'It Felt Safe'. Experiences With an Early Cognitive Behavioural Approach After Lumbar Spinal Surgery: A Qualitative Study of Participants' Perspectives.
Heidi Tegner, Ida Wentzel Winther, Nanna Rolving and 3 others
PMID 42442719WHAT IT FOUND
Eleven post-spine-surgery patients describe what made an early physiotherapy programme feel safe: a caring therapist, home visits, and goals set with them.
This is their experience, not proof of benefit. The parent trial's primary outcome was null.
Key findings
01Participants described the early post-surgery period as overwhelming and valued the physiotherapist's presence, a trusting relationship, and pain education as making them feel safe, heard, and not alone.
02Individualised goals, a simple written exercise schema, and the ability to progress at their own pace (rather than being pushed for intensity) were experienced as empowering and motivating compared with prior physiotherapy experiences.
03Home-based sessions were valued as creating a bridge between hospital and daily life, but participants noted a gap in communication when transitioning to community-based rehabilitation, leaving them feeling they had to start over.
STILL TO COME
How it was doneWhat they foundWhat it means for PTs
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What it does not show
Only 11 participants, all from the intervention arm of the parent RCT — there is no comparison with what patients in the usual-care group experienced during the same period. Several members of the research team had developed and/or delivered the GAPE intervention, and one of the two interviewers was the participants' own GAPE physiotherapist, introducing insider bias that the authors acknowledge. Over half the participants were highly educated, which may limit transferability to patients with lower health literacy. The authors state that the positive experiences described (feeling safe, being heard, a trusting relationship) likely reflect non-specific therapeutic factors common to high-quality physiotherapy rather than the specific cognitive-behavioural components of GAPE, and that the study cannot distinguish between the two. The parent RCT's primary outcome (sedentary behaviour at 3 months) was null; the significant findings were on secondary outcomes (fear of movement at 3 months, sedentary behaviour at 12 months). Interviews were conducted during the pandemic by phone or video, which may have shaped how participants described the in-person home visits they had received earlier.
Declared interests
The authors declare no conflicts of interest. Funding came from the Research Fund of Rigshospitalet (Copenhagen University Hospital), the Tryg Foundation, the Association of Danish Physiotherapists, the Danish Rheumatism Association, and the Gangsted Foundation. However, several members of the research group had been involved in developing and delivering the GAPE intervention in the parent RCT, and one of the two interviewers was the participants' own GAPE physiotherapist — a relationship the authors flag as a potential source of insider bias.
The easy way to misread this
Do not read the positive participant experiences as evidence that the GAPE programme improves physical activity or reduces pain. This is a qualitative study of 11 people who all received the intervention; there is no comparison group, and the parent RCT's primary outcome (sedentary behaviour at 3 months) was null. The authors themselves note that the feelings of safety, being heard, and a trusting relationship described here are likely non-specific therapeutic factors present in any well-delivered physiotherapy, not unique effects of the cognitive-behavioural content.