Factors Influencing the Choice Between Surgical Intervention and Physiotherapy for Individuals Experiencing Lumbar Spine Issues: A Qualitative Study in Iran

Lumbar spine disorders are a prevalent global health issue, with surgery and physiotherapy being the most common treatment options. Although many studies have explored the clinical outcomes of these treatments, little is known about the decision-making process from the perspective of both patients and healthcare providers in Iran. This process is shaped by a range of medical, social, psychological, and systemic factors. Accurately identifying these determinants and understanding their influence is essential for guiding patients toward informed and effective treatment decisions. The aim of this study was to explore the factors affecting the decision to choose between surgery and physiotherapy as treatment options by Iranian patients with lumbar spine disorders using the views of the patients, health care providers and decision-makers. The study utilized semi-structured interviews to collect data from 27 stakeholders, comprising 12 patients, 9 healthcare professionals (surgeons and physiotherapists), and 6 policymakers/administrators from Tehran, East Azarbaijan, and Yazd provinces. Participants were selected through purposeful sampling with maximum variation to ensure diverse representation across age, gender, condition type, and treatment preference. Data were analyzed using thematic analysis, with research rigor maintained through member checking, peer review, and inter-coder reliability assessments. Four themes were identified; service provider factors (eg provider knowledge/expertise, provider preference), service recipient factors (eg trust, financial worries), health system/insurance-related issues (eg cost coverage, treatment facility distance), and societal/family influences (eg media depictions, traditional beliefs). For example, the decision for surgery of some patients was due to other health professionals promoting quicker results, whereas some opposed surgical advice because of past experiences. The decision to use surgery or physiotherapy for lumbar spine problems in Iran is multivariate. Interventions to facilitate shared decision-making and patient education can improve concordance between clinical recommendations and patient preferences. There is a need for culturally sensitive decision aids and policy changes.