A mixed method investigation of predictors of pain and disability in patients with lumbar spinal stenosis

This study identified characteristics associated with pain and disability in LSS at entry to treatment and factors contributing to long-term reduction of pain and disability. It also revealed how patients with LSS appraise the stressors of pain and disability and use coping resources. This study used qualitative and quantitative methods to address the dearth of research in the LSS literature regarding factors associated with severity of pain and disability upon entry to treatment and the influence of coping resources on post-treatment outcomes. A cohort of 34 patients was evaluated to understand the relative contribution of perceived health, self-efficacy, and social support on the stressors of pain and disability using a combination of bivariate and multivariate regression analyses and patient interviews. Several key findings emerged from this research. First, there was an inverse relationship between perceived physical and mental health and severity of disability upon entry to treatment. In interviews, patients with LSS described a variety of sources contributing to stressors of pain and disability including physical limitations, reduced confidence, lack of control, vulnerability, mental health concerns, reduced social participation, frustrations at needing support, and financial limitations. Better perceived physical health had the greatest contribution to reduced levels of pain and disability post-treatment. In interviews, a variety of behaviors were described that improved coping including a greater understanding of limitations and needs along with beliefs for pushing through and remaining positive. In line with the Stress and Coping Model, patients with stronger coping behaviors and more resources reduced the severity and improved outcomes of pain and disability associated with LSS. There is an increased need for research improving the quality of life in later years particularly when faced with a chronic disabling condition such as LSS. Early identification of those at risk for higher pain and disability as well as support for positive coping behaviors post-treatment can help patients with LSS maintain a higher level of participation in society. The factors uncovered in this study serve to inform translational research, clinical practice, and policy recommendations, which may ultimately add to treatment and resources for reducing pain and disability associated with LSS.