Introduction
Surgery is a common treatment for neurogenic claudication (NC) to relieve pain and walking disability but 40% people continue to experience pain and lack of mobility post-operatively. To date, little is known about the experience of undergoing and recovery from surgery for NC. The aim of this study was to explore people’s experience of recovery1 and post-operative walking and their preferences for rehabilitation2.
Methods
Audio-recorded semi-structured interviews were conducted by one researcher. A purposive sample (age, gender, ethnicity, walking ability) of patients following surgery for NC were recruited from three UK NHS hospitals. Topic guides were developed and piloted a priori, and included open-ended questions to explore the experience of recovery and rehabilitation. Interviews were transcribed verbatim and analysed using reflexive thematic analysis3.
Results
Sixteen interviews were conducted (50% telephone, 50% video-call, mean duration 42 mins). Participants (8 female; mean age 70.0 years, time since surgery, 5.7 months, 56% white British) reported that their experience of surgery and their recovery was a major event for them. All participants expressed a degree of satisfaction and gratitude for their surgery however, the extent of this varied considerably. Three themes were developed that described the experience of walking recovery and rehabilitation. The first theme ‘making sense of recovery and walking rehabilitation using a biomedical model’ identified that patient’s perception of NC and recovery was shaped using a biomedical model rather than holistic approach. The second theme ‘the mismatch between expectation and recovery’ had two subthemes: ‘the unanticipated burden of the recovery journey’ illustrated the long and effortful period of recovery; ‘expectations of outcome’ explored expectations of life after surgery and considered how these aligned with treatment outcomes. The third theme ‘one size doesn’t fit all: the need for tailored rehabilitation’ illustrated how participants navigated the complex requirements of walking rehabilitation and largely had to assume responsibility for their own rehabilitation. Many participants were dissatisfied with the lack of tailored care following discharge from hospital. Participants preferred in-person, tailored, supervised rehabilitation that commenced 2-6 weeks post surgery. Some participants preferred one-to-one and some group-based rehabilitation. Some patients thought pre-operative rehabilitation would be beneficial.
Discussion
This study showed that experiences of recovery are mixed, and expectations of walking recovery and outcome were largely interpreted using a biomedical model. Recovery was often perceived as burdensome and challenging to navigate. The mismatch between recovery expectation and reality lead to dissatisfaction and participants desired a tailored rehabilitation approach to support self-management. Strengths of the project include study methodology and the diversity in the participants. Health care professionals should be aware that the experience and recovery from surgery for NC can be challenging and burdensome. They should support patients by helping to set realistic expectations of post-operative recovery and provide tailored rehabilitation.