Impact of anxiety during hospitalization on the clinical outcome of patients with osteoporotic thoracolumbar vertebral fracture: a prospective multicentric study

Background: Anxiety in combination with osteoporotic vertebral compression fractures (OVCFs) of the spine remains understudied. The purpose of this study was to analyze whetheranxiety has an impact on the short-term functional outcome of patients with an OVCF. Furthermore, a direct impact of the fracture on the patient’s anxiety during hospitalization should be recognized. Methods: A prospective multicentric study in a German-speaking area was performed. All inpatients with an OVCF of the thoracolumbar spine from 2017 to 2020 were included. Trauma mechanism, analgetic medication, anti-osteoporotic therapy, timed-up-and-go test (TuG), mobility, Barthel index, Oswestry-Disability Index (ODI) and EQ5D-5L were documented. For statistical analysis, the U test, chi-square independence test, Spearman correlation, General Linear Model for repeated measures, Bonferroni analysis and Wilcoxon test were used. The item anxiety/depression of the EQ5D-5L was analyzed to describe the patients’ anxiousness. Results: Data from 518 patients from 17 different hospitals were evaluated. Fracture severity showed a significant correlation (r=0.087, p=0.0496) with anxiety. During the hospital stay, pain medication (p<0.001), anti-osteoporotic medication (p<0.001), and initiation of surgical therapy (p<0.001) were associated with less anxiety. The anxiety of a patient at discharge was negatively related to the functional outcomes at the individual follow-up: TuG (p<0.001), Barthel index (p<0.001), ODI (p<0.001) and EQ5D-5L (p<0.001). Conclusions: Higher anxiety is associated with lower functional outcome after OVCF. The item anxiety/depression of the EQ5D-5L provides an easily accessible, quick and simple tool that can be used to screen for poor outcomes and may also offer the opportunity for a specific anxiety intervention.