A Critical Analysis of the Exercise Prescription and Return to Activity Advice That Is Provided in Patient Information Leaflets Following Lumbar Spine Surgery

Abstract

Background and objectives: Lumbar spine surgery may be considered if pharmacologic, rehabilitation and interventional approaches cannot provide sufficient recovery from low back-related pain. Postoperative physiotherapy treatment in England is often accompanied by patient information leaflets, which contain important rehabilitation advice. However, in order to be an effective instrument for patients, the information provided in these leaflets must be up to date and based on the best available evidence and clinical practice. This study aims to critically analyse the current postoperative aspects of rehabilitation (exercise prescription and return to normal activity) that are provided in patient information leaflets in England as part of an evaluation of current practice following lumbar spine surgery. Materials and Methods: Patient information leaflets from English National Health Service (NHS) hospitals performing lumbar spine surgery were sourced online. A content analysis was conducted to collect data on postoperative exercise prescription and return to normal activities. Results: Thirty-two patient information leaflets on lumbar surgery were sourced (fusion, n = 11; decompression, n = 15; all lumbar procedures, n = 6). Many of the exercises prescribed within the leaflets were not based on evidence of clinical best practice and lacked a relationship to functional activity. Return to normal activity advice was also wide ranging, with considerable variation in the recommendations and definitions provided. Conclusions: This study highlights a clear variation in the recommendations of exercise prescription, dosage and returning to normal activities following lumbar spine surgery. Future work should focus on providing a consistent and patient-centred approach to recovery.

Early postoperative physical activity and function: a descriptive case series study of 53 patients after lumbar spine surgery

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Consensus statement for perioperative care in lumbar spinal fusion: Enhanced Recovery After Surgery (ERAS®) Society recommendations

“…The uncertainty of outcomes can contribute to preoperative fear and anxiety, which can negatively affect recovery after surgery. Combining preoperative education with consistent written patient information materials is, therefore, also essential [42].…”

Post-Hospitalization Problems and Nursing Care Needs of Patients who Underwent Thoracolumbar Spine Surgery

“…4 The surgery is indicated only if the six weeks of aggressive conservative treatment failed to control radicular pain and progressive neurological deficits. 2, 5 Scheffel et al 6 reported that lumbar discectomy and spinal fusions are the most common surgical procedures for low back pain. There is scarcity of evidence showing the challenges patients face after thoracolumbar spine surgery during post-hospitalization period.…”