WHY DON'T PEOPLE ATTEND?PATIENT AND HEALTHCARE PROVIDER EXPERIENCE AND PERCEPTIONS OF A PREOPERATIVE REHABILITATION CLASS FOR LUMBAR DISCECTOMY: A QUALITATIVE STUDY

H. Alsaif¹, P. Goodwin², T. O'Neill¹, M. Callaghan², G. Yeowell²

¹University of Manchester, Centre for Epidemiology Versus Arthritis, Manchester, United Kingdom, ²Manchester Metropolitan University, Department of Health and Professions, Manchester, United Kingdom

Background: Preoperative rehabilitation is widely used in the management of patients undergoing lumbar discectomy. There are few studies investigating patients' and healthcare providers' experiences of this form of therapy, and such data are important in helping develop and deliver effective care for patients undergoing lumbar discectomy.

Purpose: This study aimed to develop an understanding of both patients' and clinicians' experiences, perceptions, and preferences of preoperative rehabilitation classes for lumbar discectomy, including an understanding of why patients fail to attend these classes.

Methods: A qualitative interpretive approach using focus groups and individual interviews was utilised. Interviews were conducted with three groups at an NHS hospital in North West England between October 2019 and March 2020. Group 1, patients who attended a preoperative rehabilitation class. Group 2, patients who were invited but did not attend, and Group 3, clinicians who delivered the preoperative rehabilitation classes. Thematic analysis was used to analyse the data.

Results: Twenty participants were interviewed, seven attendees, five non-attendees, and eight clinicians. Patient and clinician themes were comparable, so they were presented together. The preoperative class's primary objectives were to deliver preoperative education, empower patients with effective self-management, and deliver individualised care per the surgeon's preference. Healthcare providers aim to address patients' preoperative needs and inquiries by providing efficient rehabilitation to the right patients at the right time. Four themes were identified:
1. motivations for service delivery change;
2. benefits of service change;
3. challenges and barriers;
4. opportunities for service delivery development.
For some patients and healthcare providers, the preoperative lumbar discectomy class was essential as a solution for the staffing and time issues and class content patients required to help them on their surgical pathway. Separately, some healthcare providers and patients felt that an online class would be more effective and could eliminate many barriers to attendance, which included distance to travel, transportation, parking difficulty and cost.

Conclusions: Preoperative rehabilitation was considered a valuable service and perceived to be essential by most patients and clinicians. However, tailored care may improve patient satisfaction, attendance and expectations. The current study's findings help shape rehabilitation. Future research should include tailored modes of delivery.

Implications: The current study's findings will help shape the preoperative lumbar discectomy treatment by exposing patients' experiences, perceptions, perceived requirements and beliefs and considering the value of the preoperative intervention. A deeper understanding and making sense of the patient's and healthcare providers' experiences will extend knowledge regarding what is important to patients during their preoperative lumbar discectomy time. Knowledge of this will help the healthcare providers provide relevantly and tailored preoperative rehabilitation for lumbar discectomy patients based on patient requirements that could improve future patient experiences, management, and outcomes.

Funding acknowledgements: This research was conducted as part of the doctoral degree of Alsaif funded by the Government of Saudi Arabia.

Keywords:
Preoperative rehabilitation
Lumbar discectomy
Qualitative

Topics:
Musculoskeletal: spine

Did this work require ethics approval? Yes

Institution: The National Health Service (NHS) in England

Committee: The Health and Care Research Wales (HCRW)

Ethics number: (reference 21/NE/0056).