Developing an evidence-based prehabilitation programme designed to improve functional outcomes after lumbar fusion surgery - A feasibility study using the Medical Research Council framework

• Published in: European journal of physiotherapy Vol. 22; no. 1; pp. 51 - 61
• Main Authors: Lotzke, Hanna, Gutke, Annelie, den Hollander, Marlies, Smeets, Rob, Lundberg, Mari
• Format: Journal Article
• Language: English
• Published: Taylor & Francis 02.01.2020
• Subjects: activity; behavioural approach; chronic low back pain; chronic musculoskeletal pain; cognitive; cognitive behavioural approach; disability; exposure in-vivo; fear-avoidance; Fysioterapi; intervention; kinesiophobia; low-back-pain; person-centred; physical; physical activity; Physiotherapy; Prehabilitation; prevention; quality; reduction; Rehabilitation; spinal fusion surgery
• ISSN: 2167-9169; 2167-9177
• DOI: 10.1080/21679169.2018.1553999

Purpose: A prehabilitation phase is suggested as the ideal way to prepare patients for optimal outcomes from surgery. Our aim was to describe the lessons we learned from developing PREPARE, an evidence-based prehabilitation programme based on a cognitive behavioural approach designed to improve functional outcomes after lumbar fusion surgery. Methods: We used the Medical Research Council (MRC) framework approach for developing and designing a complex intervention, specifically the two phases; 'Development' and 'Feasibility and Piloting'. Various aspects of treatment fidelity were evaluated during the phase 'Feasibility and Piloting'. As part of the feasibility element, a pilot Single Subject Research Design study was performed. Eleven patients awaiting lumbar fusion surgery participated in the study. We evaluated in particular the use and application of outcome measures. Results: Significant lessons were learned which we used to adjust the prehabilitation programme to better fit a surgical context. The original treatment manual was elaborated on, the outcome measures adjusted, and the content of the intervention altered. Finally, the PREPARE programme was published in the form of a study protocol. Conclusions: There are significant lessons to be learned from testing a study protocol before it is implemented in a large-scale randomised controlled trial (RCT).