Rehabilitation following primary lumbar discectomy: patient and physiotherapist perceptions

  • Rushton A
  • Heneghan N
  • Heap A
  • et al.
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Abstract

Relevance: This is relevant to the conference themes (2) Research, education and practice, and (4) Responding to changing population needs. There is a lack of qualitative research exploring patient and physiotherapist perceptions of rehabilitation following spinal surgery. Post-operative rehabilitation varies considerably post lumbar discectomy surgery, with 30-70% patients experiencing residual pain and ongoing disability. The mean age of patients undergoing surgery is 45 years and this working age presents multiple challenges to patients for their recovery and return to work/function. An understanding of patient perceptions is valuable to provide insights into patients' experiences and outcomes. Likewise, perceptions of physiotherapists are valuable and could be used to optimise rehabilitation and improve patient outcomes. Differences in views between patients and physiotherapists are also important to understand. Purpose(s): To evaluate patient and physiotherapist perceptions about rehabilitation following lumbar discectomy surgery. Methods/analysis: This was a qualitative focus group study of patients' and physiotherapist's experiences of rehabilitation following lumbar discectomy. It was informed from the theoretical perspective of phenomenology and embedded within an external pilot and feasibility trial randomising patients across two UK sites. Patients from both arms of the trial (1:1 physiotherapy plus Patient Leaflet intervention, or Patient Leaflet alone), as well as all trial roles of: introducer, recruiter, assessor and treating physiotherapist and both inpatient and outpatient physiotherapists, were represented in the focus groups. A topic guide, developed from the literature and piloted, informed the focus groups, which were facilitated and observed by experienced researchers. Five focus groups took place between April and July 2014. A frame work analysis of thematic coding (with deductive and inductive components) by two researchers captured findings common to both patients and physiotherapists. Result(s): Data from 3 previous focus groups with patients and carers (n = 11) and 2 with physiotherapists (n = 12) contributed to the developed analytic framework. Emerging themes included: the value of patient leaflets (individualised physiotherapy as interventions; the importance of self-motivation in the recovery pathway, benefits of group physiotherapy for some patients; and patient preference influencing rehabilitation. Discussion and conclusions: Triangulation of data across the two groups of participants illustrated common findings for both users and providers of rehabilitation. Both patients and physiotherapists found a patient leaflet and individualised physiotherapy interventions acceptable, and agreed that a patient leaflet was a desirable and appropriate sole intervention for some patients. They also agreed that other patients needed individualised physiotherapy, and for some, a group approach was valuable. Personal priorities, for example returning to work, influenced patient preferences for rehabilitation following surgery. Impact and implications: This is the first research to explore patient and physiotherapists perceptions of different approaches to rehabilitation following lumbar discectomy using focus groups. When considering the type of intervention post-surgery, patient priorities are important, as they do not always match those of the clinician. The data support the feasibility and pilot trial findings that some patients respond well to a leaflet, while others require further intervention to a leaflet. To satisfy the needs of patients post lumbar discectomy a stepped care approach might be suitable.

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APA

Rushton, A., Heneghan, N. R., Heap, A., White, L., Calvert, M., & Goodwin, P. C. (2016). Rehabilitation following primary lumbar discectomy: patient and physiotherapist perceptions. Physiotherapy, 102, e16. https://doi.org/10.1016/j.physio.2016.10.023

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