J-LSMS 2018 | Archive | Issues 1 to 4

JOURNAL OF THE LOUISIANA STATE MEDICAL SOCIETY

Assessing Psychological Resilience among Pre-Surgery PLIF Patients in Louisiana: Psychometric Evaluationof theBrief Resilient CopingScale

Scott Wilks, PhD, Stephen Guillory, PA-C, Jennifer Geiger, MSW, Kevin Goodson, MD, Tatiana Begault, BS, Zibei Chen, MSW, Jorge Isaza, MD

Thepurposeof this studywas toexaminepsychometricproperties of theBrief ResilienceCopingScale (BRCS), ameasure of psychological resilience, to determine its applicability among pre-spine surgery patients. The sample comprised 85 adults in south Louisiana scheduled for posterior lumbar interbody fusion (PLIF). We utilized a prospective survey design with independent self-report data one week pre-surgery. Empirical measures included the BRCS, Oswestry Index (back functioning), and three coping strategy scales; the latter measures for descriptive and validity purposes. The typical participant was a 65-year-old married, Caucasian male; no histories of diabetes, heart disease, smoking; moderate back functioning yet a high degree of resilience. BRCS factor analysis revealed its items loading on a single factor, presumably resilience. BRCS reliability was strong. Validity findings were somewhat mixed. The BRCS appears to be an applicable measure of resilience for pre-spine surgery patients, though further research is warranted to endorse BRCS validity.

METHODS

INTRODUCTION

Psychological resilience is a personal characteristic of adaptation and adjustment when facing hardship, trauma, or substantial exposure to stress. Research has shown resilience to be valuable not only for psychological health (e.g., mood, emotions, cognition), but also for immediate and long term physical health outcomes, including AIDS mortality, cardiovascular disease and stroke. 1 The physical health outcome in the current study potentially applicable to resilience chronic back pain, specifically low back pain (LBP). Literature distinguishes resilience as a psychosocial predictor of functionality germane to LBP, as well as healthcare utilization and frequency of such related to chronic LBP. 2 Regarding surgical treatment for LBP, the number of spine fusions in the U.S. have trended dramatically upward over the past two decades; lumbar fusions as the majority at 52%. 3 Given the aforementioned identification of resilience as a predictor of healthcare utilization for LBP and the increasing numbers of lumbar fusions for treatment of LBP, we recognized the relevance of understanding psychological resilience for LBP patients and, equally important, understanding standardized measures to assess said resilience. The purpose of the current study was to conduct an empirical psychometric assessment of a standardized measure of psychological resilience – the Brief Resilient Coping Scale (BRCS). 4 This allowed us to assess descriptively the level of psychological resilience of persons seeking LBP treatment while simultaneously testing the psychometric properties of the BRCS. The sample consisted of LBP patients in Louisiana scheduled for posterior lumbar interbody fusion (PLIF).

Design and Sampling

The current study utilized a prospective survey design with self- reported data. Pre-surgery was the selected data interval based on a premise of resilience theory: For resilience to be observed, demonstrable adversity must be present. 5 Logic and research dictate that patients who undergo surgery typically have higher physical and psychological health adversity levels at pre-surgery compared to post-surgery. 6 Accordingly, we deemed pre- surgery as the optimal period to assess patients’ resilience and to evaluate the resilience measure. One week prior to scheduled posterior lumbar interbody fusion (PLIF), adult participants completed questionnaires, independently self-reported in surgeons’ offices, related to demographics, psychological coping, and a physical back health measure (see measures). Participants were under the care of one of two orthopedic surgeons fellowship trained in spine surgery; these surgeons practiced at one orthopedic clinic in south Louisiana. Numerical codes were assigned to each participant to ensure anonymity. Relevant institutional review boards, academic and clinic, approved the study, thereby protecting HIPAA compliance. Eighty-five patients (N = 85) voluntarily completed all measures and comprised the total sample.

Measures

Demographics and health history . The following demographics were identified in literature as potentially influential to spine/spine surgery health, and thus examined: age, ethnicity, marital status, and insurance/payment

2 J La State Med Soc VOL 170 JANUARY/FEBRUARY 2018

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