Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2020 May;24(5):909-920.
doi: 10.1002/ejp.1537. Epub 2020 Feb 21.

Probing the mechanisms underpinning recovery in post-surgical patients with cervical radiculopathy using Bayesian networks

Bernard X W Liew  1 , Anneli Peolsson  2 , Marco Scutari  3 , Hakan Löfgren  4   5 , Johanna Wibault  2   6   7 , Åsa Dedering  8   9 , Birgitta Öberg  2 , Peter Zsigmond  10 , Deborah Falla  11
Affiliations
Free article

Probing the mechanisms underpinning recovery in post-surgical patients with cervical radiculopathy using Bayesian networks

Bernard X W Liew et al. Eur J Pain. 2020 May.
Free article

Abstract

Background: Rehabilitation approaches should be based on an understanding of the mechanisms underpinning functional recovery. Yet, the mediators that drive an improvement in post-surgical pain-related disability in individuals with cervical radiculopathy (CR) are unknown. The aim of the present study is to use Bayesian networks (BN) to learn the probabilistic relationships between physical and psychological factors, and pain-related disability in CR.

Methods: We analysed a prospective cohort dataset of 201 post-surgical individuals with CR. In all, 15 variables were used to build a BN model: age, sex, neck muscle endurance, neck range of motion, neck proprioception, hand grip strength, self-efficacy, catastrophizing, depression, somatic perception, arm pain intensity, neck pain intensity and disability.

Results: A one point increase in a change of self-efficacy at 6 months was associated with a 0.09 point decrease in a change in disability at 12 months (t = -64.09, p < .001). Two pathways led to a change in disability: a direct path leading from a change in self-efficacy at 6 months to disability, and an indirect path which was mediated by neck and arm pain intensity changes at 6 and 12 months.

Conclusions: This is the first study to apply BN modelling to understand the mechanisms of recovery in post-surgical individuals with CR. Improvements in pain-related disability was directly and indirectly driven by changes in self-efficacy levels. The present study provides potentially modifiable mediators that could be the target of future intervention trials. BN models could increase the precision of treatment and outcome assessment of individuals with CR.

Significance: Using Bayesian Network modelling, we found that changes in self-efficacy levels at 6-month post-surgery directly and indirectly influenced the change in disability in individuals with CR. A mechanistic understanding of recovery provides potentially modifiable mediators that could be the target of future intervention trials.

Trial registration: ClinicalTrials.gov NCT01547611.

PubMed Disclaimer

References

REFERENCES

    1. Altmaier, E. M., Russell, D. W., Kao, C. F., Lehmann, T. R., & Weinstein, J. N. (1993). Role of self-efficacy in rehabilitation outcome among chronic low back pain patients. Journal of Counseling Psychology, 40, 335-339. https://doi.org/10.1037/0022-0167.40.3.335
    1. Andersen, T. E., Karstoft, K.-I., Brink, O., & Elklit, A. (2016). Pain-catastrophizing and fear-avoidance beliefs as mediators between post-traumatic stress symptoms and pain following whiplash injury - A prospective cohort study. European Journal of Pain, 20, 1241-1252. https://doi.org/10.1002/ejp.848
    1. Andresen, A. K., Paulsen, R. T., Busch, F., Isenberg-Jorgensen, A., Carreon, L. Y., & Andersen, M. O. (2018). Patient-reported outcomes and patient-reported satisfaction after surgical treatment for cervical radiculopathy. Global Spine Journal, 8, 703-708. https://doi.org/10.1177/2192568218765398
    1. Arnstein, P., Caudill, M., Mandle, C. L., Norris, A., & Beasley, R. (1999). Self efficacy as a mediator of the relationship between pain intensity, disability and depression in chronic pain patients. Pain, 80, 483-491. https://doi.org/10.1016/S0304-3959(98)00220-6
    1. Bono, C. M., Ghiselli, G., Gilbert, T. J., Kreiner, D. S., Reitman, C., Summers, J. T., … Lamer, T. (2011). An evidence-based clinical guideline for the diagnosis and treatment of cervical radiculopathy from degenerative disorders. The Spine Journal, 11, 64-72. https://doi.org/10.1016/j.spinee.2010.10.023

Publication types

Associated data