본 연구는 허리 척추수술환자의 일상생활기능, 불안, 우울과 통증파국화의 관계와 통증파국화에 미치는 영향을 파악하여 척추수술환자에게 필요한 효과적인 간호중재 방안의 기초자료를 제시하고자 시도되었다.
자료 수집은 2017년 4월부터 10월까지 C시 소재 일개 종합병원에서 허리 척추수술을 받은 환자를 대상으로 자가보고 설문지를 이용하여 이루어졌다.
연구도구는 일상생활기능은 Japanese Orthopedic Association Low Back Pain Evaluation Questionnaire로, 불안은 State-Trait Anxiety Inventory로, 우울은 Beck’s Depression Inventory로, 통증파국화는 Pain Catastrophizing Scale로 측정하였다. 수집된 자료는 SPSS Win 22.0 program을 이용하여 t-test, ANOVA, Pearson''s correlation coefficient, Scheffe test, Multiple regression analysis로 확인하였다.

본 연구의 결과는 다음과 같다.

1) 허리 척추수술환자의 일상생활기능의 하부영역은 100점 만점에 허리통증은 75.84점, 허리기능은 56.07점, 보행능력은 57.25점, 사회생활기능은 40.78점, 정신건강은 57.25점이었다. 불안은 80점 만점에 43.42점이었고, 우울은 63점 만점에 9.81점이었다. 통증파국화 정도는 52점 만점에 15.55점으로, 하부영역 중 무기력한 사고는 4.76점, 과장적 사고는 3.56점, 반추적 사고는 7.22점이었다.

2) 일반적 특성의 인구사회학적 및 질병관련 특성에 따른 통증파국화의 차이를 살펴본 결과, 배우자가 없는 대상자의 통증파국화 정도는 18.32점으로 배우자가 있는 대상자의 14.39점보다 높았다(t=-2.03, p=.044). 입원기간이 14일 이상인 대상자의 통증파국화 정도는 17.92점으로 14일 미만인 대상자의 14.08점보다 높았으며(t=-2.12, p=.036), 수술 후 요통 정도가 ‘중등도’ 이상인 대상자가 ‘경증’인 대상자보다 통증파국화 정도가 높았다(F=8.35, p<.001).

3) 허리 척추수술환자의 통증파국화는 일상생활기능의 모든 하위영역, 즉 허리통증(r=-.24, p=.004), 허리기능(r=-.24, p=.005), 보행능력(r=-.37, p<.001), 사회생활기능(r=-.32, p<.001), 정신건강(r=-.53, p<.001)과 역 상관관계가 있었다. 그리고, 통증파국화는 불안(r=.46, p<.001), 우울(r=.50, p<.001)과는 정 상관관계가 있었다. 즉 일상생활기능이 낮을수록 통증파국화 정도가 높았고, 불안 또는 우울 정도가 높을수록 통증파국화 정도도 높았다.

4) 허리 척추수술환자의 통증파국화에 영향을 미치는 요인을 분석한 결과, 일반적 특성 중 통증파국화와 유의한 차이를 보인 배우자의 유무, 입원기간, 수술 후 요통 정도를 공변량으로 했을 때, 일상생활기능, 불안, 우울은 통증파국화를 40% 예측 설명하는 것으로 나타났다(F=8.25, p<.001). 그러나 일상생활기능의 하위영역인 정신건강만이 유의한 영향을 미치는 것으로 확인되었다(β=-.23, p=.023).

이상의 결과를 종합해 볼 때 허리 척추수술환자의 일상생활기능 중 정신건강이 통증파국화의 주요 영향 요인임을 알 수 있었다. 따라서 척추수술환자의 통증파국화를 낮추기 위해서는 신체적 회복뿐 아니라 수술 후 정신건강을 고려한 맞춤형 간호 중재 방안이 필요하다.

This Study was carried out to present basic data for the effective methods of nursing intervention necessary for spinal surgery patients by assessing the effects on the relationship with daily life functions, anxiety, depression and pain catastrophizing, and pain catastrophizing of the lumbar spinal surgery patients.
Data was collected by using self-reported questionnaire survey on patients who underwent lumbar spinal surgery at a general hospital located in C City from April to October, 2017.
As the research tool, the Japanese Orthopedic Association Low Back Pain Evaluation Questionnaire was used to measure the daily life functions, State-Trait Anxiety Inventory for anxiety, Beck’s Depression Inventory for depression and Pain Catastrophizing Scale for pain catastrophizing. Data collected was analyzed and confirmed by means of t-test, ANOVA, Pearson''s correlation coefficient, Scheffe test and Multiple regression analysis by using SPSS Win 22.0 program.

Results of this Study are as follows:

1) Subordinate domains of the daily life functions of the lumbar spinal surgery patients displayed the following scores out of the full score of 100 points: 75.84 for low back pain, 56.07 for lumbar function, 57.25 walking ability, 40.78 for social life functions and 57.25 for mental health. Meanwhile the score for anxiety was 43.42 out of the full score of 80 while that for depression was 9.81 out of the full score of 63. Score for the extent of pain catastrophizing was 15.55 out of the full score of 52, while the scores for its subordinate domains including helpnessness, magnification, rumination were 4.76, 3.56 and 7.22, respectively.

2) As the results of the observation of the differences in the pain catastrophizing in accordance with the sociodemographic and disease related characteristics of the general characteristics, the score for the extent of pain catastrophizing in patients without spouse was 18.32 points, which was higher than that of the subject with spouse at 14.39 points (t=-2.03, p=.044). The score for the extent of the pain catastrophizing for subjects with the duration of hospitalization of more than 14 days was 17.92 points, which was higher than that for subjects with less than 14 days of hospitalization at 14.08 points (t=-2.12, p=.036). Moreover, subjects with higher than ‘moderate’ level of backache after the surgery displayed higher extent of pain catastrophizing than the subjects with ‘slight’ level of backache (F=8.35, p<.001).

3) The extent of pain catastrophizing had inverse correlation with all the subordinate domains of the daily life functions, including low back pain (r=-.24, p=.004), lumbar function (r=-.24, p=.005), walking ability (r=-.37, p<.001), social life function (r=- .32, p<.001) and mental health (r=-.53, p<.001). Moreover, the extent of pain catastrophizing had positive correlation with anxiety(r=.46, p<.001) and depression(r=.50, p<.001). That is, the extent of pain catastrophizing was high with lower daily life functions, and with high level of anxiety or depression.

4) As the results of the analysis of factors that affect the extent of pain catastrophizing of lumbar spinal surgery patients, it was found that daily life functions, anxiety and depression can predictively explain 40% of pain catastrophizing when the existence of spouse, duration of hospitalization and extent of lumbar pain after the surgery, which displayed significant differences with pain catasrophizing among the general characteristics, were set as the covariates (F=8.25, p<.001). However, it was confirmed that only the mental health, which is a subordinate domain of daily life functions, imparts significant effect (β=-.23, p=.023).

In summary of the above results, it can be seen that mental health among the daily life functions of the lumbar spinal surgery patients is the key influential factor for the extent of pain catastrophizing. Therefore, there is not only a need for physical recovery but also a need for customized method of nursing intervention with consideration for mental health following the lumbar spinal surgery patients in order to lower the extent of pain catastrophizing.