School of Physical Therapy, Faculty of Health Sciences, Western University, London, ON, Canada.
St Georges Hospital NHS Foundation Trust, London, UK.
BMC Musculoskelet Disord. 2024 Sep 12;25(1):731. doi: 10.1186/s12891-024-07790-7.
Knowledge of patient lived experiences of functioning and disability is limited. This study aims to address the gap in the literature by exploring patient lived experiences of functioning and disability following lumbar discectomy.
A secondary analysis, reported in line with the Standards for Reporting Qualitative Research, was conducted of qualitative data exploring patient journeys following lumbar discectomy surgery (DiscJourn). Adult patients (≥ 16 years) undergoing elective or emergency primary lumbar discectomy were recruited from one National Health Service secondary care centre in the UK. Semi-structured interviews were conducted at 1-3 weeks and 1-year post surgery. Participants who completed both semi-structured interviews were eligible for the secondary analysis. Transcripts from the semi-structured interviews were analysed using interpretative phenomenological analysis (IPA). IPA involved two independent reviewers identifying themes for individual data sets followed by an iterative process involving the wider research team to identify overarching themes that represented the whole date set. Subthemes generated from the IPA were mapped against the International Classification of Functioning, Disability and Health (ICF) framework at the level of chapters, in order to ascertain the ICF's utility in capturing experiences of functioning and disability. Strategies to enhance trustworthiness of data analysis included blind coding, peer examination and debrief, declaration of pre-conceived beliefs and active reflexivity throughout the study.
Nine participants met the eligibility criteria and their interview transcripts were analysed. Patient lived experiences of functioning and disability were captured by three overarching themes: Immediate impact following surgery, Multiple roads to recovery over 1 year, and Functioning influenced by personal loci of control. Each theme consisted of three subthemes which were subsequently mapped onto the ICF. Three subthemes mapped to the ICF's body component, 1 to activity and participation and 3 to environment. Two subthemes themes did not map onto the ICF.
Findings provide valuable insights into patient experiences of functioning and disability following lumbar discectomy. Convergence in experiences of functioning and disability were identified immediately following surgery. Divergence in such experiences were identified with regards to the roads to recovery over 1 year and the individuals' locus of control. Findings build on the body of literature exploring patients functioning and disability following discectomy and make recommendations for future research and clinical practice.
患者对功能和残疾的体验的了解有限。本研究旨在通过探索腰椎间盘切除术患者的功能和残疾体验来填补文献空白。
对探索腰椎间盘切除术患者术后旅程的定性数据（DiscJourn）进行二次分析，符合定性研究报告标准。在英国一家国家卫生服务二级保健中心招募了接受择期或急诊初次腰椎间盘切除术的成年患者（≥16 岁）。在术后 1-3 周和 1 年进行半结构化访谈。完成两次半结构化访谈的参与者有资格进行二次分析。使用解释现象学分析（IPA）对半结构化访谈的记录进行分析。IPA 涉及两位独立的审阅者识别个人数据集的主题，然后由更广泛的研究团队进行迭代过程，以确定代表整个数据集的总体主题。从 IPA 生成的子主题与国际功能、残疾和健康分类（ICF）框架在章节层面进行映射，以确定 ICF 在捕捉功能和残疾体验方面的效用。增强数据分析可信度的策略包括盲编码、同行检查和汇报、预先设定的信念声明以及整个研究过程中的积极反思。
符合资格标准的 9 名参与者的访谈记录进行了分析。患者对功能和残疾的体验由三个总体主题所捕获：手术后的即时影响、1 年内的多种康复之路，以及受个人控制源影响的功能。每个主题都包含三个子主题，随后映射到 ICF 上。三个子主题映射到 ICF 的身体组成部分，1 个映射到活动和参与，3 个映射到环境。两个子主题主题没有映射到 ICF 上。
研究结果为腰椎间盘切除术患者的功能和残疾体验提供了有价值的见解。在手术后立即发现了功能和残疾体验的趋同。在 1 年内的康复道路以及个体的控制源方面，发现了这种体验的分歧。研究结果建立在探索椎间盘切除术患者功能和残疾的文献基础上，并为未来的研究和临床实践提出了建议。
