Alemam D.1,2, Moloney N.3, Leaver A.1, Alsobayel H.2, Mackey M.1
1The University of Sydney, Faculty of Health Sciences, Sydney, Australia, 2King Saud University, Department of Rehabilitation Sciences, Riyadh, Saudi Arabia, 3Macquarie University, Faculty of Medicine and Health Sciences, Sydney, Australia
Background: Chronic low back pain (cLBP) is recognized as a leading cause of disability. The contributions of cultural and psychosocial factors to cLBP-related disability have been established in many populations, but to date not in a Saudi Arabian population. Gender is important determinant of disability related to cLBP, however, the contribution of gender have not been investigated in Saudi population.
Purpose: The aim of this study was to examine the cross-sectional associations between demographic, cultural, and psychosocial factors, pain intensity, pain behaviours, physical activity and disability in people with cLBP. A second aim was to explore whether gender contributes to the level of disability in Saudi population.
Methods: An Arabic version of several self-administrated questionnaires were used comprising the Visual Analogue Scale (VAS), Modified Oswestry Disability Index (MODI), Cultural and Psychosocial Influences on Disability (CUPID), Back Beliefs Questionnaire (BBQ), Fear-Avoidance Beliefs Questionnaire (FABQ), Depression Anxiety Stress Scale (DASS-21) and International Physical Activity Questionnaire (IPAQ). The Pain Behaviour Scale (PaBS) was used to evaluate pain behaviours during performance of five functional tasks. Descriptive statistics were used to report demographic features of participants. Mean (SD) and ranges values were reported for continuous data, and frequencies (percent) for categorical data. Gender difference in study variables was explored using independent sample t-test. The relationships between disability and all variables were explored using Chi square tests and Pearson correlation coefficients. Potential factors to predict disability were assessed using univariate and multiple linear regression analysis.
Results: 115 participants were included in this study. Statistically significant correlations were found between disability and; pain intensity, fear avoidance beliefs (physical activity & work) and depression (r= 0.60, 0.50, 0.52, 0.50 respectively, p 0.001 for all). Anxiety, stress and pain behaviours were moderately but significantly correlated with disability (r= 0.40, 0.44, 0.44, respectively p 0.001 for all). No statistically significant difference was found between males and females in cLBP related disability. Multiple linear regression analysis indicated that pain intensity, negative back beliefs, psychological distress (depression, anxiety& stress), fear-avoidance beliefs, absenteeism and participants age were significantly associated with disability related to cLBP.
Conclusion(s): This results support the multifactorial nature of cLBP-related disability. Pain intensity was found strongly associated with level of disability. This relation needs to be clearly understood in future research, in particular, to understand what factors are more strongly associated with pain intensity. Pain behaviours was also moderately associated with level of disability. To clarify the role of pain behaviours in disability related to cLBP, future studies are needed to investigate pain behaviours in different contexts.
Implications: Wide range of psychosocial factors, pain related behaviours and cultural factors have identified in this study as important determinants to disability related to cLBP. In particular, pain intensity and fear avoidance beliefs have emerged as important contributors to disability level. This result should encourage the health care practitioners to consider these factors for effective chronic pain management.
Funding acknowledgements: This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
Topic: Musculoskeletal: spine
Ethics approval: Ethical approvals were obtained from Ethics Committees of the university of Sydney (2015/771) and King Fahad Medical City (15-306E)
All authors, affiliations and abstracts have been published as submitted.
