Evidence-based development of a post-surgical lumbar discectomy leaflet intervention: a Delphi consensus study

Goodwin, Peter; Wright, Chris; Allan, Carla; Crowther, L; Darley, C.R.; Heap, Alison; Paul, E; White, Louise J.; Rushton, Alison

doi:10.1136/bmjopen-2014-006069

Cited by 9 publications

(8 citation statements)

References 17 publications

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“…Our opinion is that a written educational booklet contributed in the restoration of physical activity. The same opinion is shared by other researchers [8, 10-12]. …”

Section: Discussionsupporting

confidence: 64%

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Influence of Early Intensive Rehabilitation on Functional Mobility after Low Back Surgery

Bizheva

Lubenova

Maznev

et al. 2016

Open Access Maced J Med Sci

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AIM:The research aims to determine the influence of early goal-oriented physical therapy program in combination with educational booklet and standard physical therapy without written instructions on functional mobility outcomes in patients after low back surgery.MATERIAL AND METHODS:Thirty patients with similar functional impairments were randomly divided into two groups, a control group (CG n = 10) and an experimental group (EG n = 20). The outcome measures include time to move from lying to sitting position, the TUG test and the 6-meter walk test. Rehabilitation program includes daily physical therapy with mild to moderate intensity, achieving sitting position and education sessions how to perform activities of daily living (ADL) from the first day after surgery.RESULTS:There was a significant improvement from baseline in two groups for all performed tests (p < 0.001). Statistical significant differences between two groups for transfers in bed on discharge (p < 0.05), in one month (p < 0.01) and for TUG in one month (p < 0.05) were found.CONCLUSION:The study revealed that early rehabilitation program consists of therapeutic exercises and written educational booklet after low back surgery improves transfer abilities and basic activities in one month.

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“…Our opinion is that a written educational booklet contributed in the restoration of physical activity. The same opinion is shared by other researchers [8, 10-12]. …”

Section: Discussionsupporting

confidence: 64%

“…The importance of written patient education as an integral component of postoperative rehabilitation is increasing [10]. This indicates the need for developing a program for home practice and self-performing exercises.…”

Section: Discussionmentioning

confidence: 99%

Influence of Early Intensive Rehabilitation on Functional Mobility after Low Back Surgery

Bizheva

Lubenova

Maznev

et al. 2016

Open Access Maced J Med Sci

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“…A qualitative focus group study of patients’ and physiotherapists’ experiences of rehabilitation following lumbar discectomy was embedded within an external pilot and feasibility trial (ISRCTN registry 33808269 ). 17 Within the trial, patients across two UK sites (Queen Elizabeth Hospital Birmingham (QEHB) and Salford Royal Foundation Trust (SRFT)) were randomised to either an optimised 1:1 physiotherapy intervention 18 plus patient leaflet (n=29) or patient leaflet 19 alone (n=30). The trial ran from January 2013 to July 2014, inclusive of recruitment, intervention, outcome assessment and focus groups.…”

Section: Methodsmentioning

confidence: 99%

“…The surgery-specific patient leaflet was developed through a Delphi process involving patients, physiotherapists and spinal surgeons. 19 The 1:1 physiotherapy outpatient intervention encompassed education, advice, mobility exercises, core stability exercises, a progressive approach to exercise to increase intensity and encouragement of early return to work and activity. 18 …”

Section: Methodsmentioning

confidence: 99%

Patient and physiotherapist perceptions of rehabilitation following primary lumbar discectomy: a qualitative focus group study embedded within an external pilot and feasibility trial

et al. 2017

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ObjectiveTo evaluate patients’ and physiotherapists’ perceptions, preferences and feelings about rehabilitation following lumbar discectomy surgery.DesignA qualitative focus group study, informed from the theoretical perspective of phenomenology, of patients’ and physiotherapists’ experiences of rehabilitation following lumbar discectomy was conducted. The focus groups were used to explore patients’ and physiotherapists’ perceptions and their preferences and feelings about different approaches to rehabilitation. The focus groups were facilitated and observed by experienced researchers and were informed by a topic guide that had been piloted previously.SettingThe study was embedded within an external pilot and feasibility trial that randomised patients across two secondary care spinal surgery sites in the UK to receive either 1:1 physiotherapy and leaflet or leaflet-only interventions.ParticipantsFive focus groups took place between April and July 2014. A framework analysis of thematic coding (deductive and inductive components) by two researchers captured identified themes common to both patients and physiotherapists. Data from three focus groups with patients and carers (n=11) and two with physiotherapists (n=15) contributed to the analytic framework.ResultsEmerging themes included: the value of patient leaflets with or without physiotherapy interventions; the importance of self-motivation in the recovery pathway; benefits of group physiotherapy for some patient groups and patient preference influencing rehabilitation.ConclusionPatients and physiotherapists perceived the study patient leaflet and 1:1 physiotherapy interventions as high quality and valuable. Patients’ personal priorities, for example, their need to return to work, influenced their preferences for rehabilitation interventions following surgery.

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“…No surgery-specific leaflet existed nationally; therefore, the Patient Leaflet was developed through a 3-round Delphi study, from information in existing leaflets at the 5 spinal centres and focus groups involving patients and clinicians. [ 25 ] The Delphi study used a purposive sample (n = 51) of experts including spinal surgeons, inpatient and outpatient physiotherapists and patients post lumbar discectomy from the 5 spinal centres. The Patient Leaflet included sections on: anatomy, disc herniation, surgery, activity post surgery, exercises and their progression, and frequently asked questions.…”

Section: Methodsmentioning

confidence: 99%

Physiotherapy Post Lumbar Discectomy: Prospective Feasibility and Pilot Randomised Controlled Trial

et al. 2015

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ObjectivesTo evaluate: acceptability and feasibility of trial procedures; distribution of scores on the Roland Morris Disability Questionnaire (RMDQ, planned primary outcome); and efficient working of trial components.Design and SettingA feasibility and external pilot randomised controlled trial (ISRCTN33808269, assigned 10/12/2012) was conducted across 2 UK secondary care outpatient physiotherapy departments associated with regional spinal surgery centres.ParticipantsConsecutive consenting patients aged >18 years; post primary, single level, lumbar discectomy.InterventionsParticipants were randomised to either 1:1 physiotherapy outpatient management including patient leaflet, or patient leaflet alone.Main Outcome MeasuresBlinded assessments were made at 4 weeks post surgery (baseline) and 12 weeks post baseline (proposed primary end point). Secondary outcomes included: Global Perceived Effect, back/leg pain, straight leg raise, return to work/function, quality of life, fear avoidance, range of movement, medication, re-operation.ResultsAt discharge, 110 (44%) eligible patients gave consent to be contacted. 59 (54%) patients were recruited. Loss to follow up was 39% at 12 weeks, with one site contributing 83% losses. Mean (SD) RMDQ was 10.07 (5.58) leaflet and 10.52 (5.94) physiotherapy/leaflet at baseline; and 5.37 (4.91) leaflet and 5.53 (4.49) physiotherapy/leaflet at 12 weeks. 5.1% zero scores at 12 weeks illustrated no floor effect. Sensitivity to change was assessed at 12 weeks with mean (SD) change -4.53 (6.41), 95%CI -7.61 to -1.44 for leaflet; and -6.18 (5.59), 95%CI -9.01 to -3.30 for physiotherapy/leaflet. RMDQ mean difference (95%CI) between change from baseline to twelve weeks was 1.65(-2.46 to 5.75). Mean difference (95%CI) between groups at 12 weeks was -0.16 (-3.36 to 3.04). Participant adherence with treatment was good. No adverse events were reported.ConclusionsBoth interventions were acceptable, and it is promising that they both demonstrated a trend in reducing disability in this population. A randomised controlled trial, using a different trial design, is needed to ascertain the effectiveness of combining the interventions into a stepped care intervention and comparing to a no intervention arm. Findings will guide design changes for an adequately powered randomised controlled trial, using RMDQ as the primary outcome.Trial RegistrationISRCTN registry 33808269

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Evidence-based development of a post-surgical lumbar discectomy leaflet intervention: a Delphi consensus study

Cited by 9 publications

References 17 publications

Influence of Early Intensive Rehabilitation on Functional Mobility after Low Back Surgery

Influence of Early Intensive Rehabilitation on Functional Mobility after Low Back Surgery

Patient and physiotherapist perceptions of rehabilitation following primary lumbar discectomy: a qualitative focus group study embedded within an external pilot and feasibility trial

Physiotherapy Post Lumbar Discectomy: Prospective Feasibility and Pilot Randomised Controlled Trial

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