Patient journey following lumbar spinal fusion surgery (FuJourn): A multicentre exploration of the immediate post-operative period using qualitative patient diaries

Alison Rushton, Feroz Jadhakhan, Annabel Masson, Victoria Athey, J. Bart Staal, Martin L. Verra, Andrew Emms, Michael Reddington, Ashley Cole, Paul C. Willems, Lorin Benneker, Nicola R Heneghan, A Soundy

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The aim of this study was to capture and understand the immediate recovery journey of patients following lumbar spinal fusion surgery and explore the interacting constructs that shape their journey. A qualitative study using Interpretive Phenomenological Analysis (IPA) approach. A purposive sample of 43 adult patients (≥16 years) undergoing ≤4 level instrumented fusion for back and/or leg pain of degenerative cause, were recruited pre-surgery from 4 UK spinal surgery centres. Patients completed a weekly diary expressed in their own words for the first 4 weeks following surgery to capture their life as lived. Diary content was based on previous research findings and recorded progress, recovery, motivation, symptoms, medications, healthcare appointments, rehabilitation, positive/negative thoughts, and significant moments; comparing to the previous week. To maximise completion and data quality, diaries could be completed in paper form, word document, as online survey or as audio recording. Strategies to enhance diary adherence included a weekly prompt. A framework analysis for individual diaries and then across participants (deductive and inductive components) captured emergent themes. Trustworthiness was enhanced by strategies including reflexivity, attention to negative cases and use of critical co-investigators. Twenty-eight participants (15 female; n = 18 (64.3%) aged 45-64) contributed weekly diaries (12 withdrew post-surgery, 3 did not follow through with surgery). Adherence with diaries was 89.8%. Participants provided diverse and vivid descriptions of recovery experiences. Three distinct recovery trajectories were identified: meaningful recovery (engagement in physical and functional activities to return to functionality/mobility); progressive recovery (small but meaningful improvement in physical ability with increasing confidence); and disruptive recovery (limited purpose for meaningful recovery). Important interacting constructs shaped participants' recovery including their pain experience and self-efficacy. This is the first account of immediate recovery trajectories from patients' perspectives. Recognition of a patient's trajectory may inform patient-centred recovery, follow-up and rehabilitation to improve patient outcomes.

Original languageEnglish
Article numbere0241931
JournalPLOS One
Issue number12
Publication statusPublished - 1 Dec 2020

Bibliographical note

Funding Information:
This work was supported by the Chartered Society of Physiotherapy Charitable Trust Physiotherapy Research Foundation, grant number PRF-16-A21. about-csp/how-we-work/charitable-trust Authors receiving award: AR, JBS, MV, AE,MR, AS, AC, PW, LB, NR. The funder played no role in study design, data collection and analysis, decision to publish, or preparation of the manuscript. 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.

Publisher Copyright:
© 2020 Rushton et al. This is an open access article distributed under the terms of the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

ASJC Scopus subject areas

  • General Biochemistry,Genetics and Molecular Biology
  • General Agricultural and Biological Sciences
  • General


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