Structural barriers and facilitators to accessing postsurgical rehabilitation in adults who were treated with surgery for low back pain: protocol for a scoping review

Abstract

Abstract Background Low back pain (LBP) is a major contributor to disability and rehabilitation needs globally. A proportion of patients with LBP undergo surgery and require postsurgical rehabilitation to optimize functioning. However, many encounter barriers to accessing rehabilitation due to structurally generated inequities linked to socioeconomic position. Structural barriers to accessing rehabilitation intersect with diversity-related factors (e.g., gender, ethnicity) to perpetuate stigma and marginalization, leading to tremendous consequences. This literature needs to be reviewed to identify key themes and knowledge gaps focused on structural factors to accessing post-surgical rehabilitation. Our objectives are to conduct a scoping review of the literature to (1) systematically map the literature on the experiences with structural barriers and facilitators to accessing post-surgical rehabilitation of adults who were treated with surgery for LBP (including with or without radiculopathy, symptomatic spinal stenosis); (2) investigate whether these experiences differ when grouped by diversity-related factors (e.g., gender, ethnicity, geographic region). Methods We will conduct a scoping review of the literature based on Joanna Briggs Institute (JBI) scoping review guidance and report it according to PRISMA-Scoping Reviews. We will search multiple databases from inception to 2025 for qualitative research exploring experiences with structural barriers or facilitators to rehabilitation access after surgery among adults with LBP. Drawing upon the World Health Organization (WHO) Action on Social Determinants of Health framework, structural factors to accessing rehabilitation will include socioeconomic and political contexts; governance; macroeconomic, social and public policies; and cultural and societal values/norms. Paired reviewers will independently screen articles and extract data. Results will be summarized and grouped by type of LBP and rehabilitation, and by intersections with diversity-related factors (e.g., gender, age, ethnicity, disabilities, geographic region). Our interdisciplinary team will engage with an Advisory Committee of knowledge users with lived experience throughout. Discussion Aligned with WHO and EUROSPINE priorities, our scoping review will elucidate the structural barriers and facilitators influencing access to post-surgical rehabilitation for LBP more inclusively. Findings will advance knowledge of structural challenges experienced by adults needing post-surgical rehabilitation, informing rehabilitation and other healthcare strategies to remove barriers and improve functioning globally. Systematic review registration: Open Science Framework (OSF) https://osf.io/26h9w

Keywords

• Post-surgical rehabilitation
• Low back pain
• Structural barriers
• Structural facilitators
• Scoping review