We all recognise that consent is extremely important. The principals and the specifics of surgical procedure are also critical. What is less clear are the different post operative regimes that surgeons use.

If at the time of listing for surgery and at pre-operative assessment quality information is given to patients regarding rehabilitation this has the potential for maximising the final recovery from a spinal disorder. Avoiding mixed messages and using best evidence are a common part of every day spinal practice. Patients relatives are often concerned and by involving them in the process with consistent and clear messages about return to activity ‘mixed messages’ can be overcome.

It can be time consuming repeating the same information to similar patient groups on a regular basis and the provision of quality information sources means that ‘face to face ‘ patient time is spent on the important issues for both parties.

The ‘curabo’ effect has recently been documented and reveals the importance of attitude and motivation, in both patient and surgeon.

Post-operative management after lumbar surgery is inconsistent leading to uncertainty amongst surgeons and patients reactivation and return to work. To address this uncertainty about post-operative restrictions, a patient centred evidenced-based booklet on post-operative management after lumbar discectomy or un-instrumented decompression has been developed.

This was achieved through a systematic literature search which produced a best-evidence synthesis of information and advice on post-operative restrictions, activation, rehabilitation, and expectations about outcomes. The literature review found little evidence for post-operative activity restrictions, and a strong case for an early active approach to post-operative management. The booklet was built around key messages derived from the evidence statements extracted from the literature review and aimed to reduce uncertainty, promote positive beliefs, encourage early reactivation, and provide practical advice on self-management.

Following a focused literature review, a patient-centred, evidence-based booklet was developed. The aim was to guide post-operative management and facilitate recovery. Initial peer and patient evaluations were encouraging and the booklet (Your Back Operation www.tso.co.uk/bookshop) is currently factored into a trial investigating the post-operative management of spinal patients.

To date, 80 patients have been recruited into a randomised trial to receive the booklet. At 6 months post-surgery all of these patients are requested to complete a questionnaire on the booklet. This questionnaire contained forced-choice questions on readability, style, information level, believability, length, content and helpfulness.

Feedback is very positive. The average overall rating of the booklet was 8.6/10. Over 80% found it easy to read, interesting, and of appropriate length. Over 80% also stated they had learnt new and helpful information. All subjects stated that they would recommend the booklet to a friend, and the majority stated that they frequently referred to the booklet. The predominant messages received and understood by the patients were related to the safe benefits of early activation and return to normal activities.

It remains to be seen if the results of the study show that the booklet influences final outcome. Certainly early results show that spinal surgery patients appreciate evidence-based information in booklet form, and suggest that this booklet may be an important adjunct to post-operative management of spinal patients. In practical terms it is a well received communication that intuitively assists in patient care at very low cost.

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