[[alternative]]Delay in Seeking Surgical Treatment of Spondylolisthesis and Factors Influencing Functional Recovery after Lumbar Fusion

[[abstract]]內固定骨融合手術是嚴重腰椎滑脫的主要治療方式，術後病患的身體功能狀態可獲得相當程度的改善。但在台灣，一般民眾對脊椎手術常有恐懼與負面的看法，而有延遲接受手術治療，並可能進而影響其術後身體功能狀態恢復的情形。研究目的在探討腰椎滑脫病人：(1)延遲就醫情形及其影響因素，(2)延遲接受手術情形及其影響因素，(3)術前失能情形及其影響因素，(4)術後身體活動功能恢復情形及其影響因素。採描述相關之縱貫性研究設計，以腰椎滑脫並接受後側減壓及內固定骨融合術之病人為研究對象。採方便取樣，於臺灣北部某醫學中心進行收案，共收案86人。於手術前、手術後一、三及六個月，以結構式問卷進行資料收集。問卷內容包括基本資料表、病人延遲就醫情形調查表、歐氏下背痛失能量表、修正版簡式老年憂鬱量表及疼痛數字等級量表。所得資料以描述性統計、獨立樣本t檢定、變異數分析、皮爾森相關、線性迴歸及廣義線性估計模式進行分析。研究對象平均延遲就醫時間為29.16個月，平均延遲接受手術時間為23.71個月。平均失能指數由術前、術後一個月、術後三個月至術後六個月分別為48.52分、40.73分、28.67分及18.19分。下背痛、憂鬱、年齡和性別為術前失能嚴重程度之重要預測因子，共可解釋40.9%之變異量。年齡、性別、延遲接受手術時間及術前下背痛為失能嚴重度隨時間變化之重要共變因子。因此在臨床上對高齡、女性的腰椎滑脫病人，應積極治療下背疼痛情形，並留意憂鬱情緒的評估與預防。針對易產生延遲接受手術行為之病人，提供相關醫療資訊，追蹤後續就醫情形，並建議儘早接受手術，以免影響手術後身體功能恢復的情形。[[abstract]]Posterior lumbar decompression and fusion is the primary surgical treatment for patients with severe spondylolisthesis, and patients can have great improvement in physical function after the surgery. However, concerns regarding complications of the surgery often hindered patients from receiving the indicated surgery in time and this delay may have negative impacts on patients’ recovery. This study aimed to investigate spondylolisthesis patients’: (1) delay in seeking medical treatment, (2) delay in receiving surgerying, (3) factors influencing preoperative disability, and (4) factors influencing function recovery after lunbar fusion. The study is a longitudinal descriptive correlational design. Eighty six spondylolisthesis patients underwent the posterior lumbar decompression and fusions were recruited from a medical center in northern Taiwan. The data were collected by using the study questionnaires before surgery, one, three and six months after surgery. The questionnaires included delay in seeking medical treatment questionnaire, Oswestry disability index 2.1, revised geriatric depression scale- short form and pain numeric rating scale. The data were analyzed using descriptive statistics, independent sample t-test, ANOVA, Pearson correlation, liner regression and generalized estimating equation. The average time for delay in seeking medical treatment and delay in receiving surgery was 29.16 and 23.71 months, respectively. The participants’ mean disability indexes were 48.52, 40.73, 28.67 and 18.19 measured at baseline, one month, three months, and six months post operation, respectively. Low back pain, depression, age and gender were the significant predictors of the preoperative disability. These four variables together explained 40.9% of the variation of the disability severity. Age, gender, delay in receiving surgery, and low back pain were significant covariates for the changes of disability severity across time. Patients with spondylolisthesis should be actively treated for lower back pain and depression. Special attention should be paid to female patients. For those who have a higher risk for delay in seeking surgical treatment, we should provide relevant medical information, track whether they seek treatment or not, and encourage them to accept recommended surgery as soon as possible, in order to have a better outcomes on recovery