Psychological Wellbeing During Recovery of Posterior Spinal Fusion for Adolescent Idiopathic Scoliosis: A Qualitative Study Informed by PROMIS Domains.

OBJECTIVE: To explore the role of psychological wellbeing in the postoperative recovery experience of adolescents undergoing posterior spinal fusion (PSF) for adolescent idiopathic scoliosis (AIS), using a framework informed by PROMIS domains of positive affect, life satisfaction, and meaning and purpose.

SUMMARY OF BACKGROUND DATA: While surgical outcomes for AIS are typically evaluated using radiographic, physical measures, and even patient-reported outcomes (PROs), the psychological and emotional aspects of recovery remain underexplored. Existing PRO instruments incompletely capture the lived experience of adolescents during recovery.

METHODS: Seventeen adolescents (age 10-18 years) who underwent PSF for AIS at a single tertiary-care center participated in semi-structured interviews 2-6 months postoperatively. Interviews were conducted via videoconference, transcribed verbatim, and analyzed using Braun and Clarke's six-phase thematic analysis. Coding was performed independently by two analysts with iterative consensus and codebook refinement. Recruitment continued until thematic saturation was achieved.

RESULTS: Six major themes were identified: (1) preoperative anxiety related to uncertainty, pain, and functional outcomes; (2) recovery defined by functional milestones rather than clinical metrics; (3) emotional adaptation and coping, including growth in self-efficacy, gratitude, and faith-based practices; (4) redefinition of independence during recovery; (5) the critical role of peer and family support, with peers providing unique emotional value; and (6) meaning making and future orientation, including altruistic goals and personal growth. Patients described recovery as a stepwise progression marked by meaningful achievements, with psychological wellbeing influencing motivation, resilience, and overall satisfaction.

CONCLUSIONS: Psychological wellbeing plays a central role in the postoperative recovery experience of adolescents with AIS. Themes identified align with PROMIS domains and highlight the importance of incorporating psychological assessment and targeted interventions into perioperative care. These findings support a biopsychosocial approach to AIS treatment, emphasizing recovery as both a physical and psychological process.

STUDY DESIGN: Qualitative study.

LEVEL OF EVIDENCE: 5.