This study is of descriptive pre- and post-intervention type. The study population consists of patients undergoing disc herniation surgery referring in 2021 to Kashani educational healthcare center in Isfahan city, who were enrolled through census. After approval in the ethics code of Isfahan University of medical sciences with the code of IR.MUI.MED.REC.1400.169, the researcher referred to the place of study implementation (Kashani educational healthcare center). He identified the patients suffering from herniated disc who had this herniation surgery indication. After identifying the patients, before the surgery, the researcher presented the necessary explanations about the study objectives to the patients. In case they were willing to participate in the study, written informed consent form was taken from them.
The patients were emphasized to participate in the research up to one year considering its significance. Eventually, 120 patients were included through census method who were followed up for one year. Three months post-operation, 116, six months 112, and one year 104 patients remained in the study.
The inclusion criteria were as follows: all patients who were candidates for disc herniation surgery with age range of 20 to 60 years of age, no physical or psychological disease, and do not have rheumatic disease. Furthermore, informed consent was another important inclusion criteria. The patients who did not announce their consent for participation, those who died in the course of study for any reason, and the ones with psychological or physical diseases and had previous disc herniation surgery were excluded.
The patients were investigated pre-operation, 3, 6, and 12 postoperation using standard questionnaires. These questionnaires included short-form 12 (SF-12) questionnaire for measuring quality of life, Oswestry low back pain disability questionnaire for measuring the level of disability, EuroQol quality of life scale for measuring the health associated quality of life, and DASS questionnaire to measure the depression, anxiety, and stress.
SF12 questionnaire
This questionnaire is a general instrument for measuring the health status of people 14 years of age in the above. It includes the subscales of physical functioning, playing the physical roles, bodily pains, general health, energy and vitality, social functioning, playing the emotional roles, as well as psychological health. The relative validity related to the physical items of this instrument for 12 physical items was 0.67 on average, while for the psychological ones it was 0.97. Reliability assessment of this instrument was performed through repeated test reliability method, whereby the correlation was found 0.89 and 0.76 for physical and psychological items respectively.
Physical Component Summary (PCS) measure include General Health (GH), Physical Functioning (PF), Role Physical (RP), and Body Pain (BP). Mental Component Summary (MCS) measure include Vitality (VT), Social Functioning (SF), Role Emotional (RE), and Mental Health (MH).
A score of 50 for any of the SF-12 domains or component summaries is equivalent to the reference population mean, and the standard deviation is set at 10.
Score>50, indicate better physical or mental health than the mean.
Score<50, indicate worse physical or mental health than the mean.
Higher score represents higher quality of life (18).
The Modified Oswestry Low Back Pain Disability Questionnaire
This questionnaire consists of 10 six-option sections (the functions covered are personal care, lifting, walking, sitting, standing, sleeping, social life, traveling, and employment/ homemaking (replacing the sex life item). capturing the functions of individuals in their daily activities. Each section ranks the level of disability in functioning from zero (desired functioning with no feelings of pain) up to 10 (disability in doing activities because of pain). Option A is assigned zero while the rest of options are assigned 2 scores. Overall, the score of each section is 10, and the total disability index ranges from 0% (no disability) to 100% (the most severe disability). In this questionnaire, 0-20%, 20-40%, 40-60%, 60-80%, and 80-100% are categorized as minimal disability, moderate disability, severe disability, crippled, and debilitating disability respectively. The value obtained from the Cronbach alpha coefficient for determining internal consistency of this questionnaire has been obtained 0.92 (2).
EuroQol EQ-5D Quality of Life Scale
It is a simple and general instrument that can be used for investigating the health and effects of treatment on a wide range of diseases. It offers a simple descriptive profile and a single index value for the health status, which can be used in economic and clinical assessments of healthcare as well as examining the public health. This questionnaire is completed by the respondents, it is cognitively convenient, and its completion lasts around 4 min.
It includes a descriptive section and visual scale section. The first section includes five unicellular dimensions, examining the status of excitement, self-care, general activities, pain/discomfort, and anxiety/depression at three levels of no difficulty, difficult to some extent, and extremely difficult. For each person, a special health status is defined from the combination of one level of all five dimensions (243 health states). On the other hand, lack of consciousness and death are completed by the patient's care providers. Overall, there are 245 states for this section of the questionnaire. The second part of the questionnaire is a 20-cm visual scale graduated from zero (the worst health status conceivable) to 100 (the best conceivable health status), whereby the person marks their current health status on this scale (19).
Depression Anxiety Stress Scale (DASS21)
This scale was designed by Lavibdand (1995). It is a set of three self-reporting scales for assessing negative emotional states in depression, anxiety, and stress. Anthony et al. (1998) performed factor analysis for this scale, and again found three factors of depression, anxiety, and stress. The results of that study showed that 68% of the variance of the entire scale would be accounted for by these three factors. The Cronbach alpha coefficient for all three factors was 0.97, 0.92, and 0.95 respectively. Each of the subscales of DASS has seven items, where the final score of each subscale is obtained through summing up the scores of items related to that. Each score is scored from zero (it does not apply to me et al.) to 3 (it applies to me completely). The intensity of each of the subscales of depression, anxiety, and stress is as follows. Depression: normal (0-9), mild (10-13), moderate (14-20), severe (21-27), very severe (28); anxiety: normal (0-7), mild (8-9), moderate (10-14), severe (15-19), very severe (20); stress: normal (0-14), mild (15-18), moderate (19-25), severe (26-32), and very severe (33) (20).
Once collected, the date were analyzed in SPSS 22 at significance level of less than 0.05. For the quantitative variables, for data description, mean and standard deviation were applied. On the other hand regarding the qualitative variables, distribution and frequency percentage were used. Data normality was checked by Kolmogorov-Smirnov test, and for data analysis, T-test and chi-square tests were utilized. At the end it should be noted that the information of all patients was confidential and researcher would not use these data in any other study.