D. Alamam1,2, A. Leaver3, H. Alsobayel4, N. Moloney5, J. Lin3, M. Mackey3
1The University of Sydney, Health Sciences, Sydney, Australia, 2King Saud University, Health Sciences, Riyadh, Saudi Arabia, 3The University of Sydney, Sydney, Australia, 4King Saud University, Riyadh, Saudi Arabia, 5Macquarie University, Sydney, Australia

Background: Low back pain (LBP)-related disability is a multifactorial health condition with several contributing factors, such as individual, psychological and biological/physical factors. Cultural factors such as ethnicity and religion, are also known to influence pain perception, pain-related beliefs, and disability. There is a dearth of data on whether different cultural factors such as language, ethnicity and religion influence the associations between disability and pain-beliefs, especially in non-English speaking populations.

Purpose: The aim of this systematic review and meta-analysis was to assess the relationship between LBP-related disability and pain-related beliefs among non-English speaking populations with non-specific LBP. Further, this study aimed to assess the effects of selected cultural factors on the strength of the relationship between pain-beliefs and LBP-related disability.

Methods: A systematic review and meta-analyses were performed according to Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines.

Results: Pooled estimates of correlation coefficients between disability and pain beliefs using random-effects meta-analysis methods were conducted. Fifty-nine studies, (n=15,383) were included. A moderate correlation was identified between disability and pain self-efficacy (among chronic LBP r = −0.51, p ≤ 0.001), and a weak correlation between disability and FABQ-W (acute LBP r = 0.23, p ≤ 0.001). Otherwise, fair correlations were identified between disability and most pain beliefs (range r = −0.30 to 0.47, p ≤ 0.001). Pooled correlation coefficients between disability and all pain-related beliefs (except FABQ-W subscale) represent medium effects and suggest that lower disability was associated with greater pain self-efficacy, less pain-related fear, less catastrophic thinking, and less negative back-pain beliefs about the nature and cause of LBP. The role of cultural factors on relationships between disability and pain beliefs was examined according to spoken language, as few studies reported ethnicity or religion. 

Conclusion(s): This review examined the magnitude of relationships between several pain beliefs and LBP-related disability among non-English speaking populations including among Arabian -speaking populations, and subsequently the influence of selected cultural aspects on these relationships. Good consistency was found between each pain belief construct across different language groups suggesting that relationships between disability and pain-related beliefs are similar in direction and strength across divergent non-English speaking populations.

Implications: The results of this review may indicate that universal aspects of the pain experience exist and indicating that the determinants of disability might be universal. Results in this meta-analysis showed that the LBP experience has common aspects across divergent language groups. This may provide valuable information and will inform the management of LBP. For example, clinicians might use the well-established pain-management principles between different societal and language groups, and this might be suitably transferrable in the context of that patient's culture. Whilst there was an overall consistency of correlations for pain beliefs with the disability, some statistically significant differences were observed between individual groups, either in different geographic areas or in the same country but speaking different languages. This suggests that differences might still exist between some cultural groups and might relate to other factors like spirituality. Unfortunately, few studies reported religious data of different ethnicities and religions among non-English speaking populations, thus the influence of more cultural dimensions on relationships could not be explored. Therefore, this review highlights a substantial gap in the literature investigating pain beliefs in some language groups and geographical areas. This further highlight the need for continued research on the influence of pain-beliefs on disability among more diverse cultures.

Funding, acknowledgements: This research was funded by a scholarship grant from King Saud University

Keywords: Low back pain related disability, pain beliefs, culture

Topic: Musculoskeletal: spine

Did this work require ethics approval? No
Institution: The University of Sydney
Committee: The University of Sydney
Reason: The study design is a systematic review and meta-analysis

All authors, affiliations and abstracts have been published as submitted.

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