Abstract
Purpose
The behavioural change wheel methodology and social cognitive theory were combined to inform and develop a rehabilitation programme following lumbar fusion surgery (REFS).
This qualitative study evaluated participant's experiences of lumbar fusion surgery, including REFS, to identify valued programme content (‘active ingredients’).
Background
A feasibility-RCT suggested REFS achieved a meaningful impact in disability and pain self-efficacy compared to ‘usual care’ (p=0.014, p=0.007).
In keeping with MRC guidance a qualitative evaluation was undertaken to understand possible mechanisms of action.
Methods
Thematic analysis was utilised on data from semi-structured, face-to-face interviews, in a purposive sample (REFS n=10, ‘usual care’ n=10).
Results
Three themes (8 sub-themes) were identified, which illuminated the experiences of 1) the impact of living with a chronic lumbar disorder 2) reflections on recovery, and 3) the experience of rehabilitation with(out) REFS.
REFS participants identified valued programme content including the opportunity for vicarious learning, the shared rehabilitation experience, and expert physiotherapy. They were unable to identify pre-eminent programme content, in keeping with inter-dependent ‘active ingredients’. Abstraction with the overarching theme of ‘loss of self’ was evident for analysis across all themes.
Conclusion
In conclusion the findings were theoretically congruous with other published works e.g. recent mega-ethnographic review of patients experience of chronic non-malignant pain. Two emergent areas were identified to inform future REFS iterations and better understand potential mechanisms of action.
1-Participants fear of harm appears directly attributable to the instillation of metalware, this association is mediated by inadequate advice.
2-Lumbar fusion surgery is not perceived as elective.
No conflicts of interest
Funding; NIHR (Doctoral fellowship, awarded to J Greenwood)
