{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,7]],"date-time":"2026-10-07T16:05:01Z","timestamp":1791389101614,"version":"4.3.3"},"reference-count":32,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2025,3,16]],"date-time":"2025-03-16T00:00:00Z","timestamp":1742083200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diseases"],"abstract":"<jats:p>Background: Patients with vertebral metastases often experience spinal instability, chronic pain, and psychological distress, all of which can significantly reduce quality of life. Spinal instability, measured by the Spinal Instability Neoplastic Score (SINS), may exacerbate functional impairment and emotional distress, underscoring the potential benefit of personalized recovery interventions. Material and methods: This prospective, observational study investigated the impact of personalized recovery interventions on spinal instability, psychological distress, and quality of life in oncological patients with vertebral metastases. Results: The experimental group received tailored rehabilitation strategies, while the control group underwent standard oncological care. Spinal instability was assessed using the Spinal Instability Neoplastic Score (SINS), psychological distress was measured with the Hopelessness Depression Symptom Questionnaire (HDSQ), and quality of life was evaluated using the European Quality of Life-5 Dimensions (EQ-5D). The experimental group demonstrated significantly lower mean SINS scores, indicating reduced spinal instability, and lower HDSQ scores, suggesting decreased psychological distress. They also exhibited improvements in mobility, self-care, usual activities, and anxiety\/depression dimensions of the EQ-5D. Furthermore, the experimental group had longer survival times, lower fracture rates, and reduced prevalence of osteoporosis, anemia, and vomiting. These findings underscore the potential benefits of integrating physical and psychological rehabilitation into routine oncological management. Conclusions: Personalized recovery interventions appear to enhance functional independence, emotional well-being, and overall quality of life in patients with vertebral metastases. Future research should focus on longitudinal, multicenter, randomized controlled trials to confirm these findings and further elucidate the complex interplay between spinal instability, psychological distress, and functional recovery.<\/jats:p>","DOI":"10.3390\/diseases13030085","type":"journal-article","created":{"date-parts":[[2025,3,17]],"date-time":"2025-03-17T11:04:22Z","timestamp":1742209462000},"page":"85","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":2,"title":["Impact of Personalized Recovery Interventions on Spinal Instability and Psychological Distress in Oncological Patients with Vertebral Metastases"],"prefix":"10.3390","volume":"13","author":[{"given":"No\u00e9mi","family":"N\u00e9meth","sequence":"first","affiliation":[{"name":"Doctoral School of Biomedical Sciences, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania"},{"name":"Department of Psycho-Neuroscience and Rehabilitation, University of Oradea, 410073 Oradea, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5960-9043","authenticated-orcid":false,"given":"Florica","family":"Voi\u021b\u0103-Mekeres","sequence":"additional","affiliation":[{"name":"Doctoral School of Biomedical Sciences, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania"},{"name":"Department of Morphological Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 1 Universitatii Street, 410087 Oradea, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liviu","family":"Laz\u0103r","sequence":"additional","affiliation":[{"name":"Doctoral School of Biomedical Sciences, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania"},{"name":"Department of Psycho-Neuroscience and Rehabilitation, University of Oradea, 410073 Oradea, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lavinia","family":"Davidescu","sequence":"additional","affiliation":[{"name":"Department of Medical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 1 Universitatii Street, 410087 Oradea, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"C\u0103lin Tudor","family":"Hozan","sequence":"additional","affiliation":[{"name":"Department of Surgical Disciplines, Faculty of Medicine and Pharmacy, University of Oradea, 410087 Oradea, Romania"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2025,3,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"7","DOI":"10.3322\/caac.21590","article-title":"Cancer Statistics, 2020. CA","volume":"70","author":"Siegel","year":"2020","journal-title":"Cancer J. Clin."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"363","DOI":"10.3322\/caac.21565","article-title":"Cancer Treatment and Survivorship Statistics, 2019. CA","volume":"69","author":"Miller","year":"2019","journal-title":"Cancer J. Clin."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"45","DOI":"10.1016\/j.apnr.2017.12.002","article-title":"Factors Associated with Psychological Distress amongst Outpatient Chemotherapy Patients: An Analysis of Depression, Anxiety and Stress Using the DASS-21","volume":"40","author":"McMullen","year":"2018","journal-title":"Appl. Nurs. Res. ANR"},{"key":"ref_4","first-page":"796","article-title":"Evaluation of Quality of Life and Health Care Needs in Cancer Patients Receiving Chemotherapy","volume":"35","author":"Temiz","year":"2020","journal-title":"J. Cancer Educ. Off. J. Am. Assoc. Cancer Educ."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"791","DOI":"10.1002\/pon.4601","article-title":"Predictors of Emotional Distress a Year or More after Diagnosis of Cancer: A Systematic Review of the Literature","volume":"27","author":"Cook","year":"2018","journal-title":"Psychooncology"},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"321","DOI":"10.1007\/s12160-011-9294-9","article-title":"Fatigue, Depression, Sleep, and Activity during Chemotherapy: Daily and Intraday Variation and Relationships among Symptom Changes","volume":"42","author":"Jim","year":"2011","journal-title":"Ann. Behav. Med. Publ. Soc. Behav. Med."},{"key":"ref_7","doi-asserted-by":"crossref","first-page":"260","DOI":"10.1016\/j.jad.2017.04.020","article-title":"Depression and Insomnia as Mediators of the Relationship between Distress and Quality of Life in Cancer Patients","volume":"217","author":"Cha","year":"2017","journal-title":"J. Affect. Disord."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"E1221","DOI":"10.1097\/BRS.0b013e3181e16ae2","article-title":"A Novel Classification System for Spinal Instability in Neoplastic Disease: An Evidence-Based Approach and Expert Consensus from the Spine Oncology Study Group","volume":"35","author":"Fisher","year":"2010","journal-title":"Spine"},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"95","DOI":"10.1634\/theoncologist.2015-0266","article-title":"The Effect of Introducing the Spinal Instability Neoplastic Score in Routine Clinical Practice for Patients with Spinal Metastases","volume":"21","author":"Versteeg","year":"2016","journal-title":"Oncologist"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"S231","DOI":"10.1097\/BRS.0000000000001822","article-title":"The Spinal Instability Neoplastic Score: Impact on Oncologic Decision-Making","volume":"41","author":"Versteeg","year":"2016","journal-title":"Spine"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"160","DOI":"10.1016\/S1470-2045(11)70002-X","article-title":"Prevalence of Depression, Anxiety, and Adjustment Disorder in Oncological, Haematological, and Palliative-Care Settings: A Meta-Analysis of 94 Interview-Based Studies","volume":"12","author":"Mitchell","year":"2011","journal-title":"Lancet Oncol."},{"key":"ref_12","unstructured":"Chand, S.P., and Arif, H. (2025). Depression. StatPearls, StatPearls Publishing."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"k1415","DOI":"10.1136\/bmj.k1415","article-title":"Depression and Anxiety in Patients with Cancer","volume":"361","author":"Pitman","year":"2018","journal-title":"BMJ"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"1487","DOI":"10.1038\/s41380-019-0595-x","article-title":"Depression and Anxiety in Relation to Cancer Incidence and Mortality: A Systematic Review and Meta-Analysis of Cohort Studies","volume":"25","author":"Wang","year":"2020","journal-title":"Mol. Psychiatry"},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"359","DOI":"10.1023\/A:1021882717784","article-title":"The Hopelessness Depression Symptom Questionnaire","volume":"21","author":"Metalsky","year":"1997","journal-title":"Cogn. Ther. Res."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"917","DOI":"10.1093\/jpepsy\/jsp004","article-title":"How to Select, Calculate, and Interpret Effect Sizes","volume":"34","author":"Durlak","year":"2009","journal-title":"J. Pediatr. Psychol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"261","DOI":"10.1016\/j.spinee.2017.07.008","article-title":"Patient-Reported Outcomes after Surgical Stabilization of Spinal Tumors: Symptom-Based Validation of the Spinal Instability Neoplastic Score (SINS) and Surgery","volume":"18","author":"Hussain","year":"2018","journal-title":"Spine J."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"432","DOI":"10.3171\/2018.9.SPINE18147","article-title":"Spinal Instability Neoplastic Score Component Validation Using Patient-Reported Outcomes","volume":"30","author":"Hussain","year":"2019","journal-title":"J. Neurosurg. Spine"},{"key":"ref_19","doi-asserted-by":"crossref","unstructured":"Guzik, G. (2016). Quality of Life of Patients after Surgical Treatment of Cervical Spine Metastases. BMC Musculoskelet. Disord., 17.","DOI":"10.1186\/s12891-016-1175-8"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1093\/neuonc\/noab214","article-title":"Recent Advances and New Discoveries in the Pipeline of the Treatment of Primary Spinal Tumors and Spinal Metastases: A Scoping Review of Registered Clinical Studies from 2000 to 2020","volume":"24","author":"Furlan","year":"2022","journal-title":"Neuro-Oncology"},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"1970","DOI":"10.1007\/s00586-011-1867-6","article-title":"Surgery Improves Pain, Function and Quality of Life in Patients with Spinal Metastases: A Prospective Study on 118 Patients","volume":"20","author":"Quan","year":"2011","journal-title":"Eur. Spine J."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"2050312117717507","DOI":"10.1177\/2050312117717507","article-title":"The Effects on Anxiety and Quality of Life of Breast Cancer Patients Following Completion of the First Cycle of Chemotherapy","volume":"5","author":"Charalambous","year":"2017","journal-title":"SAGE Open Med."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"228","DOI":"10.1515\/sjpain-2021-0190","article-title":"Resilience as a Protective Factor in Face of Pain Symptomatology, Disability and Psychological Outcomes in Adult Chronic Pain Populations: A Scoping Review","volume":"23","author":"Chng","year":"2023","journal-title":"Scand. J. Pain"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1080\/21642850.2021.1911656","article-title":"Spinal Cord Injury and Aging: An Exploration of the Interrelatedness between Key Psychosocial Factors Contributing to the Process of Resilience","volume":"9","author":"Jenkins","year":"2021","journal-title":"Health Psychol. Behav. Med."},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"e1034","DOI":"10.1016\/j.wneu.2019.05.067","article-title":"SINS Score and Stability: Evaluating the Need for Stabilization Within the Uncertain Category","volume":"128","author":"Pennington","year":"2019","journal-title":"World Neurosurg."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"492","DOI":"10.1016\/j.spinee.2020.10.017","article-title":"Health Related Quality of Life Outcomes Following Surgery and\/or Radiation for Patients with Potentially Unstable Spinal Metastases","volume":"21","author":"Versteeg","year":"2021","journal-title":"Spine J."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"802595","DOI":"10.3389\/fonc.2022.802595","article-title":"Ten years after SINS: Role of surgery and radiotherapy in the management of patients with vertebral metastases","volume":"12","author":"Serratrice","year":"2022","journal-title":"Frontiers in Oncology"},{"key":"ref_28","first-page":"615","article-title":"Comprehensive Clinical Literature Review of Managing Bone Metastases in Breast Cancer: Focus on Pain and Skeletal-Related Events","volume":"27","author":"Hamash","year":"2023","journal-title":"Number 6\/December"},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"13","DOI":"10.2190\/EUFN-RV1K-Y3TR-FK0L","article-title":"Psychosocial Interventions for Depression, Anxiety, and Quality of Life in Cancer Survivors: Meta-Analyses","volume":"36","author":"Osborn","year":"2006","journal-title":"Int. J. Psychiatry Med."},{"key":"ref_30","doi-asserted-by":"crossref","unstructured":"Luo, F., Ye, M., Wang, A., Qian, C., Zhang, J., Hu, B., Lv, T., Chen, J., Yan, J., and Chen, F. (2021). Efficacy of Cognitive Behavioral Therapy on Mood Disorders, Sleep, Fatigue, and Quality of Life in Parkinson\u2019s Disease: A Systematic Review and Meta-Analysis. Front. Psychiatry, 12.","DOI":"10.3389\/fpsyt.2021.793804"},{"key":"ref_31","first-page":"455","article-title":"Cancer Rehabilitation May Improve Function in Survivors and Decrease the Economic Burden of Cancer to Individuals and Society","volume":"46","author":"Silver","year":"2013","journal-title":"Work"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"692","DOI":"10.1007\/s00508-017-1266-z","article-title":"Improvement of Quality of Life and Psychological Distress after Inpatient Cancer Rehabilitation: Results of Alongitudinal Observational Study","volume":"129","author":"Riedl","year":"2017","journal-title":"Wien. Klin. Wochenschr."}],"container-title":["Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-9721\/13\/3\/85\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,9]],"date-time":"2025-10-09T16:54:29Z","timestamp":1760028869000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-9721\/13\/3\/85"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,3,16]]},"references-count":32,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2025,3]]}},"alternative-id":["diseases13030085"],"URL":"https:\/\/doi.org\/10.3390\/diseases13030085","relation":{},"ISSN":["2079-9721"],"issn-type":[{"value":"2079-9721","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,3,16]]}}}