White Louise, Heneghan Nicola R, Furtado Navin, Baraks Karl, Parvez Zeeshan, Masson Annabel, Rushton Alison B
Physiotherapy Department, Level 1, North Suite, Queen Elizabeth Hospital, Birmingham, UK.
Queen Elizabeth Neurosciences Centre, Queen Elizabeth Hospital, Birmingham, UK.
BMJ Open. 2025 Jul 25;15(7):e101259. doi: 10.1136/bmjopen-2025-101259.
To gain insight into patients' views, perceptions, experiences and expectations postlumbar discectomy.
A qualitative study using interpretative phenomenological analysis (IPA) purposively recruited patients undergoing lumbar discectomy at one UK spinal centre. Purposive criteria included age, sex, ethnicity, symptom duration, work/sick leave, education level and co-existing psychological issues. Semi-structured interviews were conducted using a patient co-constructed topic guide. Interview transcriptions were analysed in accordance with IPA. Strategies enhancing trustworthiness included suspension of judgements and presuppositions, reflexivity, iterative coding process and critique from co-investigators.
Data from 14 participants (eight elective, 6 emergency surgery) informed four themes. The theme ready to move forwards was characterised by high satisfaction with post-operative improvement, positivity and optimism, with readiness to work towards personal goals. The theme post-operative fear and uncertainty was characterised by reflections on pre-operative difficulties fuelling fear about potential recurrence and long-term impacts. The theme of advice and guidance considered important was characterised by the expectation and value of support provided (verbal, written); instances of negative influences from healthcare interactions and access to unregulated patient information sources suggest scope for future improvement. The final theme, heterogeneity in peri-operative needs, was characterised by variation in depth/access to patient information, perceived post-operative support and wide-ranging preoperative activity/fitness.
Surgery offers physical and psychosocial changes which could be better harnessed to positively influence recovery through high quality verbal/written communication. Peri-operative advice and guidance was valued; while this was sufficient for some, personalised rehabilitation should be available owing to the identified heterogeneity.
深入了解腰椎间盘切除术后患者的观点、认知、经历和期望。
采用解释现象学分析（IPA）的定性研究，在英国一个脊柱中心有目的地招募接受腰椎间盘切除术的患者。纳入标准包括年龄、性别、种族、症状持续时间、工作/病假、教育水平和并存的心理问题。使用患者共同构建的主题指南进行半结构化访谈。访谈转录根据IPA进行分析。提高可信度的策略包括暂停判断和预设、反思性、迭代编码过程以及共同研究者的批评。
14名参与者（8名择期手术，6名急诊手术）的数据形成了四个主题。“准备好向前迈进”这一主题的特点是对术后改善高度满意、积极乐观，并准备好朝着个人目标努力。“术后恐惧和不确定性”这一主题的特点是对术前困难的反思引发了对潜在复发和长期影响的恐惧。“认为重要的建议和指导”这一主题的特点是对所提供支持（口头、书面）的期望和重视；医疗互动的负面影响以及接触未经监管的患者信息来源的情况表明未来有改进的空间。最后一个主题“围手术期需求的异质性”的特点是患者信息的深度/获取程度、感知到的术后支持以及术前广泛的活动/健康状况存在差异。
手术会带来身体和心理社会方面的变化，通过高质量的口头/书面沟通可以更好地利用这些变化对康复产生积极影响。围手术期的建议和指导受到重视；虽然这对一些人来说足够了，但鉴于已确定的异质性，应提供个性化的康复服务。
