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Title: Development and evaluation of a complex rehabilitation programme for use following lumbar fusion surgery : a feasibility randomised controlled study with mixed methodology
Author: Greenwood, James
ISNI:       0000 0004 7427 1241
Awarding Body: St George's, University of London
Current Institution: St George's, University of London
Date of Award: 2018
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One year after lumbar fusion surgery as many as 40% of patients are unsure or dissatisfied with their outcome. Despite this the use of lumbar fusion surgery is increasing, most notably in those over 60 years of age. Post-operative rehabilitation may improve clinical outcome, but the optimum rehabilitation strategy is currently unclear. Exploratory proof of concept work, evaluating a provisional rehabilitation programme, provided evidence of engagement and possible clinical impact. A systematic review with meta-analysis demonstrated complex rehabilitation, combining exercise with psychologically mediated strategies, may enhance post-operative outcome. The Medical Research Council promotes the inclusion of theory in the development complex healthcare interventions. Accordingly, a theoretical framework, based on the behavioural change wheel methodology and Social Cognitive Theory, was developed to inform the content and delivery of the REhabilitation following lumbar Fusion Surgery (REFS) programme. A randomised controlled feasibility study, with 3, 6, and 12-month follow-up, compared REFS with ‘usual care’. Between-group analyses showed statistically significant short-term improvements in disability and pain self-efficacy favouring REFS. Smaller, but potentially relevant, improvements were observed for physical function and quality of life. Longer-term results suggested a meaningful clinical impact for REFS participants. A ‘nested’ qualitative study explored participant’s rehabilitation experiences. This identified potential mechanisms of action, such as ‘sharing the rehabilitation experience’, and highlighted the complexity and inter-dependence of programme content. Emergent themes, including the association between kinesiophobia and concerns regarding the structural integrity of the surgical instrumentation, were identified. In conclusion, the studies reported in this thesis demonstrated that the theoretically informed REFS programme was feasible for delivery within the UK NHS, was associated with potential clinical impact, and with further refinement may provide a useful rehabilitation programme after lumbar fusion surgery. Overall, the researchers original contribution to knowledge relates to the inception, development, and evaluation of the REFS programme.
Supervisor: Not available Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available