Impact of Anxiety During Hospitalization on the Clinical Outcome of Patients With Osteoporotic Thoracolumbar Vertebral Fracture

F Schwarz; E Klee; P Schenk; S Katscher; K J Schnake; M Bäumlein; V Zimmermann; G Schmeiser; M A Scherer; M Müller; K Sprengel; U Spiegl; G Osterhoff; S Schramm; H Siekmann; A Franck; M-J Scheyerer; B W Ullrich; Working Group Osteoporotic Fractures of the Spine Section of the German Society of Orthopaedics and Trauma

doi:10.1177/21925682231192847

Impact of Anxiety During Hospitalization on the Clinical Outcome of Patients With Osteoporotic Thoracolumbar Vertebral Fracture

Global Spine J. 2025 Mar;15(2):417-424. doi: 10.1177/21925682231192847. Epub 2023 Aug 7.

Authors

F Schwarz¹, E Klee¹, P Schenk², S Katscher³, K J Schnake^{4

5}, M Bäumlein⁶, V Zimmermann⁷, G Schmeiser⁸, M A Scherer⁹, M Müller¹⁰, K Sprengel^{11

12}, U Spiegl¹³, G Osterhoff¹³, S Schramm¹⁴, H Siekmann¹⁵, A Franck¹⁶, M-J Scheyerer¹⁷, B W Ullrich^{18

19}; Working Group Osteoporotic Fractures of the Spine Section of the German Society of Orthopaedics and Trauma²⁰

Affiliations

¹ Department of Neurosurgery, University Hospital Jena, Jena, Germany.
² Department of Science and Research, BG Clinic Bergmannstrost Halle (Saale), Halle, Deutschland.
³ Interdisciplinary Center for Spine and Neurotrauma, Sana Clinic Borna, Borna, Germany.
⁴ Interdisciplinary Center for Spinal and Scoliosis Surgery, Waldkrankenhaus Erlangen, Erlangen, Germany.
⁵ Department of Orthopaedics and Traumatology, Paracelsus Private Medical University Nuremberg, Nuremberg, Germany.
⁶ Department of Orthopaedics and Traumatology, University Hospital Marburg, Marburg, Germany.
⁷ Department of Trauma and Orthopedic Surgery, Klinikum Traunstein, Traunstein, Germany.
⁸ Department of Spinal Surgery, Schön Clinic Hamburg Eilbek, Hamburg, Germany.
⁹ Medical Practice Clinic Orthopedics and Surgery Munich West, Munich, Germany.
¹⁰ Department of Orthopaedics and Traumatology, University Hospital Kiel, Kiel, Germany.
¹¹ Department of Traumatology, Hirslanden Clinic St. Anna, University of Lucerne, Lucerne, Switzerland.
¹² Department of Traumatology, University Hospital Zurich (USZ), University of Zurich, Zurich, Switzerland.
¹³ Department of Orthopaedics, Traumatology and Plastic Surgery, University Hospital Leipzig, Leipzig, Germany.
¹⁴ Department of Trauma and Orthopaedic Surgery, University Hospital Erlangen, Erlangen, Germany.
¹⁵ Department of Traumatology and Reconstructive Surgery, AMEOS Klinikum Halberstadt, Halberstadt, Germany.
¹⁶ Department of Orthopaedics and Traumatology, Regiomed-Clinic of Coburg, Coburg, Germany.
¹⁷ Department of Orthopaedics and Traumatology, University Hospital Duesseldorf, Duesseldorf, Germany.
¹⁸ Department of Traumatology and Reconstructive Surgery, BG Clinic Bergmannstrost Halle (Saale), Halle, Germany.
¹⁹ Department of Hand, Trauma- and Reconstructive Surgery, University Hospital Jena, Jena, Germany.
²⁰ German Society for Orthopaedics and Trauma (DGOU), Berlin, Deutschland.

Abstract

Study design: Multicenter prospective cohort study.

Objectives: Anxiety in combination with osteoporotic vertebral compression fractures (OVCFs) of the spine remains understudied. The purpose of this study was to analyze whether anxiety 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: 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 = .087, P = .0496) with anxiety. During the hospital stay, pain medication (P < .001), anti-osteoporotic medication (P < .001), and initiation of surgical therapy (P < .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 < .001), Barthel index (P < .001), ODI (P < .001) and EQ5D-5L (P < .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.

Keywords: EQ5D-5L; anxiety; hospitalization; osteoporotic fracture; thoracolumbar spine.