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Immediate patient perceptions following lumbar spinal fusion surgery: semi-structured multi-centre interviews exploring the patient journey and experiences of lumbar fusion surgery (FuJourn)

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Abstract

Purpose

To understand the patient journey to Lumbar Spinal Fusion Surgery (LSFS) and patients’ experiences of surgery.

Methods

Qualitative study using interpretive phenomenological analysis. Adult participants following LSFS were recruited from 4 UK clinical sites using purposive sampling to ensure representation of key features (e.g. age). Semi-structured interviews informed by a piloted topic guide developed from the literature were audio-recorded and transcribed verbatim. Framework analysis for individual interviews and then across participants (deductive and inductive) identified emerging themes. Trustworthiness of data analyses was enhanced using multiple strategies (e.g. attention to negative cases).

Results

Four emerging themes from n = 31 patients’ narratives were identified: decision for surgery, coping strategies, barriers to recovery and recovery after surgery. Decision for surgery and recovery after surgery themes are distinguished by the point of surgery. However, barriers to recovery and coping strategies are key to the whole patient journey encompassing long journeys to surgery and their initial journey after surgery. The themes of coping strategies and barriers to recovery were inter-related and perceived by participants as parallel concepts. The 4 multifactorial themes interacted with each other and shaped the process of an individual patient’s recovery. Factors such as sporadic interventions prior to surgery, time-consuming wait for diagnosis and surgery and lack of information regarding recovery strongly influenced perceptions of outcome.

Conclusion

Patient driven data enables insights to inform research regarding surgery/rehabilitation through depth of understanding of the patient journey. Awareness of factors important to patients is important; ensuring that patient-driven data informs research and patient care.

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Acknowledgements

Eleanor Keeling and Sarah Rich from the Royal Orthopaedic Hospital. Jayne Edwards, Claire Wright and Lisa Burgess Collins from the Robert Jones and Agnes Hunt Orthopaedic Hospital NHS Foundation Trust, UK. Tim Noblet, Michael Dunn and Abby Newdick from St George's University Hospitals NHS Foundation Trust, UK. Julie Sterling and Marie Morley, patient involvement.

Funding

This work was supported by Chartered Society of Physiotherapy Charitable Trust Physiotherapy Research Foundation, grant number PRF-16-A21.

Author information

Authors and Affiliations

  1. School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON, Canada

    Alison Rushton

  2. Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, UK

    Alison Rushton, Bini Elena, Feroz Jadhakhan, Annabel Masson & Nicola R. Heneghan

  3. Radboud Institute for Health Sciences, IQ Healthcare, Radboud University Medical Centre, Nijmegen, The Netherlands

    J. Bart Staal

  4. Department of Physiotherapy, Bern University Hospital, Insel Group, Bern, Switzerland

    Martin L. Verra

  5. Department of Physiotherapy, The Royal Orthopaedic Hospital NHS Foundation Trust, Birmingham, UK

    Andrew Emms

  6. Department of Physiotherapy, Sheffield Teaching Hospitals NHS Foundation Trust, Northern General Hospital, Sheffield, UK

    Michael Reddington

  7. Department of Orthopaedics & Trauma, Sheffield Children’s Hospital NHS Foundation Trust, Sheffield, UK

    Ashley Cole

  8. Maastricht University Medical Centre, Maastricht, The Netherlands

    Paul C. Willems

  9. Department of Orthopaedic Surgery Inselspital, University of Bern, Bern, Switzerland

    Lorin Benneker

  10. School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Edgbaston, Birmingham, UK

    Andrew Soundy

Authors
  1. Alison Rushton
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  2. Bini Elena
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Contributions

AR is the chief investigator leading protocol development, approvals, analyses and dissemination. AR, JBS, MV, AC, PW, LB and NRH have led on conception, design and are overseeing data analysis, interpretation and synthesis of findings into parallel studies. NRH was the lead for patient involvement. AS oversaw the qualitative methods and data analysis. AE and MR were the principal investigators at two clinical sites. AM carried out data collection and contributed to data analysis. EB led on data analysis with AM, AR, FJ and AS. All authors have contributed to methodological decisions. All authors contributed to data interpretation, conclusions and dissemination. EB, AR, FJ and AS drafted the initial manuscript. All reviewers have read, contributed to and agreed the final manuscript. AR is the guarantor.

Corresponding author

Correspondence to Alison Rushton.

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The authors have no relevant financial or non-financial interests to disclose. The authors have no competing interests to declare that are relevant to the content of this article. All authors certify that they have no affiliations with or involvement in any organization or entity with any financial interest or non-financial interest in the subject matter or materials discussed in this manuscript. The authors have no financial or proprietary interests in any material discussed in this article.

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Rushton, A., Elena, B., Jadhakhan, F. et al. Immediate patient perceptions following lumbar spinal fusion surgery: semi-structured multi-centre interviews exploring the patient journey and experiences of lumbar fusion surgery (FuJourn). Eur Spine J 31, 3590–3602 (2022). https://doi.org/10.1007/s00586-022-07381-x

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