Comparing Low and High Recovery Expectations Among Those with Lumbar Spinal Stenosis: A Network Analysis

OBJECTIVE: This study aimed to (1) compare networks of factors for patients with low and high recovery expectations in individuals with lumbar spinal stenosis (LSS) using biopsychosocial measures and duration of symptoms and (2) identify the most influential factors within each group. METHODS: We conducted a cross-sectional study using baseline data from 598 patients with LSS. Participants were recruited through Duke University and the University of Washington spine clinics between 2021 and 2024. Recovery expectations were assessed using a 0 (lowest) to 10 (highest) numerical rating scale. We stratified participants into low and high expectation groups. Network analysis was used to assess relationships among factors for each group. Networks included chronicity and PROMIS-29 + 2 Profile. Partial correlations, centralities, network comparison measures, and network stabilities were calculated. RESULTS: There were 226 participants with low and 108 with high recovery expectations. The two networks did not have significant structural differences and strength centralities were stable. Chronicity was not significantly associated with other factors in both networks. Pain Interference and Fatigue strength centralities show greater importance in both networks. Anxiety had significantly higher strength in the low expectation group, suggesting greater relevance for individuals with low expectations. CONCLUSION: Pain Interference and Fatigue were influential for both groups, while Anxiety was more influential for those with low expectations. Future research and patient management should consider the influence of anxiety for those with low recovery expectations and pain interference and fatigue for all individuals with LSS on other associated factors.