Abstract:Purpose Following lumbar fusion surgery (LFS), 40% of patients are unsure/dissatisfied with their outcome. A prospective, single-centre, randomised, controlled trial was conducted to evaluate the feasibility (including clinical and economic impact) of a theoretically informed rehabilitation programme following LFS (REFS). Methods REFS was informed by an explicit theoretical framework and consisted of 10 consecutive weekly group rehabilitation sessions (education, low-tech cardiovascular, limb and spine strengt… Show more
“…In depth examination of the patient diaries identified 3 distinct recovery trajectories within participants' diverse and vivid descriptions of their recovery experiences: meaningful recovery (engagement in physical and functional activities to return to functionality/mobility); progressive recovery (small but meaningful improvement in physical ability with increasing PLOS ONE confidence); and disruptive recovery (limited purpose for meaningful recovery). Recovery from LSFS has not been described in the literature as a linear process, often referring to physical and functional rehabilitation and adjustment in the first few months following surgery [29,30]. Our findings support this and show that recovery is a complex and dynamic process often interrelated between physical, functional, social and emotional domains.…”
The aim of this study was to capture and understand the immediate recovery journey of patients following lumbar spinal fusion surgery and explore the interacting constructs that shape their journey. A qualitative study using Interpretive Phenomenological Analysis (IPA) approach. A purposive sample of 43 adult patients (≥16 years) undergoing ≤4 level instrumented fusion for back and/or leg pain of degenerative cause, were recruited pre-surgery from 4 UK spinal surgery centres. Patients completed a weekly diary expressed in their own words for the first 4 weeks following surgery to capture their life as lived. Diary content was based on previous research findings and recorded progress, recovery, motivation, symptoms, medications, healthcare appointments, rehabilitation, positive/negative thoughts, and significant moments; comparing to the previous week. To maximise completion and data quality, diaries could be completed in paper form, word document, as online survey or as audio recording. Strategies to enhance diary adherence included a weekly prompt. A framework analysis for individual diaries and then across participants (deductive and inductive components) captured emergent themes. Trustworthiness was enhanced by strategies including reflexivity, attention to negative cases and use of critical co-investigators. Twenty-eight participants (15 female; n = 18 (64.3%) aged 45–64) contributed weekly diaries (12 withdrew post-surgery, 3 did not follow through with surgery). Adherence with diaries was 89.8%. Participants provided diverse and vivid descriptions of recovery experiences. Three distinct recovery trajectories were identified: meaningful recovery (engagement in physical and functional activities to return to functionality/mobility); progressive recovery (small but meaningful improvement in physical ability with increasing confidence); and disruptive recovery (limited purpose for meaningful recovery). Important interacting constructs shaped participants’ recovery including their pain experience and self-efficacy. This is the first account of immediate recovery trajectories from patients’ perspectives. Recognition of a patient’s trajectory may inform patient-centred recovery, follow-up and rehabilitation to improve patient outcomes.
“…In depth examination of the patient diaries identified 3 distinct recovery trajectories within participants' diverse and vivid descriptions of their recovery experiences: meaningful recovery (engagement in physical and functional activities to return to functionality/mobility); progressive recovery (small but meaningful improvement in physical ability with increasing PLOS ONE confidence); and disruptive recovery (limited purpose for meaningful recovery). Recovery from LSFS has not been described in the literature as a linear process, often referring to physical and functional rehabilitation and adjustment in the first few months following surgery [29,30]. Our findings support this and show that recovery is a complex and dynamic process often interrelated between physical, functional, social and emotional domains.…”
The aim of this study was to capture and understand the immediate recovery journey of patients following lumbar spinal fusion surgery and explore the interacting constructs that shape their journey. A qualitative study using Interpretive Phenomenological Analysis (IPA) approach. A purposive sample of 43 adult patients (≥16 years) undergoing ≤4 level instrumented fusion for back and/or leg pain of degenerative cause, were recruited pre-surgery from 4 UK spinal surgery centres. Patients completed a weekly diary expressed in their own words for the first 4 weeks following surgery to capture their life as lived. Diary content was based on previous research findings and recorded progress, recovery, motivation, symptoms, medications, healthcare appointments, rehabilitation, positive/negative thoughts, and significant moments; comparing to the previous week. To maximise completion and data quality, diaries could be completed in paper form, word document, as online survey or as audio recording. Strategies to enhance diary adherence included a weekly prompt. A framework analysis for individual diaries and then across participants (deductive and inductive components) captured emergent themes. Trustworthiness was enhanced by strategies including reflexivity, attention to negative cases and use of critical co-investigators. Twenty-eight participants (15 female; n = 18 (64.3%) aged 45–64) contributed weekly diaries (12 withdrew post-surgery, 3 did not follow through with surgery). Adherence with diaries was 89.8%. Participants provided diverse and vivid descriptions of recovery experiences. Three distinct recovery trajectories were identified: meaningful recovery (engagement in physical and functional activities to return to functionality/mobility); progressive recovery (small but meaningful improvement in physical ability with increasing confidence); and disruptive recovery (limited purpose for meaningful recovery). Important interacting constructs shaped participants’ recovery including their pain experience and self-efficacy. This is the first account of immediate recovery trajectories from patients’ perspectives. Recognition of a patient’s trajectory may inform patient-centred recovery, follow-up and rehabilitation to improve patient outcomes.
“…Both sub-themes highlight areas of commonality and divergence across the data, which is occasionally aligned with group allocation (REFS or ‘usual care’). This identifies potential mechanisms of action, facilitates evaluation of the theoretical model, and provides a plausible explanation for the numerical results of the main feasibility study [ 11 ]. Fig.…”
Section: Resultsmentioning
confidence: 99%
“…Systematic reviews across a range of long-term conditions have demonstrated the benefit of peer support in group-based rehabilitation [ 26 – 28 ]. Therefore, the sub-theme ‘Pulling together, sharing recovery expertise’ represents a plausible mechanism of action explaining the favourable numerical outcomes of REFS compared with ‘usual care’ [ 11 ].…”
Section: Discussionmentioning
confidence: 99%
“…The REFS programme consisted of ≤ 10 sessions of group based rehabilitation comprising exercise, education, and peer support [ 10 ]. Feasibility outcomes including enrolment, engagement, and numerical analyses are described elsewhere [ 11 ].…”
Background
The use of lumbar fusion surgery is increasing in developed economies. High levels of patient dissatisfaction are reported post-operatively. To address this need, we developed a theoretically informed rehabilitation programme for use following lumbar fusion surgery (the REFS programme). We conducted a mixed methods randomised controlled feasibility study (REFS v ‘usual care’). The numerical and feasibility outcomes are reported separately. The current qualitative study was ‘nested’ within the main feasibility study to explore participants’ experiences before and after lumbar fusion surgery including the impact of rehabilitation content. This facilitated a deeper understanding of potential mechanisms of action, for theoretical and programme refinement.
Methods
A purposive sample (n = 10 ‘usual care’, n = 10 REFS) was identified from the main feasibility study cohort. Individual semi-structured interviews were conducted post-operatively (median 8 months, range 5–11). Interview data were transcribed verbatim, coded, and analysed thematically.
Results
Three themes were constructed: the breadth and severity of impact associated with a chronic lumbar disorder was summarised in theme 1, ‘Ever-decreasing circles; living with a chronic lumbar disorder’. Theme 2, ‘What have I done? Reflections on recovery from lumbar fusion surgery’, illustrated participants post-operative helplessness, which was associated with worsening mental health, problematic use of opioids, fear related to the instillation of metalware, and the important mitigating effect of informal social support. Theme 3 ‘Rehabilitation experiences’ identified critical rehabilitation programme content including exercise, a shared rehabilitation experience, the opportunity for vicarious learning, and professional expertise.
Conclusions
To enhance patient benefit future REFS programme iterations should consider reinforcement of the identified valued programme content. Additional content should be considered to mitigate post-operative fear, which frequently aligned with the instillation of metalware into the spine. Participant’s perceptions regarding the necessity of lumbar fusion surgery has potential implications for the surgical consent process.
Trial registration
Study registration; ISRCTN60891364, date registered 10/7/2014.
“…As the older population continues to increase worldwide, degenerative lumbar disease is becoming a growing cause of concern among healthcare providers [1, 2]. For patients with no effect of conservative treatment, posterior decompression is the most common treatment [3, 4].…”
BackgroundWound-related complications are an inevitable issue faced by spinal surgeons. Negative pressure drainage remains the most commonly used method to prevent postoperative hematoma and related complications. This prospective, randomized, controlled study was conducted to evaluate the efficacy of compression therapy following posterior lumbar interbody fusion, with emphasis on pain, anemia, and inflammation.MethodsSixty consecutive patients who have undergone posterior lumbar interbody fusion in the age range 43–78 years, with an average age of 59 years, were selected and randomly assigned into two groups. Factors, such as drainage volume, visual analog scale (VAS) pain score for back pain, white blood cell (WBC) count, red blood cell (RBC) count, hemoglobin (Hb) levels, erythrocyte sedimentation rate (ESR), and C-reactive protein (CRP) levels assessed on the 1st, 3rd, and 10th days postoperatively, were compared between the two groups.ResultsThe average follow-up was 6 months, ranging from 3 to 11 months. Drainage volume, VAS score, and CRP levels on the 10th day after the surgery were found to be significantly lower in the treatment group than in the control group. RBC count and Hb levels on the 3rd and 10th postoperative days were observed to be significantly higher in the treatment group than in the control group (P < 0.05). During discharge, the wounds of the patients of the both groups had healed and neither showed any symptoms of infection, hematoma, or necrosis.ConclusionCompression therapy relieves pain, alleviates anemia, and the inflammatory response following posterior lumbar interbody fusion.Trial registrationChiCTR1800015825 on chictr.org.cn, April 23, 2018, the trial registry is Chinese Clinical Trial Registry.
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