“MY BACK FEELS LIKE IT’S GOING TO SNAP”: THE IMPACT OF BACK PAIN ON PEOPLE'S ACTIVITY AND WELL-BEING

A. Hadfield¹, L. Roberts^1,2

Background: Since low back pain is the single largest cause of years lived with disability, it is essential to understand its effect on people’s lives, in order to optimise and tailor treatment.  Literature has shown that loss of function due to back pain can undermine people’s abilities to undertake work, domestic chores, recreational activities, and valued roles such as parenting and driving.  Furthermore, reduced self-esteem and perceived loss of identity can result in feelings of self-loathing, shame, frustration, anger, negativity towards others and depression.

Purpose: With the emphasis now on low back pain being episodic, there is a pressing need to understand the impact that an episode of back pain can have on people’s activity and well-being.

Methods: This research analysed data from a large mixed methods programme and included a cross-sectional, observational study of 25 initial consultations and a longitudinal study of 15 care episodes (involving 15 consultations and 38 follow-up appointments) that took place in a physiotherapy outpatient department in a city hospital in Southern England.  Patients were referred by their doctor and allocated an individual (45-minute) consultation with a clinician, with follow-up (30-minute) appointments as necessary.  Purposive sampling was undertaken to ensure that where possible, all four gender combinations were included in the data collection (M therapist and M patient; M:F; F:M; F:F) and quota sampling ensured a maximum of 4 patients were recruited from any one clinician.  All the clinical encounters were observed by one of the authors, audio-recorded and transcribed verbatim.  Data were analysed thematically using a Framework approach, comprising transcription, coding, developing a framework matrix and interpretation of the data.

Results: Six themes and 20 sub-themes summarised the impact reported by patients of the back pain episode on their lives, including: 1) work (including sickness absence, exiting the labour market, work modifications; and perceived exacerbation of symptoms); 2) sleep; 3) activities of daily living (including shopping, caring roles, housework, dressing and personal care); 4) physical activity (including sport and exercise, gardening, walking, climbing stairs, bending); 5) static activities (sitting and driving); and 6) psychosocial impacts that included low mood, a range of negative emotions and loss of identity, which featured prominently in the dataset.

Conclusion(s): This study used detailed, first-hand accounts to describe the physical and psychosocial impact of an episode of back pain on people’s activity and well-being.  This complex web of impact affected many aspects of a person’s life, and this study showed for people experiencing low back pain, low mood and negative emotion featured prominently.

Implications: In order to deliver patient-centred interventions, physiotherapists need to take a comprehensive history from the patient, with specific examples of the impact of their symptoms that can be used to tailor education, offer appropriate advice and set relevant, shared goals.  This study highlights the multifactorial nature of back pain and the importance of specifically identifying the psychosocial impact on a person’s life.  Identifying and addressing negative beliefs such as “My back feels like it is going to snap” forms an essential component of treatment.

Funding, acknowledgements: Versus Arthritis (formerly Arthritis Research UK) funded the fellowship of the senior researcher that enabled data collection (grant number 17830)

Keywords: Back pain, Impact, Well-being

Topic: Musculoskeletal: spine

Did this work require ethics approval? Yes

Institution: University of Southampton

Committee: Faculty of Environmental and Life Sciences Ethics Committee

Ethics number: 56323.A1