Assessment of Biopsychosocial Risk Factors for Medical Treatment. Published July, 2009 in the Journal of Clinical Psychology in Medical Settings. Full article available free via open access. This article reviewed the literature on the psychological factors shown to predict the outcome of spinal surgery and spinal cord stimulation. From this review, a paradigm was generated, and both exclusionary risk factors ("red flags") and cautionary risk factors ("yellow flags") were identified. Medical patient and community norms for both types of risk factors were developed using 2264 US subjects obtained from 106 sites. The demographics of the norm groups approximated US census data for gender, race, education and age. It was hypothesized that the risk scores derived from this process would predict patient response to a wide variety of medical treatments. Standardized Cautionary Risk and Exclusionary Risk scores were shown to predict both work status and satisfaction with care for patients in multiple treatment groups (spinal surgery, upper extremity surgery, brain injury, work hardening, chronic pain, acute injury, and injured litigants). Repeat testing showed these risk scores demonstrated test-retest reliabilities ranging from .85 to .91. The application of this method to the clinical setting was also discussed, as were the study's limitations.
A compelling case for the need for presurgical psychological evaluations, and the cost offset it generates