Dismore Lorelle Louise, van Wersch Anna, Critchley Rebecca, Murty Aradhyula, Swainston Katherine
Department of Innovation, Research and Development, North Tyneside General Hospital, Northumbria Healthcare NHS Foundation Trust, North Shields, UK.
School of Social Sciences, Humanities & Law, Teesside University, Middlesbrough, UK.
Br J Pain. 2022 Jun;16(3):317-325. doi: 10.1177/20494637211060278. Epub 2022 Jan 31.
Hallux valgus and hallux rigidus are two common forefoot conditions causing deformity, pain, functional limitations, disability and deteriorating health status resulting in the requirement for surgery. Even when surgery is performed by an experienced surgeon, there remains a potential for patients to experience dissatisfaction and unfavourable outcomes. Adverse results are moderated by psychosocial variables; however, there is a paucity of qualitative research providing insight into how patients perceive their outcomes and the factors affecting their recovery.
The study aimed to qualitatively explore patients' experiences of their surgical outcomes following forefoot surgery and factors associated with their recovery. Semi-structured interviews with 15 patients who received surgery for hallux valgus and/or hallux rigidus were conducted.
Thematic analysis generated five themes: physical limitations, the psychosocial impact of surgical recovery, regaining normality, patients' expectations for physical recovery and an altered body-image. Physical and psychosocial factors were inter-related. Patients experiencing problematic outcomes were functionally limited, had low mood and were unable to return to a normal life post-surgery. The women reported weight related issues and were limited in their footwear and clothing choices, negatively impacting on their self-esteem.
A forefoot condition is multifaceted, with patients experiencing a range of physical and psychological factors that may influence their outcomes and recovery from surgery. Patients need to be supported holistically with the use of a biopsychosocial model. A multidisciplinary approach to care and treatment within the forefoot surgical pathway with the inclusion of allied health professionals will enable to better support patients to enhance their outcomes.
拇外翻和僵硬性拇趾是两种常见的前足疾病，可导致畸形、疼痛、功能受限、残疾以及健康状况恶化，进而需要进行手术。即使手术由经验丰富的外科医生实施，患者仍有可能不满意并出现不良后果。心理社会变量可减轻不良结果；然而，缺乏定性研究来深入了解患者如何看待其手术结果以及影响其康复的因素。
本研究旨在定性探索前足手术后患者对手术结果的体验以及与康复相关的因素。对15例接受拇外翻和/或僵硬性拇趾手术的患者进行了半结构化访谈。
主题分析产生了五个主题：身体限制、手术康复的心理社会影响、恢复正常、患者对身体康复的期望以及身体形象改变。身体和心理社会因素相互关联。出现问题结果的患者功能受限、情绪低落，术后无法恢复正常生活。女性报告了与体重相关的问题，在鞋类和服装选择上受到限制，对其自尊产生负面影响。
前足疾病是多方面的，患者会经历一系列可能影响其手术结果和康复的身体和心理因素。需要使用生物心理社会模型对患者进行全面支持。在前足手术路径中采用多学科护理和治疗方法，包括联合健康专业人员，将能够更好地支持患者改善其手术结果。
