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

Alan K H Lam; Olivia H Y Fung; Crystal Kwan; Jason P Y Cheung; Keith D K Luk; Alice Y Y Chiu; Martin Descarreaux; Grace P Y Szeto; Arnold Y L Wong

doi:10.1016/j.arrct.2022.100227

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

Arch Rehabil Res Clin Transl. 2022 Aug 23;4(4):100227. doi: 10.1016/j.arrct.2022.100227. eCollection 2022 Dec.

Authors

Alan K H Lam^{1

2}, Olivia H Y Fung¹, Crystal Kwan³, Jason P Y Cheung⁴, Keith D K Luk⁴, Alice Y Y Chiu⁵, Martin Descarreaux⁶, Grace P Y Szeto⁷, Arnold Y L Wong¹

Affiliations

¹ Department of Rehabilitation Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China.
² Department of Orthopaedics and Traumatology, The Chinese University of Hong Kong, Hong Kong SAR, China.
³ Department of Applied Social Sciences, The Hong Kong Polytechnic University, Hong Kong SAR, China.
⁴ Department of Orthopaedics and Traumatology, The University of Hong Kong, Hong Kong SAR, China.
⁵ Department of Physiotherapy, Duchess of Kent Children's Hospital, Hong Kong SAR, China.
⁶ Department of Human Kinetics, Université du Québec à Trois-Rivières, Trois-Rivières, Canada.
⁷ School of Medical and Health Sciences, Tung Wah College, Hong Kong SAR, China.

Abstract

Objectives: To improve our understanding of patients' perspectives regarding: (1) the decision-making and prehabilitation before lumbar spinal stenosis (LSS) surgery and (2) their postoperative experiences.

Design: Qualitative research with semi-structured interviews.

Setting: General community.

Participants: Individuals who received (N=10) and who did not receive (N=15) prehabilitation before LSS surgery were recruited at the 6-month postoperative follow-up (8 females; average age: 67.7±6.7 years) by purposive sampling. Additionally, 1 participant invited her daughter to accompany her in an interview.

Interventions: Not applicable.

Main outcome measures: Concerns and experiences of patients with LSS regarding prehabilitation and recovery after spine surgery.

Results: Thematic analysis was conducted to identify 4 themes inductively: (1) sources of information about LSS surgery; (2) factors affecting the surgical decision-making; (3) attitudes toward prehabilitation; and (4) postoperative recovery. All participants desired to have more preoperative education to inform their surgical decision-making. There were mixed opinions regarding the perceived benefits of prehabilitation because some individuals hesitated to participate in prehabilitation because of their symptoms, or the cost or time of traveling. Many participants expected some or even complete relief of LSS-related symptoms after surgery. However, not all participants experienced the expected postoperative improvements. Some participants only experienced temporary symptomatic relief, while others experienced new postoperative symptoms. Patients generally found that postoperative exercises taught by physiotherapists were useful although their compliance decreased over time.

Conclusions: Our study highlights the need for better preoperative LSS education. Because face-to-face prehabilitation or postoperative rehabilitation may not be feasible for all patients, future studies should explore whether online-based prehabilitation or postoperative rehabilitation may benefit certain patient subgroups.

Keywords: Back pain; Low back pain; Physical therapy modalities; Preoperative exercise; Qualitative research; Rehabilitation; Spinal stenosis.