Physical activity barriers and facilitators in patients awaiting spine surgery: A qualitative study.

BACKGROUND

Degenerative spine conditions and physical inactivity are major public health concerns. Engaging in physical activity before spine surgery may improve postoperative outcomes experienced by patients with lumbar stenosis or lumbar disc herniation. This study aims to identify barriers and facilitators to physical activity among patients with degenerative lumbar spine conditions awaiting surgery.

METHODS

In this qualitative patient-oriented study, guided by a patient partner who contributed to the development of the interview guide and interpretation of findings, we conducted data-prompted semi-structured interviews (a method in which personalised physical activity information is used to stimulate reflection and discussion), with patients diagnosed with lumbar spinal stenosis or lumbar disc herniation on a surgical waiting list. Interviews were structured around the Theoretical Domains Framework (TDF). Patient responses were deductively coded to TDF domains and inductively analyzed to identify subthemes. Key domains were determined through researcher consensus based on the frequency and clarity of specific beliefs within each domain.

RESULTS

We interviewed 18 patients (8 female), 11 with lumbar spinal stenosis and 7 with lumbar disc herniation, with a mean (SD) age of 54.7 (17.3) years. Five key TDF domains were identified: skills, beliefs about capabilities, beliefs about consequences, environmental context and resources, and emotion. Barriers to physical activity included a lack of physical capacity, pain and other adverse symptoms, potential for negative consequences, inappropriate environment, and negative emotions. Facilitators to physical activity were motivation, appropriate environment, supportive social influences, positive emotions, alternate strategies, and daily physical activity habits.

CONCLUSIONS

Physical activity behaviour in patients awaiting spine surgery is shaped by an interplay of physical, emotional and contextual factors. These findings can inform the design of tailored, theory-driven preoperative physical activity interventions, targeting key barriers such as pain, fear of harm, and limited access to resources, while leveraging factors including motivation, professional guidance, social support, and habit formation.