Impact of structured psychological support on anxiety and recovery in anterior cervical discectomy and fusion: a randomized controlled trial.

Abstract

Prospective randomized clinical trial. In this prospective, open-label, parallel-group randomized clinical trial, we assessed whether structured psychological support reduces perioperative anxiety and enhances recovery in anterior cervical discectomy and fusion patients. Ninety patients (July 2020 to July 2024) were randomized 1:1 to receive standard preoperative communication plus structured psychological support (intervention, n = 45) or communication alone (control, n = 45). The primary outcome was the State-Trait Anxiety Inventory score; secondary outcomes included Visual Analog Scales, the Neck Disability Index, Pittsburgh Sleep Quality Index, patient satisfaction, and swallowing function (Bazaz score). Eighty-three patients completed follow-up (forty-two intervention and forty-one control). Immediately postoperative and on day 1, the intervention group reported significantly lower State-Trait Anxiety Inventory scores (Δ = 4.28 to 4.61, p < 0.001, Cohen's d = 0.77 to 0.80), with no between-group differences by day 3 or after one month. Linear mixed modelling confirmed a sustained group effect (p < 0.001) and time-related anxiety remission (p < 0.001). On day 1, intervention patients reported lower Visual Analog Scales (Δ = 1.12, p = 0.001), and by one month, the Neck Disability Index improvement reached clinical relevance (Δ = 2.59, p = 0.019). The Pittsburgh Sleep Quality Index on day 3 and patient satisfaction immediately and on day 3 were also higher (all p < 0.05). No differences in swallowing function or safety indicators were observed. Structured psychological support safely and effectively reduces early postoperative anxiety and improves short-term pain, function, and sleep, with short-term functional benefits, supporting its inclusion in perioperative multimodal management. Patients or members of the public were not involved in the design, conduct, analysis, or reporting of this study.