The Role and Practice of Medical Humanistic Nursing in the Psychological Management of Patients with Lumbar Spine Internal Fixation during the Perioperative Period

The Role and Practice of Medical Humanistic Nursing in the Psychological Management of Patients with Lumbar Spine Internal Fixation during the Perioperative Period | Research Square window.SnipcartSettings = { analytics: { enabled: false } }; (function() { var accessVector = localStorage.getItem('access_vector') || ''; window.dataLayer = window.dataLayer || []; if (accessVector) { window.dataLayer.push({ user: { profile: { profileInfo: { snid: accessVector } } } }); } })(); (function(w,d,s,l,i){w[l]=w[l]||[];w[l].push({'gtm.start':new Date().getTime(),event:'gtm.js'});var f=d.getElementsByTagName(s)[0],j=d.createElement(s),dl=l!='dataLayer'?'&l='+l:'';j.async=true;j.src='https://www.googletagmanager.com/gtm.js?id='+i+dl;f.parentNode.insertBefore(j,f);})(window,document,'script','dataLayer','GTM-K279D39R'); Browse Preprints In Review Journals COVID-19 Preprints AJE Video Bytes Research Tools Research Promotion AJE Professional Editing AJE Rubriq About Preprint Platform In Review Editorial Policies Our Team Advisory Board Help Center Sign In Submit a Preprint Cite Share Download PDF Research Article The Role and Practice of Medical Humanistic Nursing in the Psychological Management of Patients with Lumbar Spine Internal Fixation during the Perioperative Period Chuncheung Chan, Li Jiang, Bo Zhao, Huijuan Jie, Dirong Gu, Lisi He, and 4 more This is a preprint; it has not been peer reviewed by a journal. https://doi.org/ 10.21203/rs.3.rs-6889145/v1 This work is licensed under a CC BY 4.0 License Status: Posted Version 1 posted You are reading this latest preprint version Abstract Objective To assess the impact of mental health on the prognosis of patients undergoing lumbar spinal fixation and to explore the role of humanistic nursing in improving outcomes. Background There is a gap in research regarding the changes in anxiety and depression among patients during the perioperative period for lumbar spinal fixation, and their psychological state's effect on prognosis is unclear. Design: A retrospective cohort study utilizing questionnaire surveys at 1 week preoperatively, 1 week postoperatively, and 6 months postoperatively. Methods 84 patients who underwent lumbar spinal fixation surgery received humanistic care from nurses. Follow-up surveys included sociodemographic data, SF-36 scores, Zung Self-Rating Anxiety Scale (SAS), and Zung Self-Rating Depression Scale (SDS). Data were analyzed using SPSS 22.0, with correlations assessed by the Spearman test.st. Results Preoperative SAS scores were significantly higher than postoperative scores at 1 week (43.3 vs. 33.3) and 6 months (27.5). SF-36 scores improved significantly postoperatively, indicating better quality of life. Female patients showed higher SAS and SDS scores and lower SF-36 scores, suggesting slower recovery. Conclusions Humanistic nursing interventions significantly reduce anxiety and depression and improve quality of life in patients undergoing lumbar spinal fixation surgery, emphasizing the need for psychological support, especially for female patients. Relevance to Clinical Practice: Active and effective humanistic nursing interventions led by nurses should be implemented to alleviate patients' psychological distress during the perioperative period of lumbar internal fixation, to promote patients' postoperative rehabilitation and improve patients' overall quality of life. Medical Humanistic Nursing Psychological Management༛Lumbar Spine Internal Fixation Figures Figure 1 Figure 2 What does this paper contribute to the global clinical community? This paper contributes to the global clinical community by highlighting the importance of addressing the psychological well-being of patients undergoing lumbar spinal fixation surgery. It provides evidence-based insights into the changes in anxiety and depression levels before and after surgery, and the impact of these psychological states on patient outcomes. Here are the key contributions: 1. Identification of Psychological Needs: The study identifies that patients undergoing lumbar spinal fixation surgery experience significant anxiety and depression during the perioperative period, emphasizing the need for psychological support in clinical practice. 2. Humanistic Nursing Interventions: It demonstrates the effectiveness of humanistic nursing interventions in reducing anxiety and depression, and improving the overall quality of life for patients post-surgery. 3. Gender Differences in Psychological Health: The paper highlights gender differences in mental health outcomes, showing that female patients tend to have higher levels of anxiety and depression. This information can help healthcare providers tailor their support to better address the needs of female patients. 4. Importance of Postoperative Recovery: The study underscores the significance of postoperative care that includes psychological support, which can contribute to better functional outcomes and overall well-being. 5. Proactive Mental Health Screening: By showing the correlation between chronic pain and poor mental health, the paper advocates for proactive mental health screening and intervention in patients with chronic conditions like lumbar spinal diseases. 6. Quality of Life Improvement: It provides evidence that with improved postoperative functional status, there is a significant decrease in chronic waist pain, leg pain, anxiety, and depression, which can influence healthcare policies and protocols to include mental health as a crucial component of recovery. 7. Nurse-Led Initiatives: The paper contributes to the understanding that nurses can play a leading role in implementing psychological interventions, which can reduce psychological distress and enhance postoperative rehabilitation and quality of life for patients undergoing lumbar internal fixation. These contributions are essential for developing comprehensive care plans that consider not only the physical aspects but also the mental and emotional well-being of patients undergoing major surgical procedures like lumbar spinal fixation. 1. Introduction and Background Lower back disorders frequently cause either acute or chronic pain for patients, which might be episodic or constant. Prolonged pain substantially affects the quality of life (QOL) of patients, potentially leading to detrimental mental health outcomes [ 1 – 3 ] . Lower back pain is typically marked by stiffness, pain, and muscle tension in the lumbar area, often accompanied by radiating discomfort down the legs [ 1 ] .It's estimated that approximately 70% of the adult population in developed nations have experienced lower back pain [ 2 ] , particularly among men aged 40 years and above and women aged 50 years and above [ 3 ] .Lumbar fusion surgery serves as a therapeutic approach for conditions like lumbar instability, herniated discs, spinal stenosis, and other prevalent causes of lower back pain. As an advanced surgical intervention, lumbar fusion has been shown to effectively address degenerative diseases of the lumbar spine [ 4 – 7 ] .Over the last decade, around 200,000 lumbar fusions were carried out annually on a global scale [ 8 ] . In the perioperative phase for patients undergoing lumbar surgery, the prevalence of anxiety and depression is notably high. Studies indicate that prolonged or episodic pain exceeding three months can trigger detrimental mental health conditions, such as depression [ 9 ] , and up to 85% of chronic pain sufferers might develop severe depression [ 10 ] .There are reports in the literature that persistent lower back pain can affect the quality of life of patients and exacerbate depressive symptoms [ 11 – 14 ] .Patients undergoing lumbar spinal fixation surgery often face an extended disease trajectory, which may manifest in persistent pain and associated negative emotional states, including depression. Chronic lower back pain, characterized by neural root compression, leg pain, numbness, or discomfort, can exacerbate depressive symptoms due to the relentless nature of the condition. Much of the current literature centers on the influence of preoperative psychological status on postoperative outcomes in lumbar fusion surgery patients. Some studies suggest that individuals presenting with preoperative anxiety and depression tend to report lower anxiety and/or depression levels post-surgery, higher satisfaction with the procedure, and improved quality of life scores relative to those without pre-existing mental health comorbidities [ 15 – 22 ] . However, conflicting results also exist, indicating a nuanced relationship between preoperative mental health and postoperative outcomes [ 23 ] . A retrospective comparative analysis revealed that patients with elevated preoperative depression scores experienced a significantly higher dissatisfaction rate two years post-lumbar decompression and internal fixation fusion surgery, along with a higher likelihood of recurrent spinal stenosis surgery (P < 0.01) [ 23 ] . Furthermore, studies have documented that between 16.4–73.3% of lower back pain patients, including those with depression, may face poor prognoses due to adverse mental state [ 24 ] .In recent years, with the World Health Organization's new definition of health (which includes good physical, mental, and social functioning), high-quality care services and the concept of "patient-centered" humanistic care have gained popularity. Nursing work is no longer limited to basic care procedures and professional nursing skills. Nurses apply relevant professional knowledge to manage specific patient impairments, eliminate or reduce adverse mental states, help patients maintain a positive attitude towards their illness, cooperate actively in medical rehabilitation, and significantly improve their prognosis and quality of life [ 25 – 26 ] .Orthopedic nursing has its particularity. Studies show that a considerable portion of orthopedic patients with mental health issues mainly manifest interpersonal sensitivity, depression, anxiety, hostility, or paranoia [ 27 – 28 ] .Since orthopedic surgery is one of the most important treatments, it introduces new sources of trauma and stress that may exacerbate negative mental and emotional states. For patients achieving therapeutic benefits, it has a significant impact on improving their quality of life [ 29 ] .The fear of surgery, even some emergencies like hypertension, arrhythmia, and endocrine disorders, plays a role in this context. The psychological health status of patients after lumbar spinal fixation surgery is crucial to their recovery process. Medical humanities nursing interventions play an indispensable role in this link. Such interventions involve not only close attention to the patient's physical condition but also a deep understanding and active response to the patient's psychological needs. By providing emotional support, psychological counseling, and personalized care plans, nursing staff can help patients alleviate negative emotions such as anxiety, fear, and depression that may occur after surgery, and enhance their confidence in treatment and active participation in the recovery process. In addition, humanities nursing interventions can also improve patient satisfaction and trust by establishing good nurse-patient communication, which has a significant impact on promoting the overall health and quality of life of patients. Therefore, valuing and implementing medical humanities nursing interventions has immeasurable value for the psychological health and recovery outcomes of patients after lumbar spinal fixation surgery. This study aims to delve deeper into the methods for improving patients' anxiety and depression levels before and after lumbar internal fixation surgery and to analyze the role of humanistic care in enhancing patient anxiety and depression relief. 2. Methods 2.1 Sample Exclusion criteria: Patients undergoing surgery for trauma, tumors, or revision of lumbar arthrodesis; Cases complicated with other serious diseases; A past or family history of mental illness; History of other systemic diseases; Other circumstances that were not suitable for the study; Refusal to participate in the research; Inability to complete the questionnaire and follow-up due to illiteracy. 2.1.2 Consent Form & Questionnaire After signing their informed consent, all patients answered questionnaires. The evaluation time points were selected to occur before surgery, 1 month after surgery, and 6 months after surgery. 2.2 Humanistic Nursing Interventions 2.2.1 Creation of Humanistic Nursing Atmosphere Preoperative Encouragement Cards are placed for patients awaiting surgery, clearly inscribed with warm messages like "Wish you a smooth surgery!" to deliver positive psychological. The ward environment is optimized through soft lighting, green plant decorations, and temperature-humidity regulation to create a cozy and comfortable inpatient space. Personalized portable support tools such as reading glasses, bedside commodes, and chargers are provided to address patients' practical daily needs. A "Ward Reading Corner" is established with selected science popularization materials, relaxing magazines, and psychological guidance manuals for family members, aiming to alleviate preoperative anxiety for both patients and their families. 2.2.2 Multidimensional Support and Collaboration Whole-course Psychological Care System: Psychological status is assessed through one-on-one communication, with emotional counseling provided. Pain management knowledge lectures are conducted, combining graphic materials and model demonstrations to guide patients in mastering postoperative analgesia techniques and key points of rehabilitation training. Interdisciplinary Joint Rounding Mechanism: A joint team with the Department of Medical Humanities conducts weekly rounds, dynamically tracking patients' psychological needs through interviews and establishing comprehensive "physiological-psychological-social" assessment files. Social Support Network Construction: Social workers and volunteers are invited to provide companion care services, such as preoperative conversation and postoperative daily care assistance, to strengthen the patients' emotional support system. 2.2.3 Narrative Nursing and Dynamic Recording Narrative Nursing Practice: Structured interviews are used to guide patients in expressing their disease experiences and psychological feelings. The "story retelling" technique is applied to help them reconstruct positive cognition and enhance confidence in treatment. Humanistic Nursing Log System: Responsible nurses record patients' emotional fluctuations, needs responses, and intervention effects daily, forming a continuous psychological care trajectory to provide a basis for adjusting personalized nursing plans. 2.3 Measurement Tools 2.3.1 Pain Assessment Pain was assessed on a visual analog scale (VAS) on a scale of 0 to 10, with 0 indicating no pain and 10 indicating unbearable pain, and respondents indicated the maximum intensity of their pain when filling out the questionnaire [30] . 2.3.2 Health Status Assessment The Short Form of Health Status Survey (SF-36) is used to evaluate clinical outcomes and quality of life [31] . Paired t-tests compared SF-36 scores at different time points for the same patient. The internal consistency reliability (Cronbach's α) of the SF-36 questionnaire ranges from 0.70 to 0.91, indicating good internal consistency. Furthermore, the split-half reliability of the SF-36 questionnaire is 0.971, suggesting that the scale has stable measurement properties [31-34] . 2.3.3 Depression and Anxiety Assessment Zung's Self-Rating Depression Scale (SDS) and Zung's Self-Rating Anxiety Scale (SAS) were used to assess depression and anxiety [35] . The SDS scale has good reliability and validity, and can reliably assess the severity of individual depressive symptoms. In a study, the Cronbach's α coefficient of the SDS scale was not explicitly provided, but it was mentioned that the SDS scale is simple to use and has high reliability [36-39] . The cutoff value of the SDS standard score is 53, including 53-62 for mild depression, 63-72 for moderate depression, and 73 or more for severe depression. The internal consistency (Cronbach's α) of the SAS scale is 0.897, and the test-retest reliability (SmATIC Correlation Coefficient, ICC) is 0.913, indicating a high level of reliability. Furthermore, the SAS scale has been validated in multiple studies, demonstrating good internal consistency and validity [35-36] . The standard deviation of the SAS score is 50 points, with 50 to 59 being mild anxiety, 60 to 69 being moderate anxiety, and 69 or more being severe anxiety. Applied paired t-tests to statistically compare patients' SAS and SDS scores preoperatively and postoperatively at 1 week and 6 months to determine changes in anxiety and depression levels over time. 2.4 Surgical procedures The same surgical team operated on all patients. After general anesthesia, the patient was placed in the prone position, and a posterior midline incision was made. After exposure was completed, laminectomy, discectomy, nerve decompression, autogenous bone graft fusion with an interbody fusion cage were performed, and finally, the connecting rod was installed, followed by layer-by-layer suture, drainage, and bandaging. 2.5 Data analysis SPSS 22.0 statistical software was used for data analysis. Data are expressed as the mean ± standard deviation, and Spearman’s test was used to analyze the correlation between SDS, SAS, VAS and SF-36. The statistical significance level was 5% (P <0.05 was statistically significant). 3. Results 3.1 General information description A total of 84 patients were included in this study, including 42 males and 42 females. Their age ranged from 45 to 78 years, with a mean of 61.67 ± 9.33 years. Among them, 56 underwent single-level lumbar internal fixation, and 28 underwent double-level lumbar internal fixation (Table 1 ). 3.2 Assessment of psychological state The preoperative anxiety SAS score was 43.38 ± 8.85 points, including 17 patients with preoperative anxiety (20.23%) and 6 patients with moderate anxiety (7.14%). One week after surgery, the anxiety score decreased significantly (33.35 ± 3.32 points, P < 0.01) and continued to decrease to 27.55 ± 2.92 points 6 months after surgery (P < 0.01). There were 5 patients with depression before surgery (5.95%), and the preoperative depression score of the included patients was 39.60 ± 6.01 points, which decreased to 33.81 ± 3.87 points one week after surgery (P < 0.01) and 32.30 ± 4.65 points six months after surgery (P < 0.01) (Fig. 1). After conducting paired t-tests, it was found that the SAS and SDS scores of the patients significantly decreased from pre-operation to 6 months post-operation. This indicates that the implementation of humanistic care measures has effectively alleviated the anxiety and depressive symptoms of the patients. 3.3 Functional status evaluation SF-36 scores were used to assess patients' functional status, including the SF-36 Score SmATIC (SF-S) and SF-36 Score Mental (SF-M). The preoperative SF-36 score was 60.94 ± 6.38, including 31.75 ± 5.02 for SF-S and 29.19 ± 3.96 for SF-M. The patient's functional status was significantly improved 1 week after surgery, the SF-36 score was improved to 114.32 ± 5.34 points (P < 0.01), and the SF-36 score was 118.06 ± 6.98 points at 6 months after surgery (Fig. 2). The SF-36 scores of the patients were compared before surgery, 1 week post-surgery, and 6 months post-surgery using paired t-tests. The study findings indicated a significant improvement (P < 0.01) in the SF-36 scores both 1 week and 6 months post-surgery compared to pre-surgery, suggesting that following surgical treatment and humanistic care, there was a notable enhancement in the overall functional status of the patients. (Table 2 ) (Table 3 ) (Table 4 ) 3.4 Relationship between Preoperative and Postoperative Assessments with Depression, Anxiety, and Functional Status Anxiety (SAS) Scores: Preoperatively, the average SAS score was 43.3 with a standard deviation of 8.8. After one week postoperatively, the average score decreased to 33.3, with a standard deviation of 3.3. Six months postoperatively, it further declined to 27.5, with a standard deviation of 2.9. A p-value < 0.001 indicates significant differences in SAS scores compared to preoperatively, suggesting a notable decrease after one week and six months postoperatively. Depression (SDS) Scores: Preoperatively, the average SDS score was 39.5, with a standard deviation of 6.02. One week postoperatively, the average increased to 33.8, with a standard deviation of 3.8. Six months postoperatively, it further rose to 32.2, with a standard deviation of 4.6. A p-value < 0.001 signifies significant differences compared to preoperatively, indicating an increase in SDS scores postoperatively. SF-36 Scores: Preoperatively, the average SF-36 score was 60.9, with a standard deviation of 6.3. One week postoperatively, it significantly increased to 114.3, with a standard deviation of 5.3. Six months postoperatively, it further improved to 118.1, with a standard deviation of 6.9. A p-value < 0.001 suggests significant improvements compared to preoperatively, reflecting enhanced overall health-related quality of life postoperatively. Analysis Results: A reduction in SAS and SDS scores indicates a decrease in anxiety and depressive symptoms among postoperative patients, which may be closely related to humanistic care alleviating surgical stress. An improvement in the SF-36 scores postoperatively indicates a positive change in patients' overall health-related quality of life, which is closely related to the implementation of humanistic care during the perioperative period. The significant improvement in scores from one week postoperatively onwards, and its persistence up to six months postoperatively, even with further enhancement, underscores the effectiveness of care provided. 3.5 Gender Differences: The analysis reveals that female patients had significantly higher SAS and SDS scores preoperatively, one week postoperatively, and six months postoperatively compared to male patients. Female patients also exhibited lower SF-36 scores postoperatively, one week and six months, indicating a slower recovery in functional status. This highlights the importance of humanistic care in supporting the mental health of female patients (Table 3 ). 4. Discussion The purpose of this study was to analyze the changes and causes of adverse psychological status before and after lumbar internal fixation surgery. We found that depression and anxiety improved significantly after lumbar spine disease and were inversely, but not significantly, related to daily functioning. There was preoperative anxiety in 20.23% of the patients in this study, and nearly 6% of the patients had depression. When chronic pain improved significantly after surgery, the depression and anxiety scores of all patients returned to normal levels, which also indicates that chronic pain may lead to depression, anxiety and other adverse states. At the same time, nurses actively pay attention to the negative psychology of patients and proactively implement humanistic nursing interventions in collaboration with the Department of Medical Humanities, which can also alleviate patients' anxiety and depressive mood [ 40 – 44 ] . In addition, Gender is also one of the factors affecting unhealthy psychology, with women being more prone to depression, anxiety, and other negative emotions than men. Some scholars believe that women are more sensitive and vulnerable, hence they are more susceptible to external stimuli, leading to unhealthy negative emotions such as depression and anxiety [ 45 ] .Humanistic care is particularly important for the psychological support of female patients. Positive and effective nursing of patients receiving postoperative rehabilitation influenced by psychological intervention is considered to improve quality of life, through communication, body language, initiation of contact with patients, and treating patients with consideration according to their different situations. One aim of psychological counseling is to guide patients in eliminating psychological barriers preoperatively and postoperatively alleviate pain [ 46 – 48 ] . Rehabilitation exercise actively encourages and instructs patients in early getting-out-of-bed activities and comprehensively promotes the early recovery of patients. 5. Conclusion Patients with lumbar degenerative diseases have depression and anxiety during the perioperative period due to long-term lumbar and leg pain or lower limb numbness, weakness and discomfort, among which anxiety and depression disorders are more common. In addition, Chronic pain often triggers a cascade of negative mental health impacts, including depression and anxiety, which can exacerbate physical symptoms and hinder recovery. In the realm of clinical care, there's an urgent need to heighten our vigilance towards recognizing and addressing the psychological distress in patients. By prioritizing proactive mental health interventions, we can significantly enhance clinical outcomes. The integration of humanistic nursing practices, in conjunction with the expertise from the Department of Medical Humanities, is indispensable for the holistic rehabilitation of patients undergoing orthopedic surgery. This approach not only acknowledges the psychological dimensions of healing but also actively engages in the identification and alleviation of patients' negative psychological states. It fosters a supportive environment that promotes emotional well-being, thereby contributing to a more comprehensive and effective recovery process. 6. Relevance to clinical practice Depression and anxiety are common in people with lumbar degenerative diseases because they have long-term back and leg pain, numbness, or weakness in their lower legs. Chronic waist pain, leg pain, anxiety and depression will decrease significantly as postoperative functional status improves. Nurses should pay attention to the existence of adverse psychological outcomes in clinical nursing work, actively implement humanistic nursing interventions, and positively influence patient outcomes. Active and effective nurse-led psychological interventions should be implemented to reduce the psychological distress of perioperative patients with lumbar internal fixation, improve their postoperative rehabilitation and quality of life. Declarations Patient or public contribution: Patients and their families fully understand the study concept and design before receiving the survey. The target patients were discreetly investigated by the investigators 1 week before surgery, 1 week after surgery, and 6 months after surgery. For the study subjects discharged after surgery, the care-givers participating in the study will regularly participate in telephone visits and outpatient follow-ups, and the SF-36 score, the Zung's depression self-rating scale score, and the Zung's anxiety self-rating scale score will be examined. Acknowledgements Not applicable. Author contributions C.C. (Chuncheung Chan), L.J. (Li Jiang), and B.Z. (Bo Zhao) contributed equally as first authors. C.C., L.J., and B.Z. designed the study, collected and analyzed data, and drafted the initial manuscript. H.J. (Huijuan Jie) and D.G. (Dirong Gu) contributed to data interpretation and critical revision of the manuscript. L.H. (Lisi He) and P.Z. (Pingting Zhou) assisted in experimental validation and manuscript editing. Y.Z. (Yunping Zhang) supervised the research methodology and provided technical support. H.Z. (Haiyang Zheng) and W.J. (Wenwen Jiang) oversaw the project, coordinated authors, and finalized the manuscript as corresponding authors. All authors reviewed and approved the final version of the manuscript. Funding None. Data availability The datasets used and analyzed in this study are available from the corresponding author upon reasonable request. Ethics approval and consent to participate: This study was conducted in accordance with the principles of the 1975 Declaration of Helsinki and was approved by the Ethics Committee of The Seventh Affiliated Hospital of Sun Yat - sen University (Approval No.: KY-2025-013-01). All study participants provided oral informed consent. Consent for publication : Not applicable. Competing interests: The authors declare that they have no competing interests. Author details 1.Department of Orthopedic Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518107, China 2.Department of Spine Surgery, ShenZhen University General Hospital, ShenZhen University, Guangdong 518067, China 3.Department of Medical Aesthetic Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518107, China 4.Department of obstetrics, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518107, China 5.Department of Thoracic Surgery, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518107, China 6.Department of Rehabilitation Medicine, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518107, China References Casazza BA. Diagnosis and treatment of acute low back pain. Am Fam Physician. 2012;85(4):343-350. https://pubmed.ncbi.nlm.nih.gov/22335313. Airaksinen O, Brox JI, Cedraschi C, et al. Chapter 4 European guidelines for the management of chronic nonspecific low back pain. Eur Spine J. 2006;15(S2):S192-S300. https://doi.org/10.1007/s00586-006-1072-1. Fransen M, Woodward M, Norton R, et al. Risk factors associated with the transition from acute to chronic occupational back pain. Spine. 2002;27(1):92-98. https://doi.org/10.1097/00007632-200201010-00022. Speed C. Low back pain. BMJ. 2004;328(7448):1119-1121. https://doi.org/10.1136/bmj.328.7448.1119. Ye S, Jing Q, Wei C, Lu J. Risk factors of non-specific neck pain and low back pain in computer-using office workers in China: a cross-sectional study. BMJ Open. 2017;7(4):e014914. https://doi.org/10.1136/bmjopen-2016-014914. Martin BI, Mirza SK, Spina N, et al. Trends in Lumbar Fusion Procedure Rates and Associated Hospital Costs for Degenerative Spinal Diseases in the United States, 2004 to 2015. Spine. 2019;44(5):369-376. https://doi.org/10.1097/BRS.0000000000002822. Veresciagina K, Mehrkens A, Schären S, Jeanneret B. Minimum ten-year follow-up of spinal stenosis with degenerative spondylolisthesis treated with decompression and dynamic stabilization. J Spine Surg (Hong Kong). 2018;4(1):93-101. https://doi.org/10.21037/jss.2018.03.20. Schaeren S, Broger I, Jeanneret B. Minimum four-year follow-up of spinal stenosis with degenerative spondylolisthesis treated with decompression and dynamic stabilization. Spine. 2008;33(18):E636-E642. https://doi.org/10.1097/BRS.0b013e31817d2435. Weinstein JN, Lurie JD, Tosteson TD, et al. Surgical versus Nonsurgical Treatment for Lumbar Degenerative Spondylolisthesis. N Engl J Med. 2007;356(22):2257-2270. https://doi.org/10.1056/nejmoa070302. Weinstein JN, Lurie JD, Tosteson TD, et al. Surgical Compared with Nonoperative Treatment for Lumbar Degenerative Spondylolisthesis. J Bone Joint Surg Am. 2009;91(6):1295-1304. https://doi.org/10.2106/jbjs.h.00913. Shalaby AS, El-Sharaki DR, Salem GM. Anxiety, depression, and quality of life in backache patients before and after spinal traction. Egypt J Neurol Psychiatr Neurosurg. 2018;54(1):44. doi: 10.1186/s41983-018-0048-5. PMID: 30636866; PMCID: PMC6311179. Agnus Tom A, Rajkumar E, John R, Joshua George A. Determinants of quality of life in individuals with chronic low back pain: a systematic review. Health Psychol Behav Med. 2022;10(1):124-144. https://doi.org/10.1080/21642850.2021.2022487. PMID: 35003902; PMCID: PMC8741254. The epidemiology of back pain and its relationship with depression, psychosis, anxiety, sleep disturbances, and stress sensitivity: Data from 43 low- and middle-income countries[J].General hospital psychiatry, 2016, 43:63-70.DOI:10.1016/j.genhosppsych.2016.09.008. Hnatešen D, Pavić R, Radoš I, Dimitrijević I, Budrovac D, Čebohin M, Gusar I. Quality of Life and Mental Distress in Patients with Chronic Low Back Pain: A Cross-Sectional Study. Int J Environ Res Public Health. 2022;19(17):10657. https://doi.org/10.3390/ijerph191710657. PMID: 36078372; PMCID: PMC9518072. Miller JA, Derakhshan A, Lubelski D, et al. The impact of preoperative depression on quality of life outcomes after lumbar surgery. Spine J. 2015;15(1):58-64. https://doi.org/10.1016/j.spinee.2014.06.020. Alentado VJ, Caldwell S, Gould HP, et al. Independent predictors of a clinically significant improvement after lumbar fusion surgery. Spine J. 2017;17(2):236-243. https://doi.org/10.1016/j.spinee.2016.09.011. Merrill RK, Zebala LP, Peters C, et al. Impact of Depression on Patient-Reported Outcome Measures After Lumbar Spine Decompression. Spine. 2018;43(6):434-439. https://doi.org/10.1097/BRS.0000000000002329. Høy K, Bünger C, Niederman B, et al. Transforaminal lumbar interbody fusion (TLIF) versus posterolateral instrumented fusion (PLF) in degenerative lumbar disorders: a randomized clinical trial with 2-year follow-up. Eur Spine J. 2013;22(9):2022-2029. https://doi.org/10.1007/s00586-013-2760-2. Lee J, Kim HS, Shim KD, Park YS. The Effect of Anxiety, Depression, and Optimism on Postoperative Satisfaction and Clinical Outcomes in Lumbar Spinal Stenosis and Degenerative Spondylolisthesis Patients: Cohort Study. Clin Orthop Surg. 2017;9(2):177-183. https://doi.org/10.4055/cios.2017.9.2.177. Wahlman M, Häkkinen A, Dekker J, et al. The prevalence of depressive symptoms before and after surgery and its association with disability in patients undergoing lumbar spinal fusion. Eur Spine J. 2014;23(1):129-134. https://doi.org/10.1007/s00586-013-2896-0. Netto MB, Barranco AB, Oliveira KW, Petronilho F. Influence of anxiety and depression symptoms on the quality of life in patients undergoing lumbar spine surgery. Rev Bras Ortop. 2018;53(1):38-44. https://doi.org/10.1016/j.rboe.2017.01.009. Abbott AD, Tyni-Lenné R, Hedlund R. The influence of psychological factors on pre-operative levels of pain intensity, disability and health-related quality of life in lumbar spinal fusion surgery patients. Physiotherapy. 2010;96(3):213-221. https://doi.org/10.1016/j.physio.2009.11.013. Adogwa O, Carr K, Fatemi P, et al. Psychosocial Factors and Surgical Outcomes. Spine. 2014;39(19):1614-1619. https://doi.org/10.1097/brs.0000000000000474. Fanian H, Ghassemi GR, Jourkar M, et al. Psychological profile of Iranian patients with low-back pain. East Mediterr Health J. 2007;13(2):335-346. https://pubmed.ncbi.nlm.nih.gov/17684856. Vincent H K , Horodyski M B , Vincent K R ,et al.Psychological Distress After Orthopedic Trauma: Prevalence in Patients and Implications for Rehabilitation[J].PM & R: the journal of injury, function, and rehabilitation, 2015(7-9).DOI:10.1016/j.pmrj.2015.03.007. Scott S , Brameier D T , Tryggedsson I ,et al.Prevalence, resources, provider insights, and outcomes: a review of patient mental health in orthopaedic trauma[J].Journal of orthopaedic surgery and research, 19(1):538[2024-11-27].DOI:10.1186/s13018-024-04932-4. Ayers DC, Franklin PD, Ring DC. The role of emotional health in functional outcomes after orthopaedic surgery: extending the biopsychosocial model to orthopaedics: AOA critical issues. J Bone Joint Surg Am. 2013;95(21):e165. https://doi.org/10.2106/JBJS.L.00799. PMID: 24196477; PMCID: PMC3808180. Weinerman J, Vazquez A, Schurhoff N, Shatz C, Goldenberg B, Constantinescu D, Hernandez GM. The impacts of anxiety and depression on outcomes in orthopaedic trauma surgery: a narrative review. Ann Med Surg (Lond). 2023;85(11):5523-5527. https://doi.org/10.1097/MS9.0000000000001307. PMID: 37920654; PMCID: PMC10619579. Akutay S , Ceyhan Z .The relationship between fear of surgery and affecting factors in surgical patients[J].Perioperative Medicine, 2023, 12(1):1-8.DOI:10.1186/s13741-023-00316-0. Huskisson EC. Measurement of pain. Lancet. 1974;304(7889):1127-1131. https://doi.org/10.1016/s0140-6736(74)90884-8. Ware JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30(6):473-483. https://pubmed.ncbi.nlm.nih.gov/1593914. McHorney, C.A., Ware Jr, J.E., & Raczek, A.E. (1993). The MOS 36-item short-form health survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Medical Care, 31(3), 247-263. Gandek, B., Ware Jr, J.E., Aaronson, N.K., Apolone, G., Bjorner, J.B., Brazier, J.E., Bullinger, M., Kaasa, S., Leplege, A., & Sullivan, M. (1998). Tests of data quality, scaling assumptions, and reliability of the SF-36 in eleven countries: results from the IQOLA project. International Quality of Life Assessment. Journal of Clinical Epidemiology, 51(11), 1149-1158. Ware Jr, J.E., & Kosinski, M. (2001). Interpreting SF-36 summary health measures: A response to McHorney, Ware, and Raczek. Quality of Life Research, 10(7), 609-613. Zung, W.W. (1965). A self-rating depression scale. Arch Gen Psychiatry, 12(1), 63-70. Zung, W.W. (1971). A rating instrument for anxiety disorders and a self-rating anxiety scale. Psychosomatics, 12(6), 371-379. Biggs, J.T., Wylie, L., & Ziegler, V.E. (1980). Validity of the Zung Self-Rating Depression Scale. Br J Psychiatry, 136, 184-186. Bjelland, I., Dahl, A.A., Haug, T.T., & Neckelmann, D. (2002). The validity of the Hospital Anxiety and Depression Scale: An updated literature review. J Psychosom Res, 52(2), 69-77. Santor, D.A., & Ramsay, J.O. (1998). Progress in the measurement of subjective well-being. In D.A. Sator & J.O. Ramsay (Eds.), Quality of life and mental health: Measurement, assessment, and research (pp. 1-22). Kluwer Academic Publishers. Lee J, Kim HS, Shim KD, Park YS. The Effect of Anxiety, Depression, and Optimism on Postoperative Satisfaction and Clinical Outcomes in Lumbar Spinal Stenosis and Degenerative Spondylolisthesis Patients: Cohort Study. Clin Orthop Surg. 2017;9(2):177-183. https://doi.org/10.4055/cios.2017.9.2.177. Wahlman M, Häkkinen A, Dekker J, et al. The prevalence of depressive symptoms before and after surgery and its association with disability in patients undergoing lumbar spinal fusion. Eur Spine J. 2014;23(1):129-134. https://doi.org/10.1007/s00586-013-2896-0. Netto MB, Barranco AB, Oliveira KW, Petronilho F. Influence of anxiety and depression symptoms on the quality of life in patients undergoing lumbar spine surgery. Rev Bras Ortop. 2018;53(1):38-44. https://doi.org/10.1016/j.rboe.2017.01.009. Abbott AD, Tyni-Lenné R, Hedlund R. The influence of psychological factors on pre-operative levels of pain intensity, disability and health-related quality of life in lumbar spinal fusion surgery patients. Physiotherapy. 2010;96(3):213-221. https://doi.org/10.1016/j.physio.2009.11.013. Adogwa O, Carr K, Fatemi P, et al. Psychosocial Factors and Surgical Outcomes. Spine. 2014;39(19):1614-1619. https://doi.org/10.1097/brs.0000000000000474. Biz C, Khamisy-Farah R, Puce L, Szarpak L, Converti M, Ceylan Hİ, Crimì A, Bragazzi NL, Ruggieri P. Investigating and Practicing Orthopedics at the Intersection of Sex and Gender: Understanding the Physiological Basis, Pathology, and Treatment Response of Orthopedic Conditions by Adopting a Gender Lens: A Narrative Overview. Biomedicines. 2024;12(5):974. https://doi.org/10.3390/biomedicines12050974. PMID: 38790936; PMCID: PMC11118756. Netto MB, Barranco AB, Oliveira KW, Petronilho F. Influence of anxiety and depression symptoms on the quality of life in patients undergoing lumbar spine surgery. Rev Bras Ortop. 2018;53(1):38-44. https://doi.org/10.1016/j.rboe.2017.01.009. Abbott AD, Tyni-Lenné R, Hedlund R. The influence of psychological factors on pre-operative levels of pain intensity, disability and health-related quality of life in lumbar spinal fusion surgery patients. Physiotherapy. 2010;96(3):213-221. https://doi.org/10.1016/j.physio.2009.11.013. Adogwa O, Carr K, Fatemi P, Verla T, Gazcon G, Gottfried O, Bagley C, Cheng J. Psychosocial Factors and Surgical Outcomes. Spine. 2014;39(19):1614-1619. https://doi.org/10.1097/brs.0000000000000474. Tables Table 1 Patient baseline data Species Number of cases Number of patients 84 Sex(male/female) 42/42 Age(year) 61.67 ± 9.33 Single-level lumbar internal fixation 56 Multilevel lumbar internal fixation 28 Table 2 Correlation coefficient P and P values between the SF-36 score and the SAS and SDS scores SAS P SDS P Preoperative SF − 36 -0.02 0.876 -0.09 0.426 Postoperative SF − 36 -0.12 0.364 -0.04 0.696 Table 3 The changes of SAS, SDS, and SF-36 between Preoperative and postoperative SAS SDS SF-36 Preoperative 43.3 ± 8.8 a 39.5 ± 6.0 a 60.9 ± 6.3 a Postoperative a week 33.3 ± 3.3 b 33.8 ± 3.8 b 114.3 ± 5.3 b Postoperative 6 months 27.5 ± 2.9 c 32.2 ± 4.6 b 118.1 ± 6.9 c P < 0.001 < 0.001 < 0.001 P < 0.001 between different letters by ANCOVA adjusted for age and sex. Table 4 Normality Test Kolmogorov-Smirnova a Shapiro-Wilk Statistic Degrees of Freedom Significance Statistic Degrees of Freedom Significance Pre-surgery .076 84 .200 * .984 84 .366 1 week after surgery .073 84 .200 * .978 84 .163 6 months after surgery .073 84 .200 * .990 84 .756 *.This is the lower limit of the true significance. a. Shapiro-Wilk significance correction The normality test indicates that the SF-36 scores before surgery, one week after surgery, and six months after surgery all have significance P values greater than 0.05, which conforms to a normal distribution. Additional Declarations No competing interests reported. Cite Share Download PDF Status: Posted Version 1 posted You are reading this latest preprint version Research Square lets you share your work early, gain feedback from the community, and start making changes to your manuscript prior to peer review in a journal. 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Also discoverable on Platform About Our Team In Review Editorial Policies Advisory Board Help Center Resources Author Services Accessibility API Access RSS feed Manage Cookie Preferences © Research Square 2026 | ISSN 2693-5015 (online) Privacy Policy Terms of Service Do Not Sell My Personal Information {"props":{"pageProps":{"initialData":{"identity":"rs-6889145","acceptedTermsAndConditions":true,"allowDirectSubmit":true,"archivedVersions":[],"articleType":"Research Article","associatedPublications":[],"authors":[{"id":472862953,"identity":"1043432d-097f-4fa7-aeb1-0ff9f047bd1b","order_by":0,"name":"Chuncheung Chan","email":"","orcid":"","institution":"The Seventh Affiliated Hospital of Sun Yat-sen University","correspondingAuthor":false,"prefix":"","firstName":"Chuncheung","middleName":"","lastName":"Chan","suffix":""},{"id":472862954,"identity":"8c16d4c1-b568-48ba-af2e-c3e10ee0617a","order_by":1,"name":"Li Jiang","email":"","orcid":"","institution":"ShenZhen University General Hospital","correspondingAuthor":false,"prefix":"","firstName":"Li","middleName":"","lastName":"Jiang","suffix":""},{"id":472862955,"identity":"8c956f7c-baae-4c8b-b624-c38b6bee92be","order_by":2,"name":"Bo Zhao","email":"","orcid":"","institution":"The Seventh Affiliated Hospital of Sun Yat-sen University","correspondingAuthor":false,"prefix":"","firstName":"Bo","middleName":"","lastName":"Zhao","suffix":""},{"id":472862957,"identity":"656b57e9-2ce4-47ed-aa97-9ea87cbdb52f","order_by":3,"name":"Huijuan Jie","email":"","orcid":"","institution":"The Seventh Affiliated Hospital of Sun Yat-sen University","correspondingAuthor":false,"prefix":"","firstName":"Huijuan","middleName":"","lastName":"Jie","suffix":""},{"id":472862959,"identity":"60c0cf88-018a-4c30-a297-14f58e5873d4","order_by":4,"name":"Dirong Gu","email":"","orcid":"","institution":"The Seventh Affiliated Hospital of Sun Yat-sen University","correspondingAuthor":false,"prefix":"","firstName":"Dirong","middleName":"","lastName":"Gu","suffix":""},{"id":472862962,"identity":"33509b33-d265-4730-b78f-ab810560f8d8","order_by":5,"name":"Lisi He","email":"","orcid":"","institution":"The Seventh Affiliated Hospital of Sun Yat-sen University","correspondingAuthor":false,"prefix":"","firstName":"Lisi","middleName":"","lastName":"He","suffix":""},{"id":472862963,"identity":"9d738628-3bc6-4572-87b7-316ea72259e8","order_by":6,"name":"Pingting Zhou","email":"","orcid":"","institution":"The Seventh Affiliated Hospital of Sun Yat-sen University","correspondingAuthor":false,"prefix":"","firstName":"Pingting","middleName":"","lastName":"Zhou","suffix":""},{"id":472862964,"identity":"d93bc101-93bc-4165-b111-0d01f2223c8e","order_by":7,"name":"Wenwen Jiang","email":"data:image/png;base64,iVBORw0KGgoAAAANSUhEUgAAAZAAAAAyAQMAAABI0h/eAAAABlBMVEX///8AAABVwtN+AAAACXBIWXMAAA7EAAAOxAGVKw4bAAAA60lEQVRIiWNgGAWjYBACxmYk9gMwJUGCFmYDorQgAzYJorQwtzM/e/i1zSbP4HjvscqfbXWJ82c3MH74mIPPYWzmxrJtacUGZ86l3eZtO5y44c4BZsmZ2/BpYTCTltx2OHHbjRyz24xtBxI3SCSwMfPi1cL+Dajlf+K2+2/MCsEOm0FQC4+Z5MdtB4C28Jgx8LYxJzbcIKylTJrxX3Li/jM5xtI85w4bb7iR2IzXL4b9x7dJ/jhjlziz/Yzhxx9ldbLzZyQf/PARn5YGYEDzwO1kA5MNuNUDgTxIyQ849w9exaNgFIyCUTBCAQDjvVYOOX+VWgAAAABJRU5ErkJggg==","orcid":"","institution":"The Seventh Affiliated Hospital of Sun Yat-sen University","correspondingAuthor":true,"prefix":"","firstName":"Wenwen","middleName":"","lastName":"Jiang","suffix":""},{"id":472862965,"identity":"ff38f818-8798-40d0-ae97-4c3da5bbce79","order_by":8,"name":"Yunping Zhang","email":"","orcid":"","institution":"The Seventh Affiliated Hospital of Sun Yat-sen University","correspondingAuthor":false,"prefix":"","firstName":"Yunping","middleName":"","lastName":"Zhang","suffix":""},{"id":472862967,"identity":"af61c75a-8fe2-4d06-9e32-68bb9008762c","order_by":9,"name":"Haiyang Zheng","email":"","orcid":"","institution":"The Seventh Affiliated Hospital of Sun Yat-sen University","correspondingAuthor":false,"prefix":"","firstName":"Haiyang","middleName":"","lastName":"Zheng","suffix":""}],"badges":[],"createdAt":"2025-06-13 14:38:26","currentVersionCode":1,"declarations":"","doi":"10.21203/rs.3.rs-6889145/v1","doiUrl":"https://doi.org/10.21203/rs.3.rs-6889145/v1","draftVersion":[],"editorialEvents":[],"editorialNote":"","failedWorkflow":false,"files":[{"id":85383117,"identity":"83f5b9de-3bed-4a39-9243-ec3c75420b5c","added_by":"auto","created_at":"2025-06-25 09:34:12","extension":"png","order_by":1,"title":"Figure 1","display":"","copyAsset":false,"role":"figure","size":38225,"visible":true,"origin":"","legend":"\u003cp\u003ePreoperative and postoperative psychological status assessment\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-6889145/v1/bcc6afe29e7351a611f99a5f.png"},{"id":85385690,"identity":"bbab0478-27db-47d2-8fa1-3ee2518287e8","added_by":"auto","created_at":"2025-06-25 09:50:12","extension":"png","order_by":2,"title":"Figure 2","display":"","copyAsset":false,"role":"figure","size":38225,"visible":true,"origin":"","legend":"\u003cp\u003ePreoperative and postoperative psychological status assessment\u003c/p\u003e","description":"","filename":"floatimage1.png","url":"https://assets-eu.researchsquare.com/files/rs-6889145/v1/7bc8e5f1b0b1d47788e70757.png"},{"id":85813341,"identity":"b538df6f-7bd1-4305-912b-30e02439fc53","added_by":"auto","created_at":"2025-07-02 04:31:35","extension":"pdf","order_by":0,"title":"","display":"","copyAsset":false,"role":"manuscript-pdf","size":883494,"visible":true,"origin":"","legend":"","description":"","filename":"manuscript.pdf","url":"https://assets-eu.researchsquare.com/files/rs-6889145/v1/eb1a8e7f-c6e0-47a9-b907-eee66c102c5c.pdf"}],"financialInterests":"No competing interests reported.","formattedTitle":"The Role and Practice of Medical Humanistic Nursing in the Psychological Management of Patients with Lumbar Spine Internal Fixation during the Perioperative Period","fulltext":[{"header":"What does this paper contribute to the global clinical community?","content":"\u003cp\u003eThis paper contributes to the global clinical community by highlighting the importance of addressing the psychological well-being of patients undergoing lumbar spinal fixation surgery. It provides evidence-based insights into the changes in anxiety and depression levels before and after surgery, and the impact of these psychological states on patient outcomes. Here are the key contributions:\u003c/p\u003e\n\u003cp\u003e1. Identification of Psychological Needs: The study identifies that patients undergoing lumbar spinal fixation surgery experience significant anxiety and depression during the perioperative period, emphasizing the need for psychological support in clinical practice.\u003c/p\u003e\n\u003cp\u003e2. Humanistic Nursing Interventions: It demonstrates the effectiveness of humanistic nursing interventions in reducing anxiety and depression, and improving the overall quality of life for patients post-surgery.\u003c/p\u003e\n\u003cp\u003e3. Gender Differences in Psychological Health: The paper highlights gender differences in mental health outcomes, showing that female patients tend to have higher levels of anxiety and depression. This information can help healthcare providers tailor their support to better address the needs of female patients.\u003c/p\u003e\n\u003cp\u003e4. Importance of Postoperative Recovery: The study underscores the significance of postoperative care that includes psychological support, which can contribute to better functional outcomes and overall well-being.\u003c/p\u003e\n\u003cp\u003e5. Proactive Mental Health Screening: By showing the correlation between chronic pain and poor mental health, the paper advocates for proactive mental health screening and intervention in patients with chronic conditions like lumbar spinal diseases.\u003c/p\u003e\n\u003cp\u003e6. Quality of Life Improvement: It provides evidence that with improved postoperative functional status, there is a significant decrease in chronic waist pain, leg pain, anxiety, and depression, which can influence healthcare policies and protocols to include mental health as a crucial component of recovery.\u003c/p\u003e\n\u003cp\u003e7. Nurse-Led Initiatives: The paper contributes to the understanding that nurses can play a leading role in implementing psychological interventions, which can reduce psychological distress and enhance postoperative rehabilitation and quality of life for patients undergoing lumbar internal fixation.\u003c/p\u003e\n\u003cp\u003eThese contributions are essential for developing comprehensive care plans that consider not only the physical aspects but also the mental and emotional well-being of patients undergoing major surgical procedures like lumbar spinal fixation.\u003c/p\u003e"},{"header":"1. Introduction and Background","content":"\u003cp\u003eLower back disorders frequently cause either acute or chronic pain for patients, which might be episodic or constant. Prolonged pain substantially affects the quality of life (QOL) of patients, potentially leading to detrimental mental health outcomes\u003csup\u003e[\u003cspan additionalcitationids=\"CR2\" citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eLower back pain is typically marked by stiffness, pain, and muscle tension in the lumbar area, often accompanied by radiating discomfort down the legs\u003csup\u003e[\u003cspan citationid=\"CR1\" class=\"CitationRef\"\u003e1\u003c/span\u003e]\u003c/sup\u003e.It's estimated that approximately 70% of the adult population in developed nations have experienced lower back pain \u003csup\u003e[\u003cspan citationid=\"CR2\" class=\"CitationRef\"\u003e2\u003c/span\u003e]\u003c/sup\u003e, particularly among men aged 40 years and above and women aged 50 years and above\u003csup\u003e[\u003cspan citationid=\"CR3\" class=\"CitationRef\"\u003e3\u003c/span\u003e]\u003c/sup\u003e.Lumbar fusion surgery serves as a therapeutic approach for conditions like lumbar instability, herniated discs, spinal stenosis, and other prevalent causes of lower back pain. As an advanced surgical intervention, lumbar fusion has been shown to effectively address degenerative diseases of the lumbar spine\u003csup\u003e[\u003cspan additionalcitationids=\"CR5 CR6\" citationid=\"CR4\" class=\"CitationRef\"\u003e4\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR7\" class=\"CitationRef\"\u003e7\u003c/span\u003e]\u003c/sup\u003e.Over the last decade, around 200,000 lumbar fusions were carried out annually on a global scale\u003csup\u003e[\u003cspan citationid=\"CR8\" class=\"CitationRef\"\u003e8\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn the perioperative phase for patients undergoing lumbar surgery, the prevalence of anxiety and depression is notably high. Studies indicate that prolonged or episodic pain exceeding three months can trigger detrimental mental health conditions, such as depression\u003csup\u003e[\u003cspan citationid=\"CR9\" class=\"CitationRef\"\u003e9\u003c/span\u003e]\u003c/sup\u003e, and up to 85% of chronic pain sufferers might develop severe depression\u003csup\u003e[\u003cspan citationid=\"CR10\" class=\"CitationRef\"\u003e10\u003c/span\u003e]\u003c/sup\u003e.There are reports in the literature that persistent lower back pain can affect the quality of life of patients and exacerbate depressive symptoms\u003csup\u003e[\u003cspan additionalcitationids=\"CR12 CR13\" citationid=\"CR11\" class=\"CitationRef\"\u003e11\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR14\" class=\"CitationRef\"\u003e14\u003c/span\u003e]\u003c/sup\u003e.Patients undergoing lumbar spinal fixation surgery often face an extended disease trajectory, which may manifest in persistent pain and associated negative emotional states, including depression. Chronic lower back pain, characterized by neural root compression, leg pain, numbness, or discomfort, can exacerbate depressive symptoms due to the relentless nature of the condition. Much of the current literature centers on the influence of preoperative psychological status on postoperative outcomes in lumbar fusion surgery patients. Some studies suggest that individuals presenting with preoperative anxiety and depression tend to report lower anxiety and/or depression levels post-surgery, higher satisfaction with the procedure, and improved quality of life scores relative to those without pre-existing mental health comorbidities\u003csup\u003e[\u003cspan additionalcitationids=\"CR16 CR17 CR18 CR19 CR20 CR21\" citationid=\"CR15\" class=\"CitationRef\"\u003e15\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR22\" class=\"CitationRef\"\u003e22\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eHowever, conflicting results also exist, indicating a nuanced relationship between preoperative mental health and postoperative outcomes\u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eA retrospective comparative analysis revealed that patients with elevated preoperative depression scores experienced a significantly higher dissatisfaction rate two years post-lumbar decompression and internal fixation fusion surgery, along with a higher likelihood of recurrent spinal stenosis surgery (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01)\u003csup\u003e[\u003cspan citationid=\"CR23\" class=\"CitationRef\"\u003e23\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eFurthermore, studies have documented that between 16.4\u0026ndash;73.3% of lower back pain patients, including those with depression, may face poor prognoses due to adverse mental state\u003csup\u003e[\u003cspan citationid=\"CR24\" class=\"CitationRef\"\u003e24\u003c/span\u003e]\u003c/sup\u003e.In recent years, with the World Health Organization's new definition of health (which includes good physical, mental, and social functioning), high-quality care services and the concept of \"patient-centered\" humanistic care have gained popularity. Nursing work is no longer limited to basic care procedures and professional nursing skills. Nurses apply relevant professional knowledge to manage specific patient impairments, eliminate or reduce adverse mental states, help patients maintain a positive attitude towards their illness, cooperate actively in medical rehabilitation, and significantly improve their prognosis and quality of life\u003csup\u003e[\u003cspan citationid=\"CR25\" class=\"CitationRef\"\u003e25\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR26\" class=\"CitationRef\"\u003e26\u003c/span\u003e]\u003c/sup\u003e.Orthopedic nursing has its particularity. Studies show that a considerable portion of orthopedic patients with mental health issues mainly manifest interpersonal sensitivity, depression, anxiety, hostility, or paranoia\u003csup\u003e[\u003cspan citationid=\"CR27\" class=\"CitationRef\"\u003e27\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR28\" class=\"CitationRef\"\u003e28\u003c/span\u003e]\u003c/sup\u003e.Since orthopedic surgery is one of the most important treatments, it introduces new sources of trauma and stress that may exacerbate negative mental and emotional states. For patients achieving therapeutic benefits, it has a significant impact on improving their quality of life\u003csup\u003e[\u003cspan citationid=\"CR29\" class=\"CitationRef\"\u003e29\u003c/span\u003e]\u003c/sup\u003e.The fear of surgery, even some emergencies like hypertension, arrhythmia, and endocrine disorders, plays a role in this context. The psychological health status of patients after lumbar spinal fixation surgery is crucial to their recovery process. Medical humanities nursing interventions play an indispensable role in this link. Such interventions involve not only close attention to the patient's physical condition but also a deep understanding and active response to the patient's psychological needs. By providing emotional support, psychological counseling, and personalized care plans, nursing staff can help patients alleviate negative emotions such as anxiety, fear, and depression that may occur after surgery, and enhance their confidence in treatment and active participation in the recovery process. In addition, humanities nursing interventions can also improve patient satisfaction and trust by establishing good nurse-patient communication, which has a significant impact on promoting the overall health and quality of life of patients. Therefore, valuing and implementing medical humanities nursing interventions has immeasurable value for the psychological health and recovery outcomes of patients after lumbar spinal fixation surgery. This study aims to delve deeper into the methods for improving patients' anxiety and depression levels before and after lumbar internal fixation surgery and to analyze the role of humanistic care in enhancing patient anxiety and depression relief.\u003c/p\u003e"},{"header":"2. Methods","content":"\u003ch4\u003e2.1 Sample Exclusion criteria:\u003c/h4\u003e\n\u003col class=\"decimal_type\"\u003e\n \u003cli\u003ePatients undergoing surgery for trauma, tumors, or revision of lumbar arthrodesis;\u003c/li\u003e\n \u003cli\u003eCases complicated with other serious diseases;\u003c/li\u003e\n \u003cli\u003eA past or family history of mental illness;\u003c/li\u003e\n \u003cli\u003eHistory of other systemic diseases;\u003c/li\u003e\n \u003cli\u003eOther circumstances that were not suitable for the study;\u003c/li\u003e\n \u003cli\u003eRefusal to participate in the research;\u003c/li\u003e\n \u003cli\u003eInability to complete the questionnaire and follow-up due to illiteracy.\u003c/li\u003e\n\u003c/ol\u003e\n\u003ch4\u003e2.1.2 Consent Form \u0026amp; Questionnaire\u003c/h4\u003e\n\u003cp\u003eAfter signing their informed consent, all patients answered questionnaires. The evaluation time points were selected to occur before surgery, 1 month after surgery, and 6 months after surgery.\u003c/p\u003e\n\u003cp\u003e2.2 \u0026nbsp; Humanistic Nursing Interventions\u003c/p\u003e\n\u003cp\u003e2.2.1 Creation of Humanistic Nursing Atmosphere\u003c/p\u003e\n\u003col class=\"decimal_type\"\u003e\n \u003cli\u003ePreoperative Encouragement Cards are placed for patients awaiting surgery, clearly inscribed with warm messages like \u0026quot;Wish you a smooth surgery!\u0026quot; to deliver positive psychological.\u003c/li\u003e\n \u003cli\u003eThe ward environment is optimized through soft lighting, green plant decorations, and temperature-humidity regulation to create a cozy and comfortable inpatient space.\u003c/li\u003e\n \u003cli\u003ePersonalized portable support tools such as reading glasses, bedside commodes, and chargers are provided to address patients\u0026apos; practical daily needs.\u003c/li\u003e\n \u003cli\u003eA \u0026quot;Ward Reading Corner\u0026quot; is established with selected science popularization materials, relaxing magazines, and psychological guidance manuals for family members, aiming to alleviate preoperative anxiety for both patients and their families.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e2.2.2 Multidimensional Support and Collaboration\u003c/p\u003e\n\u003col class=\"decimal_type\"\u003e\n \u003cli\u003eWhole-course Psychological Care System: Psychological status is assessed through one-on-one communication, with emotional counseling provided. Pain management knowledge lectures are conducted, combining graphic materials and model demonstrations to guide patients in mastering postoperative analgesia techniques and key points of rehabilitation training.\u003c/li\u003e\n \u003cli\u003eInterdisciplinary Joint Rounding Mechanism: A joint team with the Department of Medical Humanities conducts weekly rounds, dynamically tracking patients\u0026apos; psychological needs through interviews and establishing comprehensive \u0026quot;physiological-psychological-social\u0026quot; assessment files.\u003c/li\u003e\n \u003cli\u003eSocial Support Network Construction: Social workers and volunteers are invited to provide companion care services, such as preoperative conversation and postoperative daily care assistance, to strengthen the patients\u0026apos; emotional support system.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e2.2.3 Narrative Nursing and Dynamic Recording\u003c/p\u003e\n\u003col class=\"decimal_type\"\u003e\n \u003cli\u003eNarrative Nursing Practice: Structured interviews are used to guide patients in expressing their disease experiences and psychological feelings. The \u0026quot;story retelling\u0026quot; technique is applied to help them reconstruct positive cognition and enhance confidence in treatment.\u003c/li\u003e\n \u003cli\u003eHumanistic Nursing Log System: Responsible nurses record patients\u0026apos; emotional fluctuations, needs responses, and intervention effects daily, forming a continuous psychological care trajectory to provide a basis for adjusting personalized nursing plans.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e2.3 Measurement Tools\u003c/p\u003e\n\u003cp\u003e2.3.1 Pain Assessment\u003c/p\u003e\n\u003cp\u003ePain was assessed on a visual analog scale (VAS) on a scale of 0 to 10, with 0 indicating no pain and 10 indicating unbearable pain, and respondents indicated the maximum intensity of their pain when filling out the questionnaire\u003csup\u003e[30]\u003c/sup\u003e.\u0026nbsp;\u003c/p\u003e\n\u003cp\u003e2.3.2 Health Status Assessment\u003c/p\u003e\n\u003cp\u003eThe Short Form of Health Status Survey (SF-36) is used to evaluate clinical outcomes and quality of life\u003csup\u003e[31]\u003c/sup\u003e. Paired t-tests compared SF-36 scores at different time points for the same patient. The internal consistency reliability (Cronbach\u0026apos;s \u0026alpha;) of the SF-36 questionnaire ranges from 0.70 to 0.91, indicating good internal consistency. Furthermore, the split-half reliability of the SF-36 questionnaire is 0.971, suggesting that the scale has stable measurement properties\u003csup\u003e[31-34]\u003c/sup\u003e.\u003c/p\u003e\n\u003cp\u003e2.3.3 Depression and Anxiety Assessment\u003c/p\u003e\n\u003cp\u003e\u0026nbsp;Zung\u0026apos;s Self-Rating Depression Scale (SDS) and Zung\u0026apos;s Self-Rating Anxiety Scale (SAS) were used to assess depression and anxiety\u0026nbsp;\u003csup\u003e[35]\u003c/sup\u003e. The SDS scale has good reliability and validity, and can reliably assess the severity of individual depressive symptoms. In a study, the Cronbach\u0026apos;s \u0026alpha; coefficient of the SDS scale was not explicitly provided, but it was mentioned that the SDS scale is simple to use and has high reliability\u003csup\u003e[36-39]\u003c/sup\u003e. The cutoff value of the SDS standard score is 53, including 53-62 for mild depression, 63-72 for moderate depression, and 73 or more for severe depression. The internal consistency (Cronbach\u0026apos;s \u0026alpha;) of the SAS scale is 0.897, and the test-retest reliability (SmATIC\u0026nbsp;Correlation Coefficient, ICC) is 0.913, indicating a high level of reliability. Furthermore, the SAS scale has been validated in multiple studies, demonstrating good internal consistency and validity\u003csup\u003e[35-36]\u003c/sup\u003e. The standard deviation of the SAS score is 50 points, with 50 to 59 being mild anxiety, 60 to 69 being moderate anxiety, and 69 or more being severe anxiety.\u003c/p\u003e\n\u003cp\u003eApplied paired t-tests to statistically compare patients\u0026apos; SAS and SDS scores preoperatively and postoperatively at 1 week and 6 months to determine changes in anxiety and depression levels over time.\u003c/p\u003e\n\u003cp\u003e2.4 Surgical procedures\u003c/p\u003e\n\u003col class=\"decimal_type\"\u003e\n \u003cli\u003eThe same surgical team operated on all patients.\u003c/li\u003e\n \u003cli\u003eAfter general anesthesia, the patient was placed in the prone position, and a posterior midline incision was made.\u003c/li\u003e\n \u003cli\u003eAfter exposure was completed, laminectomy, discectomy, nerve decompression, autogenous bone graft fusion with an interbody fusion cage were performed, and finally, the connecting rod was installed, followed by layer-by-layer suture, drainage, and bandaging.\u003c/li\u003e\n\u003c/ol\u003e\n\u003cp\u003e2.5 Data analysis\u003c/p\u003e\n\u003cp\u003eSPSS 22.0 statistical software was used for data analysis. Data are expressed as the mean \u0026plusmn; standard deviation, and Spearman\u0026rsquo;s test was used to analyze the correlation between SDS, SAS, VAS and SF-36. The statistical significance level was 5% (P \u0026lt;0.05 was statistically significant).\u003c/p\u003e"},{"header":"3. Results","content":"\u003cdiv id=\"Sec24\" class=\"Section2\"\u003e \u003ch2\u003e3.1 General information description\u003c/h2\u003e \u003cp\u003eA total of 84 patients were included in this study, including 42 males and 42 females. Their age ranged from 45 to 78 years, with a mean of 61.67\u0026thinsp;\u0026plusmn;\u0026thinsp;9.33 years. Among them, 56 underwent single-level lumbar internal fixation, and 28 underwent double-level lumbar internal fixation (Table\u0026nbsp;\u003cspan refid=\"Tab1\" class=\"InternalRef\"\u003e1\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec25\" class=\"Section2\"\u003e \u003ch2\u003e3.2 Assessment of psychological state\u003c/h2\u003e \u003cp\u003eThe preoperative anxiety SAS score was 43.38\u0026thinsp;\u0026plusmn;\u0026thinsp;8.85 points, including 17 patients with preoperative anxiety (20.23%) and 6 patients with moderate anxiety (7.14%). One week after surgery, the anxiety score decreased significantly (33.35\u0026thinsp;\u0026plusmn;\u0026thinsp;3.32 points, P\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and continued to decrease to 27.55\u0026thinsp;\u0026plusmn;\u0026thinsp;2.92 points 6 months after surgery (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01). There were 5 patients with depression before surgery (5.95%), and the preoperative depression score of the included patients was 39.60\u0026thinsp;\u0026plusmn;\u0026thinsp;6.01 points, which decreased to 33.81\u0026thinsp;\u0026plusmn;\u0026thinsp;3.87 points one week after surgery (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01) and 32.30\u0026thinsp;\u0026plusmn;\u0026thinsp;4.65 points six months after surgery (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01) (Fig.\u0026nbsp;1). After conducting paired t-tests, it was found that the SAS and SDS scores of the patients significantly decreased from pre-operation to 6 months post-operation. This indicates that the implementation of humanistic care measures has effectively alleviated the anxiety and depressive symptoms of the patients.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec26\" class=\"Section2\"\u003e \u003ch2\u003e3.3 Functional status evaluation\u003c/h2\u003e \u003cp\u003eSF-36 scores were used to assess patients' functional status, including the SF-36 Score SmATIC (SF-S) and SF-36 Score Mental (SF-M). The preoperative SF-36 score was 60.94\u0026thinsp;\u0026plusmn;\u0026thinsp;6.38, including 31.75\u0026thinsp;\u0026plusmn;\u0026thinsp;5.02 for SF-S and 29.19\u0026thinsp;\u0026plusmn;\u0026thinsp;3.96 for SF-M. The patient's functional status was significantly improved 1 week after surgery, the SF-36 score was improved to 114.32\u0026thinsp;\u0026plusmn;\u0026thinsp;5.34 points (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01), and the SF-36 score was 118.06\u0026thinsp;\u0026plusmn;\u0026thinsp;6.98 points at 6 months after surgery (Fig.\u0026nbsp;2). The SF-36 scores of the patients were compared before surgery, 1 week post-surgery, and 6 months post-surgery using paired t-tests. The study findings indicated a significant improvement (P\u0026thinsp;\u0026lt;\u0026thinsp;0.01) in the SF-36 scores both 1 week and 6 months post-surgery compared to pre-surgery, suggesting that following surgical treatment and humanistic care, there was a notable enhancement in the overall functional status of the patients. (Table\u0026nbsp;\u003cspan refid=\"Tab2\" class=\"InternalRef\"\u003e2\u003c/span\u003e) (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e) (Table\u0026nbsp;\u003cspan refid=\"Tab4\" class=\"InternalRef\"\u003e4\u003c/span\u003e)\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec27\" class=\"Section2\"\u003e \u003ch2\u003e3.4 Relationship between Preoperative and Postoperative Assessments with Depression, Anxiety, and Functional Status\u003c/h2\u003e \u003cp\u003eAnxiety (SAS) Scores: Preoperatively, the average SAS score was 43.3 with a standard deviation of 8.8. After one week postoperatively, the average score decreased to 33.3, with a standard deviation of 3.3. Six months postoperatively, it further declined to 27.5, with a standard deviation of 2.9. A p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001 indicates significant differences in SAS scores compared to preoperatively, suggesting a notable decrease after one week and six months postoperatively.\u003c/p\u003e \u003cp\u003eDepression (SDS) Scores: Preoperatively, the average SDS score was 39.5, with a standard deviation of 6.02. One week postoperatively, the average increased to 33.8, with a standard deviation of 3.8. Six months postoperatively, it further rose to 32.2, with a standard deviation of 4.6. A p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001 signifies significant differences compared to preoperatively, indicating an increase in SDS scores postoperatively.\u003c/p\u003e \u003cp\u003eSF-36 Scores: Preoperatively, the average SF-36 score was 60.9, with a standard deviation of 6.3. One week postoperatively, it significantly increased to 114.3, with a standard deviation of 5.3. Six months postoperatively, it further improved to 118.1, with a standard deviation of 6.9. A p-value\u0026thinsp;\u0026lt;\u0026thinsp;0.001 suggests significant improvements compared to preoperatively, reflecting enhanced overall health-related quality of life postoperatively.\u003c/p\u003e \u003cp\u003eAnalysis Results: A reduction in SAS and SDS scores indicates a decrease in anxiety and depressive symptoms among postoperative patients, which may be closely related to humanistic care alleviating surgical stress. An improvement in the SF-36 scores postoperatively indicates a positive change in patients' overall health-related quality of life, which is closely related to the implementation of humanistic care during the perioperative period. The significant improvement in scores from one week postoperatively onwards, and its persistence up to six months postoperatively, even with further enhancement, underscores the effectiveness of care provided.\u003c/p\u003e \u003c/div\u003e \u003cdiv id=\"Sec28\" class=\"Section2\"\u003e \u003ch2\u003e3.5 Gender Differences:\u003c/h2\u003e \u003cp\u003eThe analysis reveals that female patients had significantly higher SAS and SDS scores preoperatively, one week postoperatively, and six months postoperatively compared to male patients. Female patients also exhibited lower SF-36 scores postoperatively, one week and six months, indicating a slower recovery in functional status. This highlights the importance of humanistic care in supporting the mental health of female patients (Table\u0026nbsp;\u003cspan refid=\"Tab3\" class=\"InternalRef\"\u003e3\u003c/span\u003e).\u003c/p\u003e \u003c/div\u003e"},{"header":"4. Discussion","content":"\u003cp\u003eThe purpose of this study was to analyze the changes and causes of adverse psychological status before and after lumbar internal fixation surgery. We found that depression and anxiety improved significantly after lumbar spine disease and were inversely, but not significantly, related to daily functioning.\u003c/p\u003e \u003cp\u003eThere was preoperative anxiety in 20.23% of the patients in this study, and nearly 6% of the patients had depression. When chronic pain improved significantly after surgery, the depression and anxiety scores of all patients returned to normal levels, which also indicates that chronic pain may lead to depression, anxiety and other adverse states.\u003c/p\u003e \u003cp\u003eAt the same time, nurses actively pay attention to the negative psychology of patients and proactively implement humanistic nursing interventions in collaboration with the Department of Medical Humanities, which can also alleviate patients' anxiety and depressive mood\u003csup\u003e[\u003cspan additionalcitationids=\"CR41 CR42 CR43\" citationid=\"CR40\" class=\"CitationRef\"\u003e40\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR44\" class=\"CitationRef\"\u003e44\u003c/span\u003e]\u003c/sup\u003e.\u003c/p\u003e \u003cp\u003eIn addition, Gender is also one of the factors affecting unhealthy psychology, with women being more prone to depression, anxiety, and other negative emotions than men. Some scholars believe that women are more sensitive and vulnerable, hence they are more susceptible to external stimuli, leading to unhealthy negative emotions such as depression and anxiety\u003csup\u003e[\u003cspan citationid=\"CR45\" class=\"CitationRef\"\u003e45\u003c/span\u003e]\u003c/sup\u003e.Humanistic care is particularly important for the psychological support of female patients.\u003c/p\u003e \u003cp\u003e Positive and effective nursing of patients receiving postoperative rehabilitation influenced by psychological intervention is considered to improve quality of life, through communication, body language, initiation of contact with patients, and treating patients with consideration according to their different situations. One aim of psychological counseling is to guide patients in eliminating psychological barriers preoperatively and postoperatively alleviate pain\u003csup\u003e[\u003cspan additionalcitationids=\"CR47\" citationid=\"CR46\" class=\"CitationRef\"\u003e46\u003c/span\u003e\u0026ndash;\u003cspan citationid=\"CR48\" class=\"CitationRef\"\u003e48\u003c/span\u003e]\u003c/sup\u003e. Rehabilitation exercise actively encourages and instructs patients in early getting-out-of-bed activities and comprehensively promotes the early recovery of patients.\u003c/p\u003e"},{"header":"5. Conclusion","content":"\u003cp\u003ePatients with lumbar degenerative diseases have depression and anxiety during the perioperative period due to long-term lumbar and leg pain or lower limb numbness, weakness and discomfort, among which anxiety and depression disorders are more common. In addition, Chronic pain often triggers a cascade of negative mental health impacts, including depression and anxiety, which can exacerbate physical symptoms and hinder recovery. In the realm of clinical care, there's an urgent need to heighten our vigilance towards recognizing and addressing the psychological distress in patients. By prioritizing proactive mental health interventions, we can significantly enhance clinical outcomes. The integration of humanistic nursing practices, in conjunction with the expertise from the Department of Medical Humanities, is indispensable for the holistic rehabilitation of patients undergoing orthopedic surgery. This approach not only acknowledges the psychological dimensions of healing but also actively engages in the identification and alleviation of patients' negative psychological states. It fosters a supportive environment that promotes emotional well-being, thereby contributing to a more comprehensive and effective recovery process.\u003c/p\u003e"},{"header":"6. Relevance to clinical practice","content":"\u003cp\u003eDepression and anxiety are common in people with lumbar degenerative diseases because they have long-term back and leg pain, numbness, or weakness in their lower legs. Chronic waist pain, leg pain, anxiety and depression will decrease significantly as postoperative functional status improves. Nurses should pay attention to the existence of adverse psychological outcomes in clinical nursing work, actively implement humanistic nursing interventions, and positively influence patient outcomes. Active and effective nurse-led psychological interventions should be implemented to reduce the psychological distress of perioperative patients with lumbar internal fixation, improve their postoperative rehabilitation and quality of life.\u003c/p\u003e "},{"header":"Declarations","content":" \u003cp\u003e\u003cstrong\u003ePatient or public contribution:\u0026nbsp;\u003c/strong\u003ePatients and their families fully understand the study concept and design before receiving the survey. The target patients were discreetly investigated by the investigators 1 week before surgery, 1 week after surgery, and 6 months after surgery. For the study subjects discharged after surgery, the care-givers participating in the study will regularly participate in telephone visits and outpatient follow-ups, and the SF-36 score, the Zung\u0026apos;s depression self-rating scale score, and the Zung\u0026apos;s anxiety self-rating scale score will be examined.\u003c/p\u003e\u003cp\u003e\u003cstrong\u003eAcknowledgements\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor contributions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eC.C. (Chuncheung Chan), L.J. (Li Jiang), and B.Z. (Bo Zhao) contributed equally as first authors. C.C., L.J., and B.Z. designed the study, collected and analyzed data, and drafted the initial manuscript. H.J. (Huijuan Jie) and D.G. (Dirong Gu) contributed to data interpretation and critical revision of the manuscript. L.H. (Lisi He) and P.Z. (Pingting Zhou) assisted in experimental validation and manuscript editing. Y.Z. (Yunping Zhang) supervised the research methodology and provided technical support. H.Z. (Haiyang Zheng) and W.J. (Wenwen Jiang) oversaw the project, coordinated authors, and finalized the manuscript as corresponding authors. All authors reviewed and approved the final version of the manuscript.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eFunding\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eNone.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eData availability\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe datasets used and analyzed in this study are available from the corresponding author upon reasonable request.\u003c/p\u003e\n\u003cp\u003eEthics approval and consent to participate: This study was conducted in accordance with the principles of the 1975 Declaration of Helsinki and was approved by the Ethics Committee of The Seventh Affiliated Hospital of Sun Yat - sen University (Approval No.: KY-2025-013-01). All study participants provided oral informed consent.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConsent for publication\u003c/strong\u003e:\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eNot applicable.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eCompeting interests:\u0026nbsp;\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThe authors declare that they have no competing interests.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eAuthor details\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e1.Department of Orthopedic Surgery, The Seventh Affiliated Hospital, Sun Yat-sen\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eUniversity, Shenzhen 518107, China\u003c/p\u003e\n\u003cp\u003e2.Department of Spine Surgery, ShenZhen University General Hospital, ShenZhen University, Guangdong 518067, China\u003c/p\u003e\n\u003cp\u003e3.Department of Medical Aesthetic Center, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518107, China\u003c/p\u003e\n\u003cp\u003e4.Department of obstetrics, The Seventh Affiliated Hospital, Sun Yat-sen\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eUniversity, Shenzhen 518107, China\u003c/p\u003e\n\u003cp\u003e5.Department of Thoracic Surgery, The Seventh Affiliated Hospital, Sun Yat-sen\u0026nbsp;\u003c/p\u003e\n\u003cp\u003eUniversity, Shenzhen 518107, China\u003c/p\u003e\n\u003cp\u003e6.Department of Rehabilitation Medicine, The Seventh Affiliated Hospital, Sun Yat-sen University, Shenzhen 518107, China\u003c/p\u003e"},{"header":"References","content":"\u003col\u003e\n\u003cli\u003eCasazza BA. Diagnosis and treatment of acute low back pain. Am Fam Physician. 2012;85(4):343-350. https://pubmed.ncbi.nlm.nih.gov/22335313.\u003c/li\u003e\n\u003cli\u003eAiraksinen O, Brox JI, Cedraschi C, et al. Chapter 4 European guidelines for the management of chronic nonspecific low back pain. Eur Spine J. 2006;15(S2):S192-S300. https://doi.org/10.1007/s00586-006-1072-1.\u003c/li\u003e\n\u003cli\u003eFransen M, Woodward M, Norton R, et al. Risk factors associated with the transition from acute to chronic occupational back pain. Spine. 2002;27(1):92-98. https://doi.org/10.1097/00007632-200201010-00022.\u003c/li\u003e\n\u003cli\u003eSpeed C. Low back pain. BMJ. 2004;328(7448):1119-1121. https://doi.org/10.1136/bmj.328.7448.1119.\u003c/li\u003e\n\u003cli\u003eYe S, Jing Q, Wei C, Lu J. Risk factors of non-specific neck pain and low back pain in computer-using office workers in China: a cross-sectional study. BMJ Open. 2017;7(4):e014914. https://doi.org/10.1136/bmjopen-2016-014914.\u003c/li\u003e\n\u003cli\u003eMartin BI, Mirza SK, Spina N, et al. Trends in Lumbar Fusion Procedure Rates and Associated Hospital Costs for Degenerative Spinal Diseases in the United States, 2004 to 2015. Spine. 2019;44(5):369-376. https://doi.org/10.1097/BRS.0000000000002822.\u003c/li\u003e\n\u003cli\u003eVeresciagina K, Mehrkens A, Sch\u0026auml;ren S, Jeanneret B. Minimum ten-year follow-up of spinal stenosis with degenerative spondylolisthesis treated with decompression and dynamic stabilization. J Spine Surg (Hong Kong). 2018;4(1):93-101. https://doi.org/10.21037/jss.2018.03.20.\u003c/li\u003e\n\u003cli\u003eSchaeren S, Broger I, Jeanneret B. Minimum four-year follow-up of spinal stenosis with degenerative spondylolisthesis treated with decompression and dynamic stabilization. Spine. 2008;33(18):E636-E642. https://doi.org/10.1097/BRS.0b013e31817d2435.\u003c/li\u003e\n\u003cli\u003eWeinstein JN, Lurie JD, Tosteson TD, et al. Surgical versus Nonsurgical Treatment for Lumbar Degenerative Spondylolisthesis. N Engl J Med. 2007;356(22):2257-2270. https://doi.org/10.1056/nejmoa070302.\u003c/li\u003e\n\u003cli\u003eWeinstein JN, Lurie JD, Tosteson TD, et al. Surgical Compared with Nonoperative Treatment for Lumbar Degenerative Spondylolisthesis. J Bone Joint Surg Am. 2009;91(6):1295-1304. https://doi.org/10.2106/jbjs.h.00913.\u003c/li\u003e\n\u003cli\u003eShalaby AS, El-Sharaki DR, Salem GM. Anxiety, depression, and quality of life in backache patients before and after spinal traction. Egypt J Neurol Psychiatr Neurosurg. 2018;54(1):44. doi: 10.1186/s41983-018-0048-5. PMID: 30636866; PMCID: PMC6311179.\u003c/li\u003e\n\u003cli\u003eAgnus Tom A, Rajkumar E, John R, Joshua George A. Determinants of quality of life in individuals with chronic low back pain: a systematic review. Health Psychol Behav Med. 2022;10(1):124-144. https://doi.org/10.1080/21642850.2021.2022487. PMID: 35003902; PMCID: PMC8741254.\u003c/li\u003e\n\u003cli\u003eThe epidemiology of back pain and its relationship with depression, psychosis, anxiety, sleep disturbances, and stress sensitivity: Data from 43 low- and middle-income countries[J].General hospital psychiatry, 2016, 43:63-70.DOI:10.1016/j.genhosppsych.2016.09.008.\u003c/li\u003e\n\u003cli\u003eHnate\u0026scaron;en D, Pavić R, Rado\u0026scaron; I, Dimitrijević I, Budrovac D, Čebohin M, Gusar I. Quality of Life and Mental Distress in Patients with Chronic Low Back Pain: A Cross-Sectional Study. Int J Environ Res Public Health. 2022;19(17):10657. https://doi.org/10.3390/ijerph191710657. PMID: 36078372; PMCID: PMC9518072.\u003c/li\u003e\n\u003cli\u003eMiller JA, Derakhshan A, Lubelski D, et al. The impact of preoperative depression on quality of life outcomes after lumbar surgery. Spine J. 2015;15(1):58-64. https://doi.org/10.1016/j.spinee.2014.06.020.\u003c/li\u003e\n\u003cli\u003eAlentado VJ, Caldwell S, Gould HP, et al. Independent predictors of a clinically significant improvement after lumbar fusion surgery. Spine J. 2017;17(2):236-243. https://doi.org/10.1016/j.spinee.2016.09.011.\u003c/li\u003e\n\u003cli\u003eMerrill RK, Zebala LP, Peters C, et al. Impact of Depression on Patient-Reported Outcome Measures After Lumbar Spine Decompression. Spine. 2018;43(6):434-439. https://doi.org/10.1097/BRS.0000000000002329.\u003c/li\u003e\n\u003cli\u003eH\u0026oslash;y K, B\u0026uuml;nger C, Niederman B, et al. Transforaminal lumbar interbody fusion (TLIF) versus posterolateral instrumented fusion (PLF) in degenerative lumbar disorders: a randomized clinical trial with 2-year follow-up. Eur Spine J. 2013;22(9):2022-2029. https://doi.org/10.1007/s00586-013-2760-2.\u003c/li\u003e\n\u003cli\u003eLee J, Kim HS, Shim KD, Park YS. The Effect of Anxiety, Depression, and Optimism on Postoperative Satisfaction and Clinical Outcomes in Lumbar Spinal Stenosis and Degenerative Spondylolisthesis Patients: Cohort Study. Clin Orthop Surg. 2017;9(2):177-183. https://doi.org/10.4055/cios.2017.9.2.177.\u003c/li\u003e\n\u003cli\u003eWahlman M, H\u0026auml;kkinen A, Dekker J, et al. The prevalence of depressive symptoms before and after surgery and its association with disability in patients undergoing lumbar spinal fusion. Eur Spine J. 2014;23(1):129-134. https://doi.org/10.1007/s00586-013-2896-0.\u003c/li\u003e\n\u003cli\u003eNetto MB, Barranco AB, Oliveira KW, Petronilho F. Influence of anxiety and depression symptoms on the quality of life in patients undergoing lumbar spine surgery. Rev Bras Ortop. 2018;53(1):38-44. https://doi.org/10.1016/j.rboe.2017.01.009.\u003c/li\u003e\n\u003cli\u003eAbbott AD, Tyni-Lenn\u0026eacute; R, Hedlund R. The influence of psychological factors on pre-operative levels of pain intensity, disability and health-related quality of life in lumbar spinal fusion surgery patients. Physiotherapy. 2010;96(3):213-221. https://doi.org/10.1016/j.physio.2009.11.013.\u003c/li\u003e\n\u003cli\u003eAdogwa O, Carr K, Fatemi P, et al. Psychosocial Factors and Surgical Outcomes. Spine. 2014;39(19):1614-1619. https://doi.org/10.1097/brs.0000000000000474.\u003c/li\u003e\n\u003cli\u003eFanian H, Ghassemi GR, Jourkar M, et al. Psychological profile of Iranian patients with low-back pain. East Mediterr Health J. 2007;13(2):335-346. https://pubmed.ncbi.nlm.nih.gov/17684856.\u003c/li\u003e\n\u003cli\u003eVincent H K , Horodyski M B , Vincent K R ,et al.Psychological Distress After Orthopedic Trauma: Prevalence in Patients and Implications for Rehabilitation[J].PM \u0026amp; R: the journal of injury, function, and rehabilitation, 2015(7-9).DOI:10.1016/j.pmrj.2015.03.007.\u003c/li\u003e\n\u003cli\u003eScott S , Brameier D T , Tryggedsson I ,et al.Prevalence, resources, provider insights, and outcomes: a review of patient mental health in orthopaedic trauma[J].Journal of orthopaedic surgery and research, 19(1):538[2024-11-27].DOI:10.1186/s13018-024-04932-4.\u003c/li\u003e\n\u003cli\u003eAyers DC, Franklin PD, Ring DC. The role of emotional health in functional outcomes after orthopaedic surgery: extending the biopsychosocial model to orthopaedics: AOA critical issues. J Bone Joint Surg Am. 2013;95(21):e165. https://doi.org/10.2106/JBJS.L.00799. PMID: 24196477; PMCID: PMC3808180.\u003c/li\u003e\n\u003cli\u003eWeinerman J, Vazquez A, Schurhoff N, Shatz C, Goldenberg B, Constantinescu D, Hernandez GM. The impacts of anxiety and depression on outcomes in orthopaedic trauma surgery: a narrative review. Ann Med Surg (Lond). 2023;85(11):5523-5527. https://doi.org/10.1097/MS9.0000000000001307. PMID: 37920654; PMCID: PMC10619579.\u003c/li\u003e\n\u003cli\u003eAkutay S , Ceyhan Z .The relationship between fear of surgery and affecting factors in surgical patients[J].Perioperative Medicine, 2023, 12(1):1-8.DOI:10.1186/s13741-023-00316-0.\u003c/li\u003e\n\u003cli\u003eHuskisson EC. Measurement of pain. Lancet. 1974;304(7889):1127-1131. https://doi.org/10.1016/s0140-6736(74)90884-8.\u003c/li\u003e\n\u003cli\u003eWare JE, Sherbourne CD. The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection. Med Care. 1992;30(6):473-483. https://pubmed.ncbi.nlm.nih.gov/1593914.\u003c/li\u003e\n\u003cli\u003eMcHorney, C.A., Ware Jr, J.E., \u0026amp; Raczek, A.E. (1993). The MOS 36-item short-form health survey (SF-36): II. Psychometric and clinical tests of validity in measuring physical and mental health constructs. Medical Care, 31(3), 247-263.\u003c/li\u003e\n\u003cli\u003eGandek, B., Ware Jr, J.E., Aaronson, N.K., Apolone, G., Bjorner, J.B., Brazier, J.E., Bullinger, M., Kaasa, S., Leplege, A., \u0026amp; Sullivan, M. (1998). Tests of data quality, scaling assumptions, and reliability of the SF-36 in eleven countries: results from the IQOLA project. International Quality of Life Assessment. Journal of Clinical Epidemiology, 51(11), 1149-1158.\u003c/li\u003e\n\u003cli\u003eWare Jr, J.E., \u0026amp; Kosinski, M. (2001). Interpreting SF-36 summary health measures: A response to McHorney, Ware, and Raczek. Quality of Life Research, 10(7), 609-613.\u003c/li\u003e\n\u003cli\u003eZung, W.W. (1965). A self-rating depression scale. Arch Gen Psychiatry, 12(1), 63-70.\u003c/li\u003e\n\u003cli\u003eZung, W.W. (1971). A rating instrument for anxiety disorders and a self-rating anxiety scale. Psychosomatics, 12(6), 371-379.\u003c/li\u003e\n\u003cli\u003eBiggs, J.T., Wylie, L., \u0026amp; Ziegler, V.E. (1980). Validity of the Zung Self-Rating Depression Scale. Br J Psychiatry, 136, 184-186.\u003c/li\u003e\n\u003cli\u003eBjelland, I., Dahl, A.A., Haug, T.T., \u0026amp; Neckelmann, D. (2002). The validity of the Hospital Anxiety and Depression Scale: An updated literature review. J Psychosom Res, 52(2), 69-77.\u003c/li\u003e\n\u003cli\u003eSantor, D.A., \u0026amp; Ramsay, J.O. (1998). Progress in the measurement of subjective well-being. In D.A. Sator \u0026amp; J.O. Ramsay (Eds.), Quality of life and mental health: Measurement, assessment, and research (pp. 1-22). Kluwer Academic Publishers.\u003c/li\u003e\n\u003cli\u003eLee J, Kim HS, Shim KD, Park YS. The Effect of Anxiety, Depression, and Optimism on Postoperative Satisfaction and Clinical Outcomes in Lumbar Spinal Stenosis and Degenerative Spondylolisthesis Patients: Cohort Study. Clin Orthop Surg. 2017;9(2):177-183. https://doi.org/10.4055/cios.2017.9.2.177.\u003c/li\u003e\n\u003cli\u003eWahlman M, H\u0026auml;kkinen A, Dekker J, et al. The prevalence of depressive symptoms before and after surgery and its association with disability in patients undergoing lumbar spinal fusion. Eur Spine J. 2014;23(1):129-134. https://doi.org/10.1007/s00586-013-2896-0.\u003c/li\u003e\n\u003cli\u003eNetto MB, Barranco AB, Oliveira KW, Petronilho F. Influence of anxiety and depression symptoms on the quality of life in patients undergoing lumbar spine surgery. Rev Bras Ortop. 2018;53(1):38-44. https://doi.org/10.1016/j.rboe.2017.01.009.\u003c/li\u003e\n\u003cli\u003eAbbott AD, Tyni-Lenn\u0026eacute; R, Hedlund R. The influence of psychological factors on pre-operative levels of pain intensity, disability and health-related quality of life in lumbar spinal fusion surgery patients. Physiotherapy. 2010;96(3):213-221. https://doi.org/10.1016/j.physio.2009.11.013.\u003c/li\u003e\n\u003cli\u003eAdogwa O, Carr K, Fatemi P, et al. Psychosocial Factors and Surgical Outcomes. Spine. 2014;39(19):1614-1619. https://doi.org/10.1097/brs.0000000000000474.\u003c/li\u003e\n\u003cli\u003eBiz C, Khamisy-Farah R, Puce L, Szarpak L, Converti M, Ceylan Hİ, Crim\u0026igrave; A, Bragazzi NL, Ruggieri P. Investigating and Practicing Orthopedics at the Intersection of Sex and Gender: Understanding the Physiological Basis, Pathology, and Treatment Response of Orthopedic Conditions by Adopting a Gender Lens: A Narrative Overview. Biomedicines. 2024;12(5):974. https://doi.org/10.3390/biomedicines12050974. PMID: 38790936; PMCID: PMC11118756.\u003c/li\u003e\n\u003cli\u003eNetto MB, Barranco AB, Oliveira KW, Petronilho F. Influence of anxiety and depression symptoms on the quality of life in patients undergoing lumbar spine surgery. Rev Bras Ortop. 2018;53(1):38-44. https://doi.org/10.1016/j.rboe.2017.01.009.\u003c/li\u003e\n\u003cli\u003eAbbott AD, Tyni-Lenn\u0026eacute; R, Hedlund R. The influence of psychological factors on pre-operative levels of pain intensity, disability and health-related quality of life in lumbar spinal fusion surgery patients. Physiotherapy. 2010;96(3):213-221. https://doi.org/10.1016/j.physio.2009.11.013.\u003c/li\u003e\n\u003cli\u003eAdogwa O, Carr K, Fatemi P, Verla T, Gazcon G, Gottfried O, Bagley C, Cheng J. Psychosocial Factors and Surgical Outcomes. Spine. 2014;39(19):1614-1619. https://doi.org/10.1097/brs.0000000000000474.\u003c/li\u003e\n\u003c/ol\u003e"},{"header":"Tables","content":"\u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab1\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 1\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003ePatient baseline data\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"2\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSpecies\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eNumber of cases\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eNumber of patients\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSex(male/female)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e42/42\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eAge(year)\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e61.67\u0026thinsp;\u0026plusmn;\u0026thinsp;9.33\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eSingle-level lumbar internal fixation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e56\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eMultilevel lumbar internal fixation\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e28\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab2\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 2\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eCorrelation coefficient P and P values between the SF-36 score and the SAS and SDS scores\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"5\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"char\" char=\".\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSAS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSDS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative SF \u0026minus;\u0026thinsp;36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.02\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.876\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.09\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.426\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative SF \u0026minus;\u0026thinsp;36\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c2\"\u003e \u003cp\u003e-0.12\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c3\"\u003e \u003cp\u003e0.364\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c4\"\u003e \u003cp\u003e-0.04\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"char\" char=\".\" colname=\"c5\"\u003e \u003cp\u003e0.696\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab3\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 3\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eThe changes of SAS, SDS, and SF-36 between Preoperative and postoperative\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"4\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eSAS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eSDS\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSF-36\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePreoperative\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e43.3\u0026thinsp;\u0026plusmn;\u0026thinsp;8.8\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e39.5\u0026thinsp;\u0026plusmn;\u0026thinsp;6.0 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e60.9\u0026thinsp;\u0026plusmn;\u0026thinsp;6.3 \u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative a week\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e33.3\u0026thinsp;\u0026plusmn;\u0026thinsp;3.3 \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e33.8\u0026thinsp;\u0026plusmn;\u0026thinsp;3.8 \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e114.3\u0026thinsp;\u0026plusmn;\u0026thinsp;5.3 \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePostoperative 6 months\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e27.5\u0026thinsp;\u0026plusmn;\u0026thinsp;2.9 \u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e32.2\u0026thinsp;\u0026plusmn;\u0026thinsp;4.6 \u003csup\u003eb\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e118.1\u0026thinsp;\u0026plusmn;\u0026thinsp;6.9 \u003csup\u003ec\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003eP\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e\u0026lt;\u0026thinsp;0.001\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eP\u0026thinsp;\u0026lt;\u0026thinsp;0.001 between different letters by ANCOVA adjusted for age and sex.\u003c/p\u003e \u003cp\u003e \u003cdiv class=\"gridtable\"\u003e\u003ctable float=\"Yes\" id=\"Tab4\" border=\"1\"\u003e \u003ccaption language=\"En\"\u003e \u003cdiv class=\"CaptionNumber\"\u003eTable 4\u003c/div\u003e \u003cdiv class=\"CaptionContent\"\u003e \u003cp\u003eNormality Test\u003c/p\u003e \u003c/div\u003e \u003c/caption\u003e \u003ccolgroup cols=\"7\"\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c1\" colnum=\"1\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c2\" colnum=\"2\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c3\" colnum=\"3\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c4\" colnum=\"4\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c5\" colnum=\"5\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c6\" colnum=\"6\"\u003e\u003c/div\u003e \u003cdiv align=\"left\" class=\"colspec\" colname=\"c7\" colnum=\"7\"\u003e\u003c/div\u003e \u003cthead\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c1\" morerows=\"1\" rowspan=\"2\"\u003e\u0026nbsp;\u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c4\" namest=\"c2\"\u003e \u003cp\u003eKolmogorov-Smirnova\u003csup\u003ea\u003c/sup\u003e\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colspan=\"3\" nameend=\"c7\" namest=\"c5\"\u003e \u003cp\u003eShapiro-Wilk\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003ctr\u003e \u003cth align=\"left\" colname=\"c2\"\u003e \u003cp\u003eStatistic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c3\"\u003e \u003cp\u003eDegrees of Freedom\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c4\"\u003e \u003cp\u003eSignificance\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c5\"\u003e \u003cp\u003eStatistic\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c6\"\u003e \u003cp\u003eDegrees of Freedom\u003c/p\u003e \u003c/th\u003e \u003cth align=\"left\" colname=\"c7\"\u003e \u003cp\u003eSignificance\u003c/p\u003e \u003c/th\u003e \u003c/tr\u003e \u003c/thead\u003e \u003ctbody\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003ePre-surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.076\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.200\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.984\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e.366\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e1 week after surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.073\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.200\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.978\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e.163\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colname=\"c1\"\u003e \u003cp\u003e6 months after surgery\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c2\"\u003e \u003cp\u003e.073\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c3\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c4\"\u003e \u003cp\u003e.200\u003csup\u003e*\u003c/sup\u003e\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c5\"\u003e \u003cp\u003e.990\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c6\"\u003e \u003cp\u003e84\u003c/p\u003e \u003c/td\u003e \u003ctd align=\"left\" colname=\"c7\"\u003e \u003cp\u003e\u003cb\u003e.756\u003c/b\u003e\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003e*.This is the lower limit of the true significance.\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003ctr\u003e \u003ctd align=\"left\" colspan=\"7\" nameend=\"c7\" namest=\"c1\"\u003e \u003cp\u003ea. Shapiro-Wilk significance correction\u003c/p\u003e \u003c/td\u003e \u003c/tr\u003e \u003c/tbody\u003e \u003c/colgroup\u003e \u003c/table\u003e\u003c/div\u003e \u003c/p\u003e \u003cp\u003eThe normality test indicates that the SF-36 scores before surgery, one week after surgery, and six months after surgery all have significance P values greater than 0.05, which conforms to a normal distribution.\u003c/p\u003e "}],"fulltextSource":"","fullText":"","funders":[],"hasAdminPriorityOnWorkflow":false,"hasManuscriptDocX":true,"hasOptedInToPreprint":true,"hasPassedJournalQc":"","hasAnyPriority":false,"hideJournal":true,"highlight":"","institution":"","isAcceptedByJournal":false,"isAuthorSuppliedPdf":false,"isDeskRejected":"","isHiddenFromSearch":false,"isInQc":false,"isInWorkflow":false,"isPdf":false,"isPdfUpToDate":true,"isWithdrawnOrRetracted":false,"journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true},"keywords":"Medical Humanistic Nursing, Psychological Management༛Lumbar Spine Internal Fixation","lastPublishedDoi":"10.21203/rs.3.rs-6889145/v1","lastPublishedDoiUrl":"https://doi.org/10.21203/rs.3.rs-6889145/v1","license":{"name":"CC BY 4.0","url":"https://creativecommons.org/licenses/by/4.0/"},"manuscriptAbstract":"\u003cp\u003e\u003cstrong\u003eObjective\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eTo assess the impact of mental health on the prognosis of patients undergoing lumbar spinal fixation and to explore the role of humanistic nursing in improving outcomes.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eBackground\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eThere is a gap in research regarding the changes in anxiety and depression among patients during the perioperative period for lumbar spinal fixation, and their psychological state's effect on prognosis is unclear. Design: A retrospective cohort study utilizing questionnaire surveys at 1 week preoperatively, 1 week postoperatively, and 6 months postoperatively.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eMethods\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003e84 patients who underwent lumbar spinal fixation surgery received humanistic care from nurses. Follow-up surveys included sociodemographic data, SF-36 scores, Zung Self-Rating Anxiety Scale (SAS), and Zung Self-Rating Depression Scale (SDS). Data were analyzed using SPSS 22.0, with correlations assessed by the Spearman test.st.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eResults\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003ePreoperative SAS scores were significantly higher than postoperative scores at 1 week (43.3 vs. 33.3) and 6 months (27.5). SF-36 scores improved significantly postoperatively, indicating better quality of life. Female patients showed higher SAS and SDS scores and lower SF-36 scores, suggesting slower recovery.\u003c/p\u003e\n\u003cp\u003e\u003cstrong\u003eConclusions\u003c/strong\u003e\u003c/p\u003e\n\u003cp\u003eHumanistic nursing interventions significantly reduce anxiety and depression and improve quality of life in patients undergoing lumbar spinal fixation surgery, emphasizing the need for psychological support, especially for female patients. Relevance to Clinical Practice: Active and effective humanistic nursing interventions led by nurses should be implemented to alleviate patients' psychological distress during the perioperative period of lumbar internal fixation, to promote patients' postoperative rehabilitation and improve patients' overall quality of life.\u003c/p\u003e","manuscriptTitle":"The Role and Practice of Medical Humanistic Nursing in the Psychological Management of Patients with Lumbar Spine Internal Fixation during the Perioperative Period","msid":"","msnumber":"","nonDraftVersions":[{"code":1,"date":"2025-06-25 09:34:07","doi":"10.21203/rs.3.rs-6889145/v1","editorialEvents":[{"type":"communityComments","content":0}],"status":"published","journal":{"display":true,"email":"[email protected]","identity":"researchsquare","isNatureJournal":false,"hasQc":true,"allowDirectSubmit":true,"externalIdentity":"","sideBox":"","snPcode":"","submissionUrl":"/submission","title":"Research Square","twitterHandle":"researchsquare","acdcEnabled":true,"dfaEnabled":false,"editorialSystem":"","reportingPortfolio":"","inReviewEnabled":false,"inReviewRevisionsEnabled":true}}],"origin":"","ownerIdentity":"7e32b7c0-46aa-43e7-a45a-74b172c1b2ef","owner":[],"postedDate":"June 25th, 2025","published":true,"recentEditorialEvents":[],"rejectedJournal":[],"revision":"","amendment":"","status":"posted","subjectAreas":[],"tags":[],"updatedAt":"2025-07-02T04:23:28+00:00","versionOfRecord":[],"versionCreatedAt":"2025-06-25 09:34:07","video":"","vorDoi":"","vorDoiUrl":"","workflowStages":[]},"version":"v1","identity":"rs-6889145","journalConfig":"researchsquare"},"__N_SSP":true},"page":"/article/[identity]/[[...version]]","query":{"redirect":"/article/rs-6889145","identity":"rs-6889145","version":["v1"]},"buildId":"8U1c8b4HqxoKbykW_rLl7","isFallback":false,"isExperimentalCompile":false,"dynamicIds":[84888],"gssp":true,"scriptLoader":[]}