Abstract
Background: Cognitive-behavioral interventions, typically effective in reducing anxiety and pain, have not been applied to adolescents undergoing major orthopaedic surgery.
Objectives: To determine the effectiveness of three cognitive-behavioral interventions for reducing adolescents' postoperative anxiety and pain following spinal fusion surgery for scoliosis, and whether effectiveness depended on preoperative anxiety and age.
Methods: A randomized controlled trial with four groups receiving a videotape intervention (information only, coping only, information plus coping, or control) used a convenience sample of 109 adolescents (88 female, 93 White), 11-18 years of age (M = 14). Speilberger's (1983) State Anxiety scale assessed anxiety preoperatively and postoperatively on Day 2. A visual analogue scale assessed pain postoperatively on Days 2 and 4.
Results: Information plus coping was most effective for reducing postoperative anxiety in adolescents with high preoperative anxiety. Coping instruction led to less postoperative anxiety and pain for adolescents ages 13 and younger. The control group reported the highest levels of pain on Day 4.
Conclusions: Cognitive-behavioral interventions designed to prepare adolescents for surgery should be tailored to individual factors and developmental needs, especially the adolescents' preoperative anxiety level and age.
Idiopathic scoliosis is the most prevalent deforming orthopaedic condition that affects children during their transition into adolescence, creating significant disabilities if the spinal curve progresses beyond 45[degrees]. Surgical correction is needed when a back brace fails to correct the curve. The primary problems an adolescent faces immediately following major spinal surgery are controlling anxiety and managing intense pain. Surgery to correct idiopathic scoliosis is both long (6-10 hours) and physically demanding. Because of the complexity of the surgical procedure and resulting postoperative pain and distress, spinal fusion surgery is one of the most invasive orthopaedic surgeries performed on children (Kotzer, 2000). The purpose of this study is to determine the effectiveness of three cognitive-behavioral interventions for reducing adolescents' postoperative anxiety and pain following major spinal surgery and whether preoperative anxiety and age influenced the effectiveness of the interventions.