The development and feasibility of a post-operative rehabilitation programme to improve walking in older people with neurogenic claudication

Neurogenic claudication (NC) affects 1:10 older people and reduces walking and quality of life.

It is the main indication for spinal surgery in older people yet following surgery, up to 40% report walking disability and 90% do not achieve physical activity recommendations. Changing behaviour is challenging without appropriate guidance and support. Rehabilitation could improve walking but current provision is inconsistent and ineffective.

Modifiable factors that influence post-operative walking in people with NC are unclear but if identified and targeted with theoretically-informed rehabilitation post-operative walking may be improved.

Aims: This fellowship was developed collaboratively with patient advisors and aims to i) identify the determinants of post-operative walking; ii) co-design and test the feasibility including acceptability of a theoretically-informed post-operative rehabilitation programme to improve walking in older people post-surgery for NC.

Methods: Stage one: This prospective observational study will recruit 122 adults aged ≥60-years, waiting for surgery for NC.

Measures (six-minute walk distance (6MWD, dependent variable), daily step count and objective and self-reported physical and psychosocial factors will be assessed pre-operatively and at 6 and 12 weeks post-operatively. Multivariate linear regression analysis will identify predictors of 6MWD at 12 weeks.

Stage two: This qualitative interview study will enrol 20 adults aged ≥60-years, 3 months post-surgery for NC. Audio-recorded, semi- structured interviews will explore the experience of walking in the post-operative period. Data will be analysed thematically.

Stage three: Building on the findings of the first two stages, patients and other stakeholders will co-design a post-operative rehabilitation programme to target salient determinants of walking in a series of workshops, using an experience based co-design approach. Stage four: A single arm feasibility study will enroll up to 30 adults ≥60-years old, post-surgery for NC.

Measures (e.g. 6MWD, daily step count) will be collected before and after participants complete the rehabilitation programme. Recruitment, measure completion rates, and programme attendance will be summarised descriptively.

Participants’ experience of the rehabilitation programme and research processes will be explored in an audio-recorded focus group of 8-12 participants and data analysed thematically. Dissemination: A PhD thesis will be produced.

Professional journals, clinical and public meetings, scientific conferences, social media, podcasts and patient summaries will be used to disseminate the findings. Patient advisors will help disseminate results. The findings will inform the design of a randomised controlled trial investigating the effect the programme.