Lindbäck Y1, Enthoven P1, Öberg B1
1Linköping University, Department of Medical and Health Sciences, Faculty of Medicine and Health Sciences, Division of Physiotherapy, Linköping, Sweden
Background: The influence on health for patients with degenerative lumbar spine disorders (disc herniation, spinal stenosis, spondylolisthesis, disc degenerative disease) are considerable, with long pain duration, frequent recurrences and functional limitations. With an aging population, the number of patients with spinal stenosis and other long-standing types of low back pain is growing, resulting in a greater need for intervention. Surgery for spinal stenosis and disc herniation is efficient at 3-month follow-up, but 22%-39% of patients are doubtful or dissatisfied at the 1-year follow-up. Only few studies have investigated the effects of physiotherapy interventions in patients with spinal stenosis and disc herniation, even though non-surgical intervention should be exhausted before surgery.
Prehabilitation is defined as augmenting functional capacity prior to surgery, which may have a beneficial effect on post-surgery outcomes. Prehabilitation before spinal surgery has only been evaluated in a few studies. In the randomised control trial; Prepare, we evaluated pre-surgery physiotherapy in patients with degenerative lumbar spine disorders. Since pre-surgery phase is a new setting for physiotherapy, our interest is to add the patients' experiences to the quantitative results. Exploring patients' experiences based on their own stories may contribute to new insights and a deeper understanding useful in the development of care for their needs early and in the pre-surgery context.
Purpose: To describe patients' experiences of how symptoms are explained, and their experiences of the influences on back-related health after pre-surgery physiotherapy.
Methods: Explorative qualitative design using semi-structured interviews analysed with content analysis. The 18 informants were scheduled for spinal surgery and had participated in pre-surgery physiotherapy.
Results: Categories and subcategories describing patients' experiences how symptoms are explained, and the influences on back-related health after pre-surgery physiotherapy.
1. Influences on symptoms, physical function and sleep
1A Pain and numbness
1B Physical function and sleep
2. Influences on coping and well-being
2A Feelings of stress, fear and insecurity
2B Ability to manage symptoms
2C An opportunity to reflect on interventions
3. Explanations of back-related symptoms and wanting to be well-informed
3A The symptom is mainly an injury in the spine
3B The symptoms can be influenced by exercises
3C Searching for feelings of trust to the spine
3D Strategies to become well-informed about symptoms
3E Uncertainty how intervention can influence symptoms
4. Influences on social functioning
4A Daily routines, work and social role
4B Longing for a more active life
5. The ability of the model of care to influence reassurance and prevention
Conclusion(s): Pre-surgery physiotherapy was described as a tool for reassurance and time to reflect on treatments and lifestyle. There were descriptions of improvements in back-related health in all the biopsychosocial dimensions. Even those who expressed no symptom improvements, felt better performing exercises than being inactive, and exercises improved their frame of mind. Symptoms were mainly described in line with a biomedical explanatory model. Those using a broader explanation were confident that physiotherapy and self-management could influence their back‑related symptoms.
Implications: Suggesting a need for more emphasis on explanatory models for surgery, pre- and post-surgery physiotherapy and self-management in the professionals' dialogue with patients.
Keywords: Content analysis, Exercise therapy, Spinal surgery
Funding acknowledgements: This work has been supported by a grant from the County Council of Östergötland, Linköping, Sweden.
Prehabilitation is defined as augmenting functional capacity prior to surgery, which may have a beneficial effect on post-surgery outcomes. Prehabilitation before spinal surgery has only been evaluated in a few studies. In the randomised control trial; Prepare, we evaluated pre-surgery physiotherapy in patients with degenerative lumbar spine disorders. Since pre-surgery phase is a new setting for physiotherapy, our interest is to add the patients' experiences to the quantitative results. Exploring patients' experiences based on their own stories may contribute to new insights and a deeper understanding useful in the development of care for their needs early and in the pre-surgery context.
Purpose: To describe patients' experiences of how symptoms are explained, and their experiences of the influences on back-related health after pre-surgery physiotherapy.
Methods: Explorative qualitative design using semi-structured interviews analysed with content analysis. The 18 informants were scheduled for spinal surgery and had participated in pre-surgery physiotherapy.
Results: Categories and subcategories describing patients' experiences how symptoms are explained, and the influences on back-related health after pre-surgery physiotherapy.
1. Influences on symptoms, physical function and sleep
1A Pain and numbness
1B Physical function and sleep
2. Influences on coping and well-being
2A Feelings of stress, fear and insecurity
2B Ability to manage symptoms
2C An opportunity to reflect on interventions
3. Explanations of back-related symptoms and wanting to be well-informed
3A The symptom is mainly an injury in the spine
3B The symptoms can be influenced by exercises
3C Searching for feelings of trust to the spine
3D Strategies to become well-informed about symptoms
3E Uncertainty how intervention can influence symptoms
4. Influences on social functioning
4A Daily routines, work and social role
4B Longing for a more active life
5. The ability of the model of care to influence reassurance and prevention
Conclusion(s): Pre-surgery physiotherapy was described as a tool for reassurance and time to reflect on treatments and lifestyle. There were descriptions of improvements in back-related health in all the biopsychosocial dimensions. Even those who expressed no symptom improvements, felt better performing exercises than being inactive, and exercises improved their frame of mind. Symptoms were mainly described in line with a biomedical explanatory model. Those using a broader explanation were confident that physiotherapy and self-management could influence their back‑related symptoms.
Implications: Suggesting a need for more emphasis on explanatory models for surgery, pre- and post-surgery physiotherapy and self-management in the professionals' dialogue with patients.
Keywords: Content analysis, Exercise therapy, Spinal surgery
Funding acknowledgements: This work has been supported by a grant from the County Council of Östergötland, Linköping, Sweden.
Topic: Musculoskeletal: spine; Orthopaedics; Education: clinical
Ethics approval required: Yes
Institution: Faculty of Medicine and Health Sciences
Ethics committee: The Regional Ethical Review Board in Linköping, Sweden
Ethics number: 2014/218-31
All authors, affiliations and abstracts have been published as submitted.
