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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: There has been a 65% increase in lumbar spinal fusion surgery (LSFS) worldwide over the last 13 years with annual costs of £26 million in the UK. Patient dissatisfaction with outcome and persistent pain and disability incur further costs. Three trials provide low quality evidence for the effectiveness of physiotherapy rehabilitation and our research investigating physiotherapy/surgeon practice concluded rehabilitation should be tailored to the individual patient owing to considerable clinical heterogeneity. Understanding the patient journey is essential to inform rehabilitation.
Purpose: To explore and understand patients' experiences of LSFS capturing the strategies used to cope and manage, from their onset of their problems, through decision for surgery and the early stages of recovery.
Methods: Qualitative study using an Interpretive Phenomenological Analysis (IPA) approach that embraces data analysis by considering the meaning of experience. In depth semi-structured interviews were conducted with adult patients within 2 weeks following their LSFS across 3 UK spinal centres. A topic guide was developed from the literature and piloted. It explored pre-operative and post-operative experiences, including expectations from surgery, facilitators and barriers to recovery, adherence to advice, experience of rehabilitation and return to normal activities. Interviews were audio recorded and transcribed verbatim. Emergent themes were interpreted for each participant and subsequently clustered into subordinate themes. This framework analysis was completed for each transcript individually before comparing across participants to identify patterns and relationships. Trustworthiness was addressed by considering data to minor themes, blind coding from 3 experienced researchers, peer and patient critique/review, and code and recode audits.
Results: Data from 28 semi-structured interviews contributed to the developed analytic framework. Emerging themes included 1) underlying attitudes and beliefs to surgical intervention, 2) the absence or presence of pre-operative symptoms after surgery, 3) the importance of self-motivation and self-efficacy in both the pre-operative and recovery pathways and the 4) advice, education and guidance provided to and sought by patients in relation to expectations of surgery and post-operative rehabilitation. The 5) discharge process and 6) access to peer support including the role of the web-based community and resources were also highlighted. A collaborative approach to the analysis representing professional, public and patient perspectives enhanced quality of data analysis.
Conclusion(s): A rich density of data afforded an understanding of the patient journey both before, during and immediately after LSFS from the patient perspective. Although extensive variability existed between patient journeys, common patterns were identified. Participants who reported higher levels of self-efficacy felt positive and able to manage the initial post-operative stage. In contrast, participants with lower perceived self-efficacy were fearful of the process ahead, stated preferences for longer hospital stays and more prescriptive post-operative guidance. Understanding patients' experiences of LSFS has highlighted components within their journey that may be improved. Results will inform further interviews with participants at 12 months following surgery to capture the later stages of their journeys.
Implications: Findings will inform stratification of care to enable improved effectiveness. Findings will help to identify which patients post LSFS to target with physiotherapy and will enable more effective rehabilitation and use of physiotherapy resources.
Keywords: Spinal fusion surgery, Patient experience and journey, qualitative
Funding acknowledgements: The Chartered Society of Physiotherapy Charitable Trust Physiotherapy Research Foundation.
Purpose: To explore and understand patients' experiences of LSFS capturing the strategies used to cope and manage, from their onset of their problems, through decision for surgery and the early stages of recovery.
Methods: Qualitative study using an Interpretive Phenomenological Analysis (IPA) approach that embraces data analysis by considering the meaning of experience. In depth semi-structured interviews were conducted with adult patients within 2 weeks following their LSFS across 3 UK spinal centres. A topic guide was developed from the literature and piloted. It explored pre-operative and post-operative experiences, including expectations from surgery, facilitators and barriers to recovery, adherence to advice, experience of rehabilitation and return to normal activities. Interviews were audio recorded and transcribed verbatim. Emergent themes were interpreted for each participant and subsequently clustered into subordinate themes. This framework analysis was completed for each transcript individually before comparing across participants to identify patterns and relationships. Trustworthiness was addressed by considering data to minor themes, blind coding from 3 experienced researchers, peer and patient critique/review, and code and recode audits.
Results: Data from 28 semi-structured interviews contributed to the developed analytic framework. Emerging themes included 1) underlying attitudes and beliefs to surgical intervention, 2) the absence or presence of pre-operative symptoms after surgery, 3) the importance of self-motivation and self-efficacy in both the pre-operative and recovery pathways and the 4) advice, education and guidance provided to and sought by patients in relation to expectations of surgery and post-operative rehabilitation. The 5) discharge process and 6) access to peer support including the role of the web-based community and resources were also highlighted. A collaborative approach to the analysis representing professional, public and patient perspectives enhanced quality of data analysis.
Conclusion(s): A rich density of data afforded an understanding of the patient journey both before, during and immediately after LSFS from the patient perspective. Although extensive variability existed between patient journeys, common patterns were identified. Participants who reported higher levels of self-efficacy felt positive and able to manage the initial post-operative stage. In contrast, participants with lower perceived self-efficacy were fearful of the process ahead, stated preferences for longer hospital stays and more prescriptive post-operative guidance. Understanding patients' experiences of LSFS has highlighted components within their journey that may be improved. Results will inform further interviews with participants at 12 months following surgery to capture the later stages of their journeys.
Implications: Findings will inform stratification of care to enable improved effectiveness. Findings will help to identify which patients post LSFS to target with physiotherapy and will enable more effective rehabilitation and use of physiotherapy resources.
Keywords: Spinal fusion surgery, Patient experience and journey, qualitative
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.
