalence of lumbar spine degenerative diseases is commonly in the Chinese patients who were female, employed as a laborer, suffered from pre-surgery back and legs pain, and had comorbidity of hypertension. LDD patients had suffered from high levels of pain intensity and poor physical and psychological quality of life before they came to doctors for receiving lumbar spine surgery. Surprisingly, patients who worked as laborer perceived lower pain intensity than housekeepers. This may be because the laborers get used to heavy weight-bearing work than the housekeepers. Work categories and severity of lumbar spine degeneration influence the levels of pain intensity. Thus, we suggest that the clinical nurses can teach and remind patients to pay more attention of pain intensity of their lumbar spine and avoid heavy weight-bearing work. Our study established base line data for LDD in Chinese adults. We hope these results can help clinical nurses to improve quality of care for the patients with LDD. Since data were collected from a large hospital in Taiwan, thus, the generalisation of these results may be limited.