Date of Award

Spring 5-25-2024

Document Type

Doctor of Nursing Practice Final Manuscript

Degree Name

Doctor of Nursing Practice

Department

Nursing

First Advisor

Dr. Joseph Burkard, DNSc, CRNA, AACN

Second Advisor

Melissa Garth, MSN, ACNP, CCRN

Abstract

Introduction: The purpose of this evidence-based practice Doctor of Nursing Practice (DNP) project was to encourage thorough assessment of pain and anxiety prior to spinal surgery in order to identify the need for implementation of additional modalities, such as osteopathic interventions for pain and anxiety management. It is pertinent that as holistic providers we address this populations often missed psychological distress and ineffective pharmacological pain regimens to promote better patient outcomes.

Background: Research says there are approximately 1.62 million instrumented spinal procedures performed annually in the United States. Spinal surgery is not uncommon, and neither is the chronic pain and anxiety it is associated with. Osteopathic manipulative medicine (OMM) has been found effective and is commonly used as a non-pharmacological, alternative modality used for pain. Chronic pain is also often associated with anxiety and depression. It has been shown that OMM may help reduce anxiety and psychological distress in those experiencing pain due to musculoskeletal disorders.

Methods: Assess anxiety (Hospital Anxiety and Depression Scale/HADS) and pain (Visual Analog Scale/VAS) using valid standardized tools preoperatively and postoperatively of agreeable spinal surgery patients. An OMM consult was placed immediately postoperative and continued throughout hospitalization for appropriate and agreeable patients. Osteopathic interventions will be determined by the osteopathic provider at consultation. These interventions will be implemented in addition to our standard care including current multi-modal pharmacological regimens as needed. Results were measured by the number of OMM consults, as well as, pain and anxiety immediately after OMM and around the time of discharge.

Results: There were a total of 20 spinal surgery patients assessed preoperatively, 13 of those patients participated fully in this project, 7 refused OMM. From the 13 patients, we have seen an improvement in pain, anxiety and depression. Out of 13 patients that underwent OMM, 100% verbalized that intervention improved pain and anxiety immediately after intervention. Using the standardized tools: pain was improved by 43%, anxiety improved by 38%, and depression improved by 32% around time of discharge. The amount of OMM consults increased by 18% over a 4 month time frame prior to implementation of the project and during. Length of stay was unable to be determined due to the high complexity of these patients' surgeries and hospital stays complicated by their multiple comorbidities, therefore was excluded from results as a reliable depiction of intervention effectiveness in this study.

Evaluation: While this is a small study, based on the results there shows great promise that considering ordering OMM early in this population can benefit their recovery postoperatively by decreasing pain and anxiety/depression. Incidentally, we were able to introduce and educate patients of alternative modalities for pain, anxiety/depression management. There were barriers including language barriers and translation of anxiety assessment tools and refusal of alternative medicine. Additional implementation into practice over longer periods of time is needed to expand results and determine true effectiveness of incorporating OMM for our spinal surgery patients.

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