The Concerns and Experiences of Patients With Lumbar Spinal Stenosis Regarding Prehabilitation and Recovery After Spine Surgery: A Qualitative Study

Preoperative spinal education for lumbar spinal stenosis (POSE-LSS): A qualitative analysis of patient experiences

BACKGROUND

Surgical intervention for lumbar spinal stenosis (LSS) is common and associated with high rates of postoperative side effects or complications. Prehabilitation programs aim to reduce postoperative complications and enhance outcomes. However, the clinical effectiveness of prehabilitation programs for patients undergoing LSS surgery has yet to be fully investigated. A key part of this investigation is to gain insight into how to design these programs through an iterative process that includes feedback from patients' experiences.

OBJECTIVE

To explore patients' experiences with a novel prehabilitation program: Pre-Operative Spinal Education for Lumbar Spinal Stenosis (POSE-LSS).

DESIGN

Individual structured telephone interviews with pragmatic qualitative analysis.

SETTING

Academic medical center.

PARTICIPANTS

Patients (n = 10) who underwent lumbar spinal stenosis surgery and completed the POSE-LSS program prior to their surgery were included (six women; four men, mean age: 62.3 years).

INTERVENTIONS

POSE-LSS is a novel multimodal, education-focused, time-efficient prehabilitation program for patients undergoing LSS surgery. Participants received the following: (1) educational booklet and video, (2) in-person physical therapy (PT) session, and (3) telemedicine visit with a physiatrist.

OUTCOME MEASURES

One-on-one structured interviews to understand patients' experiences with a LSS prehabilitation program.

RESULTS

Participants in this qualitative study described a favorable, unique, and feasible experience associated with participation in the POSE-LSS program. Three main themes were developed from these interviews about POSE-LSS: (1) it helped patients to better prepare for their surgery and improved postoperative expectations, (2) it addressed modifiable psychological factors associated with the surgical intervention, and (3) it fits into a larger support system necessary to meet patients' needs.

CONCLUSIONS

The perspectives gained from this qualitative study can inform improved design and evaluation of LSS prehabilitation programs.

Patients' experience on waiting for spinal arthrodesis: a qualitative study

PURPOSE

A number of studies have explored patients' subjective experience of waiting for spinal surgery, however, they did so through an investigation conducted post-operatively. Thus, the aim of this study was to explore the experience of patients while still on the waitlist for lumbar spinal arthrodesis.

METHODS

This qualitative study of semi-structured interviews was conducted at an orthopedic research institute in Italy. The interview track was developed by a team of professionals (physiotherapists, orthopedic surgeon, psychologist) and consisted of 40 questions. Fifteen patients, 10 females and 5 males aged between 23 and 80 years, waiting for spinal arthrodesis were interviewed. The interviews were performed, transcribed and analyzed by the multiprofessional team through thematic analysis using a reflexive approach.

RESULTS

Five main themes were generated: (1) Impact of persistent pain on patients' physical and psychological functioning; (2) Fear of the unknown and uncertainties; (3) Hope and regaining normality; (4) The impact of the unpredictability of the waiting time; (5) Need for better communication and information on the care pathway. Two minor themes were also produced.

CONCLUSIONS

These findings highlighted that patients on the waiting list for spinal arthrodesis need more certainty about waiting times, better communication with hospital staff, more thorough information about their care pathway. This could help patients feel more confident and may lead to more adequate expectations before surgery.

TRIAL REGISTRATION

The study protocol was registered on ClinicalTrials.gov database on 14/03/2022 with ID number NCT06323694.

Experiences of recovery and rehabilitation from surgery to treat neurogenic claudication. A qualitative study

PURPOSE

This study aimed to explore the experiences, expectations, attitudes and beliefs about surgery and recovery in people with neurogenic claudication, and their preferences for rehabilitation.

METHODS

Semi-structured interviews were conducted with a purposive sample of 16 patients (8 female; mean age 70 years) following surgery for neurogenic claudication. Data were transcribed verbatim, analysed using reflexive thematic analysis and interpreted using the five constructs of the Integrative Model of Expectations: treatment, timeline, behaviour, outcome, and generalised expectations.

FINDINGS

Three themes were developed: (1) making sense of recovery through a biomedical model of illness; (2) the mismatch between expectation and recovery (subthemes: the unanticipated burden of recovery; hope versus reality: expectations of the ultimate outcome); (3) one size doesn't fit all: the need for tailored rehabilitation. Participants expressed a preference for tailored, supervised rehabilitation commencing 2-6 weeks post-surgery. Some participants preferred one-to-one and some group-based rehabilitation. Some participants thought pre-operative rehabilitation would be beneficial.

CONCLUSIONS

Patient's experiences and satisfaction with their care and outcome are heavily influenced by their expectations. Tailored rehabilitation should reframe unrealistic expectations regarding care, recovery, and ultimate outcome; educate patients on the biopsychosocial model of pain; and equip patients with the knowledge and skills to optimise their outcome.IMPLICATIONS FOR REHABILITATIONPeople with neurogenic claudication interpret their condition, symptoms, and recovery from surgery through a mechanistic, biomedical lens.The experience and recovery from surgery for neurogenic claudication can be unexpectedly challenging and burdensome.Healthcare professionals should support patients by helping to set realistic expectations of post-operative care, recovery, and outcome from surgery.People undergoing surgery for neurogenic claudication want rehabilitation, personalised to their individual circumstances and requirements.

Preoperative rehabilitation optimization for spinal surgery: a narrative review of assessment, interventions, and feasibility

PURPOSE

Postoperative physical therapy (PT) is a cornerstone of orthopedic and musculoskeletal rehabilitation, proven to provide various positive clinical benefits. However, there is a paucity of literature evaluating the utility of preoperative rehabilitation specific to spine surgery. Thus, this review article aims to provide an overview of previously published studies discussing the efficacy of preoperative rehabilitation programs and its role in spinal surgery. Special emphasis was given to preoperative frailty assessments, physical performance tests, interventional strategies, feasibility, and future directions.

METHODS

We performed a literature review using PubMed, Google Scholar, EMBASE, and PubMed Central (PMC) using directed search terms. Articles that examined preoperative rehabilitation in adult spine surgery were compiled for this review. Prehabilitation programs focused on exercise, flexibility, and behavioral modifications have been shown to significantly improve pain levels and functional strength assessments in patients undergoing elective spine surgery. In addition, studies suggest that these programs may also decrease hospital stays, return to work time, and overall direct health care expenditure costs. Screening tools such as the FRAIL scale can be used to assess frailty while physical function tests like the timed-up-and go (TUGT), 5 repetition sit-to-stand test (5R-STST), and hand grip strength (HGS) can help identify patients who would most benefit from prehabilitation.

CONCLUSIONS

This review illustrates that prehabilitation programs have the potential to increase quality of life, improve physical function and activity levels, and decrease pain, hospital stays, return to work time, and overall direct costs. However, there is a paucity of literature in this field that requires further study and investigation.

The effects of a prehabilitation programme based on therapeutic exercise, back care education, and pain neuroscience education in patients scheduled for lumbar radiculopathy surgery: A study protocol for a randomised controlled trial

The aim of this present clinical trial is to evaluate the effectiveness of a multicomponent prehabilitation programme administered through educational videos versus another programme based on written exercise recommendations, in patients scheduled for lumbar radiculopathy surgery. This study will be a multicentre, controlled, randomised, parallel clinical trial. One hundred participants undergoing lumbar radiculopathy surgery who meet the established inclusion criteria will be recruited at different Spanish hospitals. The experimental group will follow a 4-week prehabilitation programme combining therapeutic exercise, back care education, and pain neuroscience education delivered through videos designed for consumption at home. The control group will be provided with written instructions to perform therapeutic exercises during the same prehabilitation time period. The primary outcome of the study will be disability, assessed using the Spanish version of the Oswestry Disability Index. The secondary outcomes will be pain perception, health-related quality of life, fear avoidance, kinesiophobia, catastrophising, anxiety, depression, physical activity, and the treatment satisfaction of the patients. This study will provide evidence for the effectiveness of a home-based multicomponent prehabilitation programme that addresses some already identified barriers to patient attendance in face-to-face programmes. Understanding the medium and long-term effects of pre-surgery lumbar muscle training and pain neuroscience education administered via instructional videos watched by patients at home, will help improve the design of prehabilitation programmes in this population while also improving the cost-effectiveness of such interventions.

Experiences and perceptions of adults pre- and/or post-lumbar spine surgery: a meta-ethnography

STUDY DESIGN

Qualitative meta-ethnography. Pre-registered with OSF:10.17605/OSF.IO/UTZE6.

PURPOSE

To understand the patient experience pre- and/or post-lumbar spine surgery.

METHODS

Literature search: A literature search was conducted in MEDLINE, EMBASE, EmCare and CINAHL from inception to October 17, 2022. Study selection criteria: Peer-reviewed qualitative or mixed-method studies of English text investigating the beliefs, perceptions, or experiences of adults (≥18 years old) pre- and/or post-lumbar spine surgery for degenerative, non-traumatic or non-infectious concerns. Data synthesis: The eMERGE meta-ethnography reporting guidelines were followed to create themes and subthemes from the original themes of the included studies. A quality appraisal was performed using the McMaster Quality Appraisal tool.

RESULTS

We included 18 studies and identified five themes that were separated into pre- and post-operative categories. The two pre-operative themes included [1]: the influence of physiotherapy interventions on patients' experiences, and [2] the importance of education/the power of communication, and the three post-operative themes included [1]: psychosocial coping [2], redefining oneself post-operatively, and [3] experience with the healthcare system.

CONCLUSIONS

These findings emphasize the complexity of the peri-operative experience for individuals undergoing lumbar spine surgery. Future research should focus on addressing psychosocial factors that may optimize patient experiences and recovery following LSS.

Caregiving for People With Spinal Cord Injury Undergoing Upper Extremity Reconstructive Surgery: A Prospective Exploration of Lived Experiences, Perioperative Care, and Change Across Time

Background

Nerve transfer (NT) and tendon transfer (TT) surgeries can enhance upper extremity (UE) function and independence in individuals with cervical spinal cord injury (SCI). Caregivers are needed to make this surgery possible, yet caregivers experience their own set of challenges.

Objectives

This comparative study explored the perioperative and nonoperative experiences of caregivers of individuals with cervical SCI, focusing on daily life activities, burden, and mental health.

Methods

Caregivers of individuals with cervical SCI were recruited and grouped by treatment plan for the person with SCI: (1) no surgery (NS), (2) TT surgery, and (3) NT surgery. Semistructured interviews were conducted at baseline/preoperative, early follow-up/postoperative, and late follow-up/postoperative. Caregivers were asked about their daily life, mental health, and challenges related to caregiving. Interviews were audio recorded, transcribed verbatim, and analyzed using thematic analysis. Quantitative, single-item standardized burden score (0-100) data were collected at each timepoint.

Results

Participants included 23 caregivers (18 family members, 4 friends, 1 hired professional). The surgeries often brought hope and motivation for caregivers. Caregivers reported increased burden immediately following surgery (less for the NT compared to TT subgroup) yet no long-term changes in the amount and type of care they provided. NS caregivers discussed social isolation, relationship dysfunction, and everyday challenges.

Conclusion

Health care providers should consider the changing needs of SCI caregivers during perioperative rehabilitation. As part of the shared surgical decision-making approach, providers should educate caregivers about the postoperative process and the extent and potential variability of short- and long-term care needs.

What moves patients to participate in prehabilitation before major surgery? A mixed methods systematic review

BACKGROUND

Prehabilitation offers patients the opportunity to actively participate in their perioperative care by preparing themselves for their upcoming surgery. Experiencing barriers may lead to non-participation, which can result in a reduced functional capacity, delayed post-operative recovery and higher healthcare costs. Insight in the barriers and facilitators to participation in prehabilitation can inform further development and implementation of prehabilitation. The aim of this review was to identify patient-experienced barriers and facilitators for participation in prehabilitation.

METHODS

For this mixed methods systematic review, articles were searched in PubMed, EMBASE and CINAHL. Articles were eligible for inclusion if they contained data on patient-reported barriers and facilitators to participation in prehabilitation in adults undergoing major surgery. Following database search, and title and abstract screening, full text articles were screened for eligibility and quality was assessed using the Mixed Method Appraisal Tool. Relevant data from the included studies were extracted, coded and categorized into themes, using an inductive approach. Based on these themes, the Capability, Opportunity, Motivation, Behaviour (COM-B) model was chosen to classify the identified themes.

RESULTS

Three quantitative, 14 qualitative and 6 mixed methods studies, published between 2007 and 2022, were included in this review. A multitude of factors were identified across the different COM-B components. Barriers included lack of knowledge of the benefits of prehabilitation and not prioritizing prehabilitation over other commitments (psychological capability), physical symptoms and comorbidities (physical capability), lack of time and limited financial capacity (physical opportunity), lack of social support (social opportunity), anxiety and stress (automatic motivation) and previous experiences and feeling too fit for prehabilitation (reflective motivation). Facilitators included knowledge of the benefits of prehabilitation (psychological capability), having access to resources (physical opportunity), social support and encouragement by a health care professional (social support), feeling a sense of control (automatic motivation) and beliefs in own abilities (reflective motivation).

CONCLUSIONS

A large number of barriers and facilitators, influencing participation in prehabilitation, were found across all six COM-B components. To reach all patients and to tailor prehabilitation to the patient's needs and preferences, it is important to take into account patients' capability, opportunity and motivation.

TRIAL REGISTRATION

Registered in PROSPERO (CRD42021250273) on May 18th, 2021.

An exploratory study to understand how people use Twitter to share experiences or information about spinal stenosis

BACKGROUND

Spinal stenosis is a narrowing of the spinal canal that may compress neurological tissues resulting in pain and disability. Although previous qualitative studies have solicited data regarding the life experience of patients with spinal stenosis or their opinions on relevant non-surgical treatments, their data was collected from participants in a controlled setting. Therefore, it remains unclear whether patients' or caregivers' concerns/opinions about spinal stenosis would be different in a non-experimental environment. Since Twitter is a popular online platform for people to share information and interact, it may reveal people's thoughts and attitudes about spinal stenosis. This study aimed to identify tweets that are related to spinal stenosis on Twitter, and to categorize them into common themes.

METHODS

A social media monitoring and analysis software program (TalkWalker) was used to search relevant tweets using the keywords 'spinal stenosis' and 'stenosis' between 29 May 2019 and 24 June 2020. Two independent reviewers screened and conducted content analysis of the tweets and classified the tweets into different themes.

RESULTS

Of 510 identified tweets, 362 tweets met the selection criteria. Five themes were identified: (1) compromised physical, psychological, and social wellbeing (n = 173); (2) diverse treatment options (n = 69); (3) coping strategies (n = 30); (4) dissemination of scientific information (n = 86); and (5) health policy (n = 4). Most of the tweets revealed negative impacts of spinal stenosis on patients' physical and psychosocial wellbeing. People with spinal stenosis shared their experiences and sought helps from others, while some people used Twitter to disseminate relevant information and research findings.

CONCLUSIONS

This is the first study exploring Twitter using an online analytical tool to identify themes related to spinal stenosis. The approach not only helps understand people's concerns about spinal stenosis in an uncontrolled environment, but also can be adopted to monitor influences of diseases or public health education on Twitter users.