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

doi:10.1371/journal.pone.0241931

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

Research output: Contribution to journal › Article › peer-review

216 Downloads (Pure)

Abstract

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 language	English
Article number	e0241931
Journal	PLOS One
Volume	15
Issue number	12
DOIs	https://doi.org/10.1371/journal.pone.0241931 https://doi.org/10.1371/journal.pone.0241931
Publication status	Published - 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. https://www.csp.org.uk/ 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

Biochemistry, Genetics and Molecular Biology(all)
Agricultural and Biological Sciences(all)
General

Access to Document

RushtonA2020Patient
Rushton A, Jadhakhan F, Masson A, Athey V, Staal JB, Verra ML, et al. (2020) Patient journey following lumbar spinal fusion surgery (FuJourn): A multicentre exploration of the immediate post-operative period using qualitative patient diaries. PLoS ONE 15(12): e0241931. https://doi.org/10.1371/journal.pone.0241931
Final published version, 798 KBLicence: Creative Commons: Attribution (CC BY)

The patient journey following lumbar spinal fusion surgery (LSFS): a qualitative analysis of the patient rehabilitation experience
Heneghan, N., Rushton, A. & Soundy, A.
THE CHARTERED SOCIETY OF PHYSIOTHERAPY
4/09/17 → 3/03/19
Project: Research

Cite this

Rushton, A., Jadhakhan, F., Masson, A., Athey, V., Staal, J. B., Verra, M. L., Emms, A., Reddington, M., Cole, A., Willems, P. C., Benneker, L., Heneghan, N. R., & Soundy, A. (2020). Patient journey following lumbar spinal fusion surgery (FuJourn): A multicentre exploration of the immediate post-operative period using qualitative patient diaries. PLOS One, 15(12), Article e0241931. https://doi.org/10.1371/journal.pone.0241931, https://doi.org/10.1371/journal.pone.0241931

@article{4eda87e88672402db880489b7702ae3f,

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

abstract = "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.",

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

note = "Funding Information: This work was supported by the Chartered Society of Physiotherapy Charitable Trust Physiotherapy Research Foundation, grant number PRF-16-A21. https://www.csp.org.uk/ 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: {\textcopyright} 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.",

year = "2020",

month = dec,

day = "1",

doi = "10.1371/journal.pone.0241931",

language = "English",

volume = "15",

journal = "PLOS One",

issn = "1932-6203",

publisher = "Public Library of Science (PLOS)",

number = "12",

}

Rushton, A, Jadhakhan, F, Masson, A, Athey, V, Staal, JB, Verra, ML, Emms, A, Reddington, M, Cole, A, Willems, PC, Benneker, L, Heneghan, NR & Soundy, A 2020, 'Patient journey following lumbar spinal fusion surgery (FuJourn): A multicentre exploration of the immediate post-operative period using qualitative patient diaries', PLOS One, vol. 15, no. 12, e0241931. https://doi.org/10.1371/journal.pone.0241931, https://doi.org/10.1371/journal.pone.0241931

TY - JOUR

T1 - Patient journey following lumbar spinal fusion surgery (FuJourn)

T2 - A multicentre exploration of the immediate post-operative period using qualitative patient diaries

AU - Rushton, Alison

AU - Jadhakhan, Feroz

AU - Masson, Annabel

AU - Athey, Victoria

AU - Staal, J. Bart

AU - Verra, Martin L.

AU - Emms, Andrew

AU - Reddington, Michael

AU - Cole, Ashley

AU - Willems, Paul C.

AU - Benneker, Lorin

AU - Heneghan, Nicola R

AU - Soundy, A

N1 - Funding Information: This work was supported by the Chartered Society of Physiotherapy Charitable Trust Physiotherapy Research Foundation, grant number PRF-16-A21. https://www.csp.org.uk/ 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.

PY - 2020/12/1

Y1 - 2020/12/1

N2 - 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.

AB - 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.

UR - http://www.scopus.com/inward/record.url?scp=85097034978&partnerID=8YFLogxK

U2 - 10.1371/journal.pone.0241931

DO - 10.1371/journal.pone.0241931

M3 - Article

C2 - 33259481

SN - 1932-6203

VL - 15

JO - PLOS One

JF - PLOS One

IS - 12

M1 - e0241931

ER -

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

Abstract

Bibliographical note

ASJC Scopus subject areas

Access to Document

Fingerprint

Projects

The patient journey following lumbar spinal fusion surgery (LSFS): a qualitative analysis of the patient rehabilitation experience

Cite this