A qualitative evaluation of participants experiences of living with back pain, lumbar fusion surgery, and post-operative rehabilitation

Background: The use of lumbar fusion surgery is increasing in developed economies. High levels of patient dissatisfaction are reported post-operatively. To address this need, we developed a theoretically informed rehabilitation programme for use following lumbar fusion surgery (the REFS programme). We conducted a mixed methods randomised controlled feasibility study (REFS v'usual care'). The numerical and feasibility outcomes are reported separately. The current qualitative study was 'nested' within the main feasibility study to explore participants' experiences before and after lumbar fusion surgery including the impact of rehabilitation content. This facilitated a deeper understanding of potential mechanisms of action, for theoretical and programme refinement. Methods: A purposive sample (n = 10'usual care', n = 10 REFS) was identified from the main feasibility study cohort. Individual semi-structured interviews were conducted post-operatively (median 8 months, range 5-11). Interview data were transcribed verbatim, coded, and analysed thematically. Results: Three themes were constructed: the breadth and severity of impact associated with a chronic lumbar disorder was summarised in theme 1,'Ever-decreasing circles; living with a chronic lumbar disorder Theme 2,'What have I done? Reflections on recovery from lumbar fusion surgery', illustrated participants post-operative helplessness, which was associated with worsening mental health, problematic use of opioids, fear related to the instillation of metalware, and the important mitigating effect of informal social support. Theme 3'Rehabilitation experiences' identified critical rehabilitation programme content including exercise, a shared rehabilitation experience, the opportunity for vicarious learning, and professional expertise. Conclusions: To enhance patient benefit future REFS programme iterations should consider reinforcement of the identified valued programme content. Additional content should be considered to mitigate post-operative fear, which frequently aligned with the instillation of metalware into the spine. Participant's perceptions regarding the necessity of lumbar fusion surgery has potential implications for the surgical consent process.