Best practice rehabilitation pathway for the management of single and double-level lumbar fusion surgery: a modified Delphi Study

Bogaert, Liedewij; Thys, Tinne; Depreitere, Bart; Wambeke, Peter Van; Dankaerts, W.; Brumagne, Simon; Moke, Lieven; Schelfaut, Sebastiaan; Jacobs, Karel A.; Spriet, Ann; Peers, Koen; Janssens, Lotte; Swinnen, Thijs Willem

doi:10.23736/s1973-9087.23.07735-3

Cited by 1 publication

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“…[32][33][34] Prehabilitation of lumbar fusion is still in its infancy, certainly compared with prehabilitation in other orthopaedic interventions such as knee and hip replacement. 35 Nevertheless, preoperative physiotherapy and psychological therapy improved pain after LFS, in the study of Nielsen et al 36 and Reichart et al 34 .…”

Section: Open Accessmentioning

confidence: 97%

Qualitative study exploring the views of patients and healthcare providers on current rehabilitation practices after lumbar fusion surgery

Thys,

Bogaert,

Dankaerts

et al. 2024

BMJ Open

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ObjectivesTo explore the views of patients and healthcare providers on current rehabilitation after lumbar fusion surgery (LFS) to fuel the development of a novel rehabilitation care pathway.DesignA cross-sectional, qualitative study with an interpretive descriptive design.SettingAcademic and non-academic hospital setting in Belgium.Participants31 caregivers from (non)-academic settings and 5 patients with LFS were purposefully sampled and in-depth interviewed.ResultsOut of the data of all interviews, participants reported opinions on 23 thematic clusters that were expressed in a time-contingent manner from the preoperative, perioperative to postoperative phase. Afterwards, themes were mapped to the Consolidated Framework for Implementation Research, with a larger role for concepts related to the innovation, inner and individual domain. As an overarching theme, the importance of an ‘individualised, patient-centred rehabilitation built on a strong therapeutic alliance with an accessible interprofessional team’ was stressed for patients undergoing LFS. Specifically, participants stated that a biopsychosocial approach to rehabilitation should start in the preoperative phase and immediately be continued postoperatively. No consensus was observed for movement restrictions postoperatively. Uniform communication between the involved caregivers was considered essential for optimal therapeutic alliance and clinical outcome. The precise role and competence of each member of the interprofessional team needs, therefore, to be clearly defined, respected and discussed. An accessible case manager to guide the patient trajectory and tackle problems could further support this. Interestingly, only patients, psychologists and physiotherapists addressed return to work as an important outcome after LFS.ConclusionsThis qualitative study identified key experiences and points to consider in the current and future rehabilitation pathway for LFS. Future research should incorporate these findings to build a novel rehabilitation pathway for LFS and evaluate its feasibility and cost-effectiveness.Trial registration numberThis study was registered at clinicaltrials.gov (NCT03427294).

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