PATIENT EXPERIENCES OF REHABILITATION AFTER LUMBAR SPINE SURGERY: A QUALITATIVE STUDY
DOI:
https://doi.org/10.71000/yb64ma37Keywords:
Back Pain, Lumbar Vertebrae, Patient-Centered Care, Physical Therapy Modalities, Postoperative Period, Qualitative Research, Rehabilitation, Spinal Surgery, Treatment OutcomeAbstract
Background: Rehabilitation following lumbar spine surgery is a critical yet complex component of patient recovery, with outcomes influenced by physical, emotional, systemic, and social factors. While clinical success is often measured by objective metrics, little is known about the subjective experiences that shape patient engagement and progress during rehabilitation.
Objective: To explore patients’ perspectives on the challenges and facilitators encountered during rehabilitation after lumbar spine surgery in a tertiary care setting in Pakistan.
Methods: A qualitative exploratory study was conducted over eight months across three urban tertiary hospitals in Pakistan. Purposive sampling recruited 22 adult patients, 6–12 months post-lumbar spine surgery, actively engaged in rehabilitation. Data were collected through semi-structured in-depth interviews, transcribed, translated, and analyzed using thematic analysis. Ethical approval was obtained, and informed consent was secured from all participants.
Results: Five major themes emerged: (1) Physical Barriers to Recovery (postoperative pain, mobility limitations, fatigue), (2) Psychological Responses to Rehabilitation (fear of reinjury, motivation fluctuations, emotional distress), (3) Healthcare System Challenges (inadequate follow-up, poor communication, limited access to physiotherapy), (4) Social and Environmental Influences (family support, financial burden, workplace pressures), and (5) Facilitators to Recovery (therapist support, clear guidance, positive mindset). These themes reflected the dynamic and multifactorial nature of the rehabilitation experience.
Conclusion: Rehabilitation after lumbar spine surgery extends beyond physical recovery and is profoundly shaped by psychological, social, and systemic dimensions. These insights highlight the need for more patient-centered, holistic rehabilitation protocols that address both clinical and experiential factors to optimize recovery outcomes.
References
Corazzelli G, Capece M, Pizzuti V, Leonetti S, D'Elia A, Santilli M, et al. Antithrombotic therapy and spinal surgery: a retrospective cohort study of 289 consecutive elderly patients with degenerative lumbar stenosis. J Neurosurg Spine. 2024;40(2):125-31.
Carrignan JA, Simmet RT, Coddington M, Gill NW, Greenlee TA, McCafferty R, et al. Are Exercise and Physical Therapy Common Forms of Conservative Management in the Year Before Lumbar Spine Surgery? Arch Phys Med Rehabil. 2020;101(8):1389-95.
Trager RJ, Daniels CJ, Perez JA, Casselberry RM, Dusek JA. Association between chiropractic spinal manipulation and lumbar discectomy in adults with lumbar disc herniation and radiculopathy: retrospective cohort study using United States' data. BMJ Open. 2022;12(12):e068262.
Bogaert L, Thys T, Depreitere B, P VANW, Dankaerts W, Brumagne S, et al. Best practice rehabilitation pathway for the management of single and double-level lumbar fusion surgery: a modified Delphi Study. Eur J Phys Rehabil Med. 2023;59(3):377-85.
Nakajima H, Matsuo H, Naruse H, Watanabe S, Honjoh K, Shoji K, et al. Clinical impact of short limited lumbar fusion for adult spinal deformity with postural and radiological abnormalities. Sci Rep. 2022;12(1):19439.
Trager RJ, Daniels CJ, Meyer KW, Stout AC, Dusek JA. Clinician approaches to spinal manipulation for persistent spinal pain after lumbar surgery: systematic review and meta-analysis of individual patient data. Chiropr Man Therap. 2023;31(1):10.
Han G, Wu H, Dai J, Li X, Yue L, Fan Z, et al. Does paraspinal muscle morphometry predict functional status and re-operation after lumbar spinal surgery? A systematic review and meta-analysis. Eur Radiol. 2023;33(8):5269-81.
Luo M, Zeng X, Jiang L, Yi Q, Zhang L, Wang H, et al. Effect of electrical stimulation on the fusion rate after spinal surgery: a systematic review and meta-analysis. Neurosurg Rev. 2024;47(1):618.
Tegner H, Rolving N, Henriksen M, Bech-Azeddine R, Lundberg M, Esbensen BA. The Effect of Graded Activity and Pain Education After Lumbar Spinal Fusion on Sedentary Behavior 3 and 12 Months Postsurgery: A Randomized Controlled Trial. Arch Phys Med Rehabil. 2024;105(8):1480-9.
Macki M, Zakaria HM, Massie LW, Elmenini J, Fakih M, Dakroub B, et al. The Effect of Physical Therapy on Time to Discharge After Lumbar Interbody Fusion. Clin Neurol Neurosurg. 2020;197:106157.
Abdi A, Bagheri SR, Shekarbeigi Z, Usefvand S, Alimohammadi E. The effect of repeated flexion-based exercises versus extension-based exercises on the clinical outcomes of patients with lumbar disk herniation surgery: a randomized clinical trial. Neurol Res. 2023;45(1):28-40.
Hara S, Andresen H, Solheim O, Carlsen SM, Sundstrøm T, Lønne G, et al. Effect of Spinal Cord Burst Stimulation vs Placebo Stimulation on Disability in Patients With Chronic Radicular Pain After Lumbar Spine Surgery: A Randomized Clinical Trial. Jama. 2022;328(15):1506-14.
Heard JC, Ezeonu T, Lee Y, Narayanan R, Kellish A, Dulitzki Y, et al. Evaluating the Association Between Physical Therapy Variables and Outcomes After Lumbar Fusion. Clin Spine Surg. 2025;38(2):E129-e34.
Crites S, Neto K, Lee M, Louie K, Boone S, Fitzpatrick B, et al. Experiences and perceptions of adults pre- and/or post-lumbar spine surgery: a meta-ethnography. Disabil Rehabil. 2024;46(12):2477-95.
Cerezci O, Başak AT. Importance of Physiotherapy after Lumbar Microdiscectomy. Turk Neurosurg. 2023;33(1):150-5.
Kemani MK, Hanafi R, Brisby H, Lotzke H, Lundberg M. Long-Term Follow-Up of a Person-Centered Prehabilitation Program Based on Cognitive-Behavioral Physical Therapy for Patients Scheduled for Lumbar Fusion. Phys Ther. 2024;104(8).
Willems SJ, Kittelson AJ, Rooker S, Heymans MW, Hoogeboom TJ, Coppieters MW, et al. A "people-like-me" approach to predict individual recovery following lumbar microdiscectomy and physical therapy for lumbar radiculopathy. Spine J. 2025;25(5):1006-17.
Mansell G, den Hollander M, Lotzke H, Smeets R, Lundberg M. A Person-Centred Prehabilitation Program based on Cognitive Behavioural Physical Therapy for patients scheduled for Lumbar Fusion surgery: A mediation analysis to assess fear of movement (kinesiophobia), self-efficacy and catastrophizing as mediators of health outcomes. Eur J Pain. 2022;26(8):1790-9.
Gouzoulis MJ, Moran J, Jeong S, Galivanche AR, Kammien AJ, Jabbouri SS, et al. Physical Therapy Utilization After Single-level Posterior Lumbar Fusion. Spine (Phila Pa 1976). 2024;49(17):E272-e8.
Zadro JR, Lewin AM, Kharel P, Naylor J, Maher CG, Harris IA. Physical therapy utilization, costs, and return-to-work status following lumbar spine surgery: A retrospective analysis of workers compensation claims in Australia. Braz J Phys Ther. 2022;26(2):100400.
Inoue T, Wada K, Sugaya J, Okazaki K, Doi T. Reoperation after short-segment lumbar spinal fusion surgery in dialysis patients: A retrospective cohort study. Medicine (Baltimore). 2024;103(46):e40581.
McDonald CL, Alsoof D, Anderson G, Johnson K, Daniels AH. Spinal Cord Stimulators and Intrathecal Pain Pump Removal Versus Retention During Posterior Lumbar Fusion: A Matched Cohort Analysis. Clin Spine Surg. 2023;36(10):E430-e4.
Sun Y, Zhang Y, Ma H, Tan M, Zhang Z. Spinal Manual Therapy for Adolescent Idiopathic Scoliosis: A Systematic Review and Meta-Analysis of Randomized Controlled Trials. Biomed Res Int. 2023;2023:7928429.
Minetama M, Kawakami M, Teraguchi M, Enyo Y, Nakagawa M, Yamamoto Y, et al. Supervised physical therapy versus surgery for patients with lumbar spinal stenosis: a propensity score-matched analysis. BMC Musculoskelet Disord. 2022;23(1):658.
Downloads
Published
Issue
Section
License
Copyright (c) 2025 Irfan Adil, Aamna Anwaar, Urooj Rafi, Muhammad Mobeen, Muhammad Naseeb Ullah Khan, Evangel Faraz Bashir (Author)
This work is licensed under a Creative Commons Attribution-NonCommercial-NoDerivatives 4.0 International License.
