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© Borgis - New Medicine 1/2014, s. 39-41
*Julianna Rozália Sallai, Gèza Bálint, Gábor Ormos
Complex assessment of the post-operative state and life quality in patients operated for herniated disc
National Institute of Rheumatology and Physiotherapy, Budapest, Hungary
Director in Chief: prof. Gyula Poór, MD, PhD, DSc
Summary
The authors assessed the health, family and social state of 29 patients following operation for herniated disc at the 3rd Rheumatology Rehabilitation Department of the National Institute of Rheumatology and Physiotherapy, Budapest, Hungary. Other 21 patients were included randomly owing to lower back pain. Out of the 29 patients only 5 received substantial medical rehabilitation within 3 months. Only 2 patients became symptom-free for longer duration, and only 2 returned to their work. Early adequate treatment, operation in due time and complex rehabilitation accompanied by adequate information and education is the only method of choice to accomplish adequate results.
In cooperation with the Social and Mental Hygienic Service of our institute we assessed with the help of questionnaires the health and social state of 29 patients having been operated for herniated disc at the III. Rheumatology Rehabilitation Department of the National Institute of Rheumatology and Physiotherapy. Besides, we made a complementary comparison in the form of similarly assessing the conditions of 21 randomly chosen patients with lower back pain. Herniated disc often needs operation being it a condition with strong negative effect on lower back pain, falling out of work, and on life quality. It is particularly important to what extent rehabilitation after operation helps to improve life quality diminished before the operation, and to what degree it contributes to the restoration of the sex-, age-, and social state related aspects of it. Our article reveals the experiences in these fields.
Social state of patients with herniated disc
11 among the 29 operated patients were females, and 18 persons were males. 2 of the 11 operated female patients took 6 months of sick leave after the surgery. Among the rest of the operated persons one patient took 9 months, while 11 patients were on 12 months’ sick leave. Only 2 female patients returned to work after the operation.
As for male patients, 4 of them took 6 months sick leave, 3 of them took 9 months, and 11 of them 12 months. These patients had already been unable to work before the operation.
2 of the male patients who did not undergo surgery took 6 months sick leave, 1 patient 9 months another for 12 months, and 1 person had been living on unemployment benefit. A person receiving unemployment benefit is not entitled to take sick leave, however, he or she is provided with free of charge health care service on the basis of the solidarity principal of the national health insurance system. National health insurance for citizens living by unemployment benefit or by other social benefits is paid from the central national budget. This amounted for 4500 HUF per capita in 2009.
Among the 15 female patients who did not undergo operation 4 took 6 months sick leave, 8 persons took 9 months, and 3 of them took 12 months.
Post-surgical rehabilitation
It is not necessary to emphasise the importance of rehabilitation after operation. However, it is important to highlight the condition regarding the rehabilitation of the above-summarised male and female patients, because this characterises the importance of the interconnection of operation and rehabilitation. This characterisation unfortunately points to the negative context of the lack of this interconnection.
Only 4 men and 1 woman out of the 29 operated patients could receive medical rehabilitation within three months after their surgery, that is, in due time. All the patients received conservative treatment prior to the operation, mostly in hospitals.
As opposed to this, 10 female patients and 15 male patients could participate in proper medical rehabilitation only much later, that is, more than half a year after the operation. There was even one person who could start his rehabilitation only years after the operation.
According to the questionnaire only 1 female and 3 male patients have become symptom-free after the operation. Only 2 of these 4 persons have enjoyed permanent recovery.
Capacity to work
Two women returned to work after operation. Three persons among the rest of them went on full (100%) disability retirement, and they did not find any appropriate job owing to their health condition. 9 female patients needed further treatments because of their health condition. 3 men were not provided with light work, one man did not take up any job because of his cardiovascular diseases. The rest of the patients, namely 14 persons, felt unable to restart working because of their disabilities.
Only few patients’ previous social condition has improved, most of them have permanently remained unable to work. This situation is strongly related to late rehabilitation after the operation. Late rehabilitation itself also had a negative psychological effect on the patients, inasmuch as it affirmed their negative self-concept as being ‘ill’, ‘disabled’ and ‘unable to work’. Therefore, our assessment suggests that the lack of rehabilitation started in due time can even deteriorate the positive effects of an otherwise successful operation.
Besides the demographical data of our questionnaire also includes inquiry about the residence of patients (capital city, city, village, homestead), the per capita monthly income in their families, their present occupation, social status (white-collar work, sitting work, heavy labour, unemployment, disability retirement, retirement), as well as about conservative treatment prior to the operation. We were looking primarily for social correlations and by doing so we have gained insight into the span of time of being unable to work before the operation, as well as about the length of time stretching between the operation and – often very late – rehabilitation. As a result, we have indirectly realised how the lack of early rehabilitation influenced patients’ disability of returning to work.
Discussion

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Piśmiennictwo
1. Bálint G, Ormos G: Sürgőssèg ès mozgásszervi rehabilitáció. [In:] Katona F, Siegler J (eds.): A rehabilitáció gyakorlata. Medicina, Budapest 2004: 14-17. 2. Burton K: How to prevent back pain? Best Pract Res Clin Rheum 2005; 19: 541-555. 3. Garret J, Jackman A, Mclaughlin C et al.: The outcomes and costs of care for acute low back pain among patients seen by primary care practitioners, chiropractors and orthopaedic surgeons. N Engl J Med 1995; 333: 913-917. 4. Hèjj G: A mozgásszervi betegsègek szerepe a kórházi ápolásban, a betegállományban, rokknatságban ès az èletminősèg mutatóiban Magyarországon. [In:] Nèpegèszsègügy 1999; 80 (Suppl): 4-6. 5. Skovron M et al.: Sociocultural factors and low back pain. Spine 1994; 19: 129-137. 6. World Health Organisation: The burden of musculoskeletal conditions at the start of the millennium. Technical Report Series 919. WHO, Geneva, 2003. 7. Yelin E: The economic and functional impact of rheumatic diseases in the US. [In:] Klippel J, Dieppe P (eds.): Rheumatology. Mosby, London 1998; 1.5.1.-1.5.4.
otrzymano: 2014-01-07
zaakceptowano do druku: 2014-02-17

Adres do korespondencji:
*Julianna Rozália Sallai
National Institute of Rheumatology and Physiotherapy
H-1023 Budapest, Frankel Leó u. 25-29, Hungary
tel. +36 1 438-8300
e-mail: sallai.julianna@freemail.hu

New Medicine 1/2014
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