Development of the "Core Yellow Flags Index" (CYFI) As a Brief Instrument for the Assessment of Key Psychological Factors in Patients Undergoing Spine Surgery

Overview

Journal Eur Spine J

Specialty Orthopedics

Date 2020 Jun 20

PMID 32556625

Citations 6

Authors

Anne F Mannion

Francine Mariaux

Raluca Reitmeir

Tamas F Fekete

Daniel Haschtmann

Markus Loibl

Dezso Jeszenszky

Frank S Kleinstuck

Francois Porchet

Achim Elfering

Affiliations

Soon will be listed here.

Abstract

Background: Depression, anxiety, catastrophising, and fear-avoidance beliefs are key "yellow flags" (YFs) that predict a poor outcome in back patients. Most surgeons acknowledge the importance of YFs but have difficulty assessing them due to the complexity of the instruments used for their measurement and time constraints during consultations. We performed a secondary analysis of existing questionnaire data to develop a brief tool to enable the systematic evaluation of YFs and then tested it in clinical practice.

Methods: The following questionnaire datasets were available from a total of 932 secondary/tertiary care patients (61 ± 16 years; 51% female): pain catastrophising (N = 347); ZUNG depression (N = 453); Hospital Anxiety and Depression Scale (anxiety subscale) (N = 308); fear-avoidance beliefs (N = 761). The single item that best represented the full-scale score was identified, to form the 4-item "Core Yellow Flags Index" (CYFI). 2422 patients (64 ± 16 years; 54% female) completed CYFI and a Core Outcome Measures Index (COMI) before lumbar spine surgery, and a COMI 3 and 12 months later (FU).

Results: The item-total correlation for each item with its full-length questionnaire was: 0.77 (catastrophising), 0.67 (depression), 0.69 (anxiety), 0.68 (fear-avoidance beliefs). Cronbach's α for the CYFI was 0.79. Structural equation modelling showed CYFI uniquely explained variance (p < 0.001) in COMI at both the 3- and 12-month FUs (β = 0.11 (women), 0.24 (men); and β = 0.13 (women), β = 0.14 (men), respectively).

Conclusion: The 4-item CYFI proved to be a simple, practicable tool for routinely assessing key psychological attributes in spine surgery patients and made a relevant contribution in predicting postoperative outcome. CYFI's items were similar to those in the "STarT Back screening tool" used in primary care to triage patients into treatment pathways, further substantiating its validity. Wider use of CYFI may help improve the accuracy of predictive models derived using spine registry data.

Citing Articles

Translation, cross-cultural adaptation and psychometric properties of the Urdu version of the avoidance endurance behavior questionnaire in patients with chronic musculoskeletal pain.

Fatima S, Asif M, Zaheer A, Arslan S, Qurat-Ul-Ain A, Farooq A J Back Musculoskelet Rehabil. 2024; 37(6):1741-1748.

PMID: 39240626 PMC: 11613119. DOI: 10.3233/BMR-240197.

Evaluation of "appropriate use criteria" for surgical decision-making in lumbar degenerative spondylolisthesis. A controlled, multicentre, prospective observational study.

Mannion A, Mariaux F, Werth P, Pearson A, Lurie J, Fekete T Eur Spine J. 2024; 33(5):1773-1785.

PMID: 38416192 DOI: 10.1007/s00586-024-08157-1.

Does loss to follow-up lead to an overestimation of treatment success? Findings from a spine surgery registry of over 15,000 patients.

Mannion A, Fekete T, ORiordan D, Loibl M, Kleinstuck F, Porchet F Eur Spine J. 2023; 32(3):813-823.

PMID: 36709245 DOI: 10.1007/s00586-023-07541-7.

Development of a machine-learning based model for predicting multidimensional outcome after surgery for degenerative disorders of the spine.

Muller D, Haschtmann D, Fekete T, Kleinstuck F, Reitmeir R, Loibl M Eur Spine J. 2022; 31(8):2125-2136.

PMID: 35834012 DOI: 10.1007/s00586-022-07306-8.

Generalization of fear of movement-related pain and avoidance behavior as predictors of work resumption after back surgery: a study protocol for a prospective study (WABS).

Masuy R, Bamelis L, Bogaerts K, Depreitere B, De Smedt K, Ceuppens J BMC Psychol. 2022; 10(1):39.

PMID: 35193697 PMC: 8862001. DOI: 10.1186/s40359-022-00736-5.

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