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'It Felt Safe'. Experiences With an Early Cognitive Behavioural Approach After Lumbar Spinal Surgery: A Qualitative
Heidi Tegner1, Ida Wentzel Winther2, Nanna Rolving3,4
1Department of Occupational Therapy and Physiotherapy, Rigshospitalet, Glostrup, Denmark.
Background And Purpose:
In patients undergoing lumbar spinal fusion, a randomised controlled trial examined the effect of an early cognitive behavioural rehabilitation intervention designed to reduce sedentary behaviour. The intervention consisted of graded activity and pain education (GAPE). The objective of this qualitative study was to explore participants' experiences with GAPE following the three-month intervention period.
Methods:
This study employed an interpretive qualitative design. Participants were purposefully recruited 3 months post-surgery. Semi-structured individual interviews were conducted, and data were analysed using a Template Analysis approach by a research group adopting an intermediate epistemological stance.
Results:
A total of 11 participants were included. Based on the data, a final template was developed comprising four themes and associated subthemes: (1) An angel in the house post-surgery, (2) Embodied experiences and regaining control, (3) Master in my own house, and (4) Bridging personalised rehabilitation across settings. The study showed that GAPE provided meaningful support during the early post-surgical period after lumbar spinal fusion. Important factors included individually formulated goals, a strong therapeutic alliance, appropriate timing, and graded activity. These components helped participants understand their bodies and pain, thereby enhancing their safety and bodily confidence. Trusting relationships with physiotherapists and home-based sessions made rehabilitation both manageable and personally meaningful.
Discussion:
Overall, GAPE supported participants' early recovery after lumbar spinal fusion by combining personalised goals, trusting therapeutic relationships, and home-based, graded activity, thereby enhancing bodily confidence and making rehabilitation manageable and meaningful. Strengths of the study include participant diversity and a reflexive, multidisciplinary research team, which strengthened data richness and transparency. However, the overrepresentation of highly educated participants and researcher involvement in intervention development may limit generalisability and introduce potential bias.
