Background/Purpose: In the absence of evidence-based post-operative rehabilitation, following fusion surgery for severe persistent low back pain, people receive advice to rest for 3 months then progressively resume normal function. Such unclear, generic advice is unhelpful, and post-operative recovery may be delayed or suboptimal. We introduced a structured post-operative rehabilitation program of individualised progressive exercise and self-management advice for people who had undergone lumbar fusion. We wanted to evaluate how helpful participants found the program.
Methods: 15 patients attending follow-up appointments were asked about their concerns, experiences, perceptions and needs. 4 patients on the program (small group, once a week for 10 weeks) were asked if and how the program helped them. The main themes that emerged were documented.
Results:
Patients primarily reported concerns about musculoskeletal or psychosocial issues rather than technical surgical problems, e.g. residual pain and disability, how to reduce analgesia, when to resume certain activities, etc, but complained of a lack of advice and support. The program enabled access to a healthcare professional who could fully address people’s concerns “…my GP said to ask my consultant but I never get to see him, so it is great that I can ask you…”
Four areas raised most concerns:
Residual symptoms: People didn’t know what to expect and presence of residual symptoms concerned them “…if the operation was a success why do I still have pain…”
Prognosis: They wanted to know what would happen “…will this metalwork wear out…will it have to come out…”. The program allowed them to ask questions and learn from others “…I am glad to hear that exercise will not cause my spine to wear out. The others in the class have helped me see that I can get better…”
Physical function: People were keen to return to more normal physical function but were unsure what to do, how and when “…they told me to gradually increase my activity, but which activity and when…”
Co-morbidity: People were unclear how co-morbidity might affect outcome “…how does my diabetes affect exercise…” “…my neck hurts as well…” but advice was lacking, unhelpful or impractical. The program gave individuals specific advice and they experienced benefits first-hand “…the consultant just kept telling me to walk, but my knee hurt and I was scared. It is so helpful that you can help me manage all of these problems…”
Conclusion: There is a need for better support to answer concerns that cause distress, anxiety and may impede post-operative recovery. Surgeons are primarily concerned about infection, implant failure, etc. Our post-operative rehabilitation program improved access to healthcare professionals who gave advice and support that might improve outcome. The program warrants more thorough evaluation.
Disclosure:
M. V. Hurley,
None;
J. Greenwood,
None;
D. N. E. Walsh,
None.
« Back to 2012 ACR/ARHP Annual Meeting
ACR Meeting Abstracts - https://acrabstracts.org/abstract/post-operative-rehabilitation-provides-unmet-need-for-better-patient-support-and-advice-following-lumbar-spinal-fusion/