Large Language Model-Based Clinical Decision Support for Antibiotic Selection and Dose Recommendation in Hospitalized Patients With Pneumonia: Multicenter Retrospective Study.

Degenerative spine conditions [] and physical inactivity [] are major public health concerns. Low back pain and related disorders remain one of the leading causes of disability worldwide []. Lumbar spinal stenosis and lumbar disc herniation are among the most common degenerative spinal conditions contributing to this burden, and both are associated with substantial pain, disability, and reduced quality of life. Lumbar spinal stenosis affects one in five older adults [,], and is characterised by functional limitations (e.g., reduced walking capacity due to neurogenic claudication), leg pain, back pain, and numbness or weakness in the lower extremities []. Similarly, disc herniation typically presents with back pain accompanied by lower extremity pain, tingling, numbness, or weakness [–]. While spinal surgery can offer substantial relief for many patients, about one in three patients with lumbar stenosis [] and one in four patients with disc herniation [] experience relatively poor surgical outcomes []. Persistent spinal pain type 2 is associated with greater disability than stroke and heart failure [], and carries a significant economic burden []. Although physical inactivity is acknowledged as a leading cause of death, morbidity, and socioeconomic burden [], engaging in physical activity before spinal surgery may also improve postoperative outcomes experienced by patients with lumbar stenosis [] or lumbar disc herniation []. Previous qualitative research has explored the preoperative experiences of patients with lumbar stenosis or lumbar disc herniation who participate in structured exercise-based programs [], but little is known about patients’ broader views on physical activity in every day life before surgery. Limited qualitative research has examined the behavioural determinants of general physical activity engagement (as opposed to structured, supervised exercise) in patients awaiting lumbar spine surgery using a theory-informed framework. This distinction is clinically meaningful, as barriers and facilitators to general physical activity may differ substantially from those encountered in structured, supervised settings. Only 17% of patients meet the WHO-recommended levels of physical activity while waiting for lumbar spine surgery []. Understanding the factors that may influence physical activity behaviour in this population is a critical first step toward developing effective interventions. To systematically identify these determinants, the Theoretical Domains Framework (TDF) was used. The TDF is a validated synthesis of 33 behaviour change theories organised into 12 domains, designed to provide a comprehensive and structured approach to understanding the factors that influence health-related behaviours [,]. Compared to broader behavioural models such as the Capability, Opportunity, Motivation-Behaviour (COM-B) model [], the TDF offers greater granularity, enabling a more detailed exploration of the cognitive, emotional, and contextual factors that may influence behaviour. Furthermore, the TDF has been specifically validated for use in qualitative research aimed at identifying barriers and facilitators to behaviour change [], and has been applied in patients with musculoskeletal and other chronic conditions [–].