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Rushton A1, Masson A1, Staal JB2, Verra M3, Emms A4, Reddington M5, Cole A6, Soundy A7, Willems P8, Benneker L9, Heneghan N1
1University of Birmingham, Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, Birmingham, United Kingdom, 2Radboud UMC, Scientific Institute for Quality of Healthcare, Nijmegen, Netherlands, 3Bern University Hospital, Physiotherapy, Bern, Switzerland, 4The Royal Orthopaedic Hospital NHS Foundation Trust, Physiotherapy, Birmingham, United Kingdom, 5Sheffield Teaching Hospitals NHS Trust, Royal Hallamshire Hospital, Physiotherapy, Sheffield, United Kingdom, 6Sheffield Children’s Hospital NHS Foundation Trust, Orthopaedics & Trauma, Sheffield, United Kingdom, 7University of Birmingham, School of Sport, Exercise and Rehabilitation Sciences, Birmingham, United Kingdom, 8Maastricht University Medical Centre, Spinal Surgery, Maastricht, Netherlands, 9University of Bern, Department of Orthopaedic Surgery Inselspital, Bern, Switzerland
Background: Surgery is the greatest single component of expenditure for managing low back pain with approximately 4500 lumbar spinal fusion surgery (LSFS) procedures annually in the UK. LSFS is used to manage pain attributed to degenerative/spondylolisthetic cause, resistant to conservative management. Low level current evidence suggests inconclusive outcomes, questioning cost effectiveness. However, our recent meta-analysis has identified clinically relevant improvement in leg pain, back pain and disability within the first month after surgery which is maintained. With high costs and large variations in outcomes it is important to develop a stratification tool that can inform clinical decision making for surgery and rehabilitation. Understanding the lived experience of the patient is an important part of this process.
Purpose: To capture a weekly record of life as lived in the first 4 weeks following LSFS from the patient perspective.
Methods: Qualitative study using Interpretive Phenomenological Analysis. A purposive sample of adult patients who had undergone LSFS were recruited across 3 UK spinal surgery centres. A weekly diary was developed from the literature and piloted. It consisted of 12 sections: progress, recovery, motivation, symptoms, medications, healthcare appointments, rehabilitation, positive/negative thoughts, significant moment during the past week and a comparison to the previous week. The final sections enabled participants to record how they have felt or their experiences over the past week. To maximise completion and data quality, the diary could be completed in paper form, word document, online via a survey tool or audio recorded. Strategies to enhance diary adherence included a weekly prompt. Diaries were completed weekly for the first 4 weeks following LSFS. A framework analysis of thematic coding (with deductive and inductive components) by 2 researchers captured emergent themes. Strategies (e.g. reflexivity) ensured trustworthiness. A collaborative approach to the analysis representing professional, public and patient perspectives enhanced the quality of the data analysis.
Results: Diary sets (1 diary entry per week for 4 weeks) from 28 participants, contributed to the developed framework. The completion rate of diary sets was 75% over the 4 weeks. Emerging themes included absence/presence of pre-operative symptoms after surgery, self-motivation and self-efficacy, ability to set goals unrelated to physical limitations, absence/presence of support and access to healthcare professionals. Access to health professionals during a week was associated with higher levels of motivation and documented positive feelings. Achieving a goal or perceived progress from the preceding week also affected motivation.
Conclusion(s): Variability existed between patients in their diaries, highlighting individual journeys. Some commonalities were identified. The presence of pre-operative symptoms was a strong negative feeling which impacted on feelings about recovery so far. Onset of ´new symptoms' during this timescale was viewed less negatively. Participants who recorded a negative 'most memorable moment' during the initial week reported this consistently in subsequent weeks.
Implications: Patient diaries were an effective method for collecting a rich density of data. Continued data collection will capture the later stages of the patient journey. Findings will ensure that patient driven data informs precision rehabilitation following LSFS with the overall aim of improving patient outcome and cost effectiveness.
Keywords: spinal surgery, patient experience and journey, patient diary
Funding acknowledgements: The Chartered Society of Physiotherapy Charitable Trust Physiotherapy Research Foundation.
Purpose: To capture a weekly record of life as lived in the first 4 weeks following LSFS from the patient perspective.
Methods: Qualitative study using Interpretive Phenomenological Analysis. A purposive sample of adult patients who had undergone LSFS were recruited across 3 UK spinal surgery centres. A weekly diary was developed from the literature and piloted. It consisted of 12 sections: progress, recovery, motivation, symptoms, medications, healthcare appointments, rehabilitation, positive/negative thoughts, significant moment during the past week and a comparison to the previous week. The final sections enabled participants to record how they have felt or their experiences over the past week. To maximise completion and data quality, the diary could be completed in paper form, word document, online via a survey tool or audio recorded. Strategies to enhance diary adherence included a weekly prompt. Diaries were completed weekly for the first 4 weeks following LSFS. A framework analysis of thematic coding (with deductive and inductive components) by 2 researchers captured emergent themes. Strategies (e.g. reflexivity) ensured trustworthiness. A collaborative approach to the analysis representing professional, public and patient perspectives enhanced the quality of the data analysis.
Results: Diary sets (1 diary entry per week for 4 weeks) from 28 participants, contributed to the developed framework. The completion rate of diary sets was 75% over the 4 weeks. Emerging themes included absence/presence of pre-operative symptoms after surgery, self-motivation and self-efficacy, ability to set goals unrelated to physical limitations, absence/presence of support and access to healthcare professionals. Access to health professionals during a week was associated with higher levels of motivation and documented positive feelings. Achieving a goal or perceived progress from the preceding week also affected motivation.
Conclusion(s): Variability existed between patients in their diaries, highlighting individual journeys. Some commonalities were identified. The presence of pre-operative symptoms was a strong negative feeling which impacted on feelings about recovery so far. Onset of ´new symptoms' during this timescale was viewed less negatively. Participants who recorded a negative 'most memorable moment' during the initial week reported this consistently in subsequent weeks.
Implications: Patient diaries were an effective method for collecting a rich density of data. Continued data collection will capture the later stages of the patient journey. Findings will ensure that patient driven data informs precision rehabilitation following LSFS with the overall aim of improving patient outcome and cost effectiveness.
Keywords: spinal surgery, patient experience and journey, patient diary
Funding acknowledgements: The Chartered Society of Physiotherapy Charitable Trust Physiotherapy Research Foundation.
Topic: Musculoskeletal: spine
Ethics approval required: Yes
Institution: National Health Service (NHS)
Ethics committee: NHS Research Ethics Committee
Ethics number: IRAS 223283
All authors, affiliations and abstracts have been published as submitted.
