Child and Parent Risk and Resilience Factors as Predictors of Long-term Recovery in Youths Undergoing Spinal Fusion Surgery

Abstract

Objectives: Undertreated pediatric post-surgical pain negatively affects quality-of-life and functioning and may lead to chronic post-surgical pain (CPSP). Predictors of recovery have been identified but more research is needed, particularly regarding resilience and social factors, and long-term effects. The aim of the present study was to investigate child and parent risk and resilience factors as predictors of long-term post-surgical recovery for adolescents. Methods: Participants were patients with Adolescent Idiopathic Scoliosis (AIS),12-18 years, undergoing spinal fusion, and their parents. Recruitment occurred at the orthopaedic units at four hospitals in Belgium. Data were collected before surgery (T0), at three (T1) and six weeks (T2), six months (T3) and one year (T4) post-surgery. Multiple regression models were used to evaluate the predictive effect of pain intensity, pain catastrophizing, psychological flexibility, and pain acceptance on long-term functioning, quality-of-life, and pain. Results: The sample comprised 100 adolescents and 61 parents. Pain at T0, T1, and T3 and adolescent pain catastrophizing (T0) predicted quality-of-life, functioning, and pain at T4 (while pain at T2 predicted quality-of-life and pain). Parent pain catastrophizing predicted pain at T4. Adolescent and parental psychological flexibility predicted quality-of-life, and parent psychological flexibility also predicted pain at T4. Adolescent acceptance at T1 predicted pain, and acceptance at T2 predicted quality-of-life, at T4. Discussion: The study identified pain and adolescent pain catastrophizing as risk factors, and adolescent and parental psychological flexibility and adolescent pain acceptance as resilience factors, for long-term recovery in youths undergoing spinal fusion. Post-surgical pain management targeting these factors may therefore promote recovery for these adolescents.