Patients’ experience of health three years after structured physiotherapy or surgery for lumbar disc herniation

Abstract

Objective: To describe the experience of health among pa tients 3 years after treatment with a structured physiothera py model or surgery for lumbar disc herniation. Design: A qualitative research study. Subjects/patients: Patients were referred to the orthopaedic clinic at Sahlgrenska University Hospital with sciatica due to lumbar disc herniation. Twenty patients who were eligi ble for surgery were treated either with a structured physio therapy model or with surgery. Methods: Openended interviews were conducted and ana lysed using content analysis. Results: Findings were grouped into two themes: feeling of wellbeing and feeling of illbeing. In the group treated with structured physiotherapy there were a high number of codes in the feeling of wellbeing theme. In the group treated with surgery there were a high number of codes in the feeling of illbeing theme. Conclusion: Patients treated with structured physiotherapy or surgery experienced feelings of wellbeing and illbeing 3 years after treatment. Patients treated with physiotherapy and surgery described varying experiences of health 3 years after treatment for lumbar disc herniation. It can be specu lated that the experience of wellbeing may be explained by the ability of structured physiotherapy treatments to em power patients.

Understanding How Patients With Lumbar Radiculopathy Make Sense of and Cope With Their Symptoms

“…It took me completely by surprise [ 55 ]. “It felt like someone had taken a knife and cut around the top of my leg and was peeling my skin down like you take off a stocking it was burning all the way down” [ 59 ]. Difficulty in legitimizing their symptoms “I feel like people have got no understanding of just how painful it can be.…”

“…I don’t think people release just how painful it is. It is excruciating pain, constant” [ 59 ]. “I just wanted to be heard, wanted them to actually listen … I feel like people with sciatica pains they are branded with the same stick…I'm sure the person next door with sciatica … would be given the exact kind of thing to do [ 55 ].” “When I think about my leg I can feel the pins and needles going down it and the pain, I'm sure it's all in the mind” [ 56 ].…”

“…No, he says, that MRI is only needed for the specialist pain team” [ 58 ]. To facilitate treatment-related decision-making “Receiving investigation results acted as a ‘turning point’ in management, enabling decisive treatment decision-making, and, for some, access to new options such as a consultant opinion” [ 59 ]. “For patients, the symptoms occurring from the bulge were the reason to seek medical aid” [ 59 ].…”

“… To facilitate treatment-related decision-making “Receiving investigation results acted as a ‘turning point’ in management, enabling decisive treatment decision-making, and, for some, access to new options such as a consultant opinion” [ 59 ]. “For patients, the symptoms occurring from the bulge were the reason to seek medical aid” [ 59 ]. When MRI fails to determine a cause “When investigations failed to identify relevant findings, participants were unable to make sense of their symptoms, to relinquish the search for the cause, or to move forward in their management” [ 58 ].…”

“… Control Difficulty in coping Inability to cope “I can cope with back pain. It’s the legs and the nerves and the bowels and the bladder that I find that scary, it is scary” [ 59 ]. Reduced treatment adherence and self-management efficacy “It reduces me to tears and at times and I can’t cope with that in my own mind somehow.…”