Strength Back - A qualitative study on the co-creation of a positive psychology digital health intervention for spinal surgery patients.

Introduction: Spinal surgery patients often experience pain as well as stress, anxiety or even depression before surgery, highlighting the need for better mental preparation before undergoing surgery. Acceptance and Commitment Therapy and positive psychology have proven effective in coping with chronic pain and providing long-term skills that enhance psychological flexibility and mental well-being.The aim of this study is to develop a digital intervention (app) based on Acceptance and Commitment Therapy and positive psychology in co-creation with all stakeholders, including patients and professionals. The aim of the intervention is to increase psychological flexibility and positive skills of spinal surgery patients to promote long-term resilience. Materials and methods: In this qualitative study, individual, semi-structured interviews were held with healthcare professionals (N = 9) and spinal surgery patients (N = 12) to identify contextual factors and needs for the app. Subsequently, three focus-group sessions were held with healthcare professionals and newly recruited patients to specify relevant values. Also, a first version of the app, named Strength Back, was developed using a participatory design. Results: The interviews confirmed the need for information and digital support to cope with insecurity, anxiety and pain, both before and after surgery. Based on iterative steps in the focus-group sessions, thirteen modules were developed focusing on procedural information, pain education, psychological flexibility and mental well-being. Discussion: The intervention Strength Back, containing information as well as Acceptance and Commitment Therapy and positive psychology exercises, has the potential to increase psychological flexibility, enhance well-being and improve postoperative recovery after spinal surgery.

Between hope and fear: A qualitative study on perioperative experiences and coping of patients after lumbar fusion surgery.

OBJECTIVE: Recovery following lumbar fusion surgery is frequently accompanied by post-operative pain, and patients often continue to experience some level of chronic pain. There is a scarcity of qualitative research focusing on patient experiences regarding lumbar fusion surgery. This study aims to clarify how lumbar fusion surgery patients experience the perioperative period; their hopes, their post-operative pain experiences, their fluctuating physical condition and accompanying emotions. METHODS: Semi-structured interviews were conducted with 12 lumbar fusion surgery patients. Transcripts of these interviews were open and axial coded by two coders using Atlas.ti software and Thematic Analysis. RESULTS: A total of thirteen categories and four overarching themes were generated from the data. Participants described their beliefs and experiences surrounding surgery, including a long preoperative illness process, tumultuous recovery and unfulfilled preoperative expectations. Participants used various forms of pain coping including activity avoidance and endurance, and emotion regulation strategies such as acceptance. CONCLUSION: This study demonstrates that, for lumbar fusion patients, surgery seems to be a last resort. Professionals should fulfill the patients need for information and focus on managing realistic expectations while respecting the distress and strain the illness process has on a patient, thereby potentially increasing patient satisfaction and enhancing postoperative recovery.