Abstract
Objective
To analyze attitudes and beliefs about movement and physical activity in people with
low back pain (LBP) and compare these beliefs between people with acute and chronic
LBP.
Design
Qualitative inductive analysis of data collected via face-to-face semistructured interviews.
Interviews were audio-recorded and transcribed verbatim.
Setting
Participants were purposively recruited from 1 region of New Zealand.
Participants
Persons with LBP (N=23), consisting of individuals with acute LBP (<6wk; n=12) and
chronic LBP (>3mo; n=11).
Interventions
Not applicable.
Main Outcome Measure
Themes that emerged from participant interview transcripts using analysis based on
Interpretative Description.
Results
Participants with acute and chronic LBP made judgments about physical activity and
rest using the same conceptual model. Concerns about creating more pain, tissue damage,
or impairment influenced the physical activity judgments of most participants with
acute and chronic LBP. These perceived risks were balanced against the perceived benefits,
the most important of which were psychological or social rather than physical. Judgments
made by those with acute and chronic LBP were context dependent and influenced by
the nature and duration of pain, the type of physical activity, the importance of
the activity, and the participant's previous experience. Participants with acute pain
who had not experienced back pain previously often expressed more uncertainty, whereas
those with chronic LBP appeared to have developed cognitive rules that determined
physical activity decisions.
Conclusions
Exploring the perceived risks, benefits, and contextual factors that influence decisions
about physical activity and rest may help clinicians to understand the behavior of
patients with acute and chronic LBP. Clinicians may best support their patients to
engage in physical activity by providing an informed assessment of risks and an explanation
about the range of potential benefits.
Keywords
List of abbreviations:
LBP (low back pain)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Years lived with disability (YLDs) for 1160 sequelae of 289 diseases and injuries 1990-2010: a systematic analysis for the Global Burden of Disease Study 2010.Lancet. 2012; 380: 2163-2196
- A systematic review of the global prevalence of low back pain.Arthritis Rheum. 2012; 64: 2028-2037
- A systematic review of low back pain cost of illness studies in the United States and internationally.Spine J. 2008; 8: 8-20
- The economic burden of back pain in the UK.Pain. 2000; 84: 95-103
- Physical activity, exercise, and physical fitness: definitions and distinctions for health-related research.Public Health Rep. 1985; 100: 126-131
- Should physical activity recommendation depend on state of low back pain?.Eur J Pain. 2014; 18: 575-581
- Effects of recreational physical activity and back exercises on low back pain and psychological distress: findings from the UCLA Low Back Pain Study.Am J Public Health. 2005; 95: 1817-1824
- Self-reported moderate-to-vigorous leisure time physical activity predicts less pain and disability over 12 months in chronic and persistent low back pain.Eur J Pain. 2014; 18: 1190-1198
- Decline in physical activity, disability and pain-related fear in sub-acute low back pain.Eur J Pain. 2005; 9: 417-425
- Does a patient's physical activity predict recovery from an episode of acute low back pain? A prospective cohort study.BMC Musculoskelet Disord. 2013; 14: 126
- Disuse and physical deconditioning in the first year after the onset of back pain.Pain. 2007; 130: 279-286
- Relationship between physical activity and disability in low back pain: a systematic review and meta-analysis.Pain. 2011; 152: 607-613
- Advances in cognitive theory and therapy: the generic cognitive model.Annu Rev Clin Psychol. 2014; 10: 1-24
- The role of fear avoidance beliefs as a prognostic factor for outcome in patients with nonspecific low back pain: a systematic review.Spine J. 2014; 14: 816-836.e4
- Clinical course of non-specific low back pain: a systematic review of prospective cohort studies set in primary care.Eur J Pain. 2013; 17: 5-15
- What do people who score highly on the Tampa Scale of Kinesiophobia really believe?: A mixed methods investigation in people with chronic non specific low back pain.Clin J Pain. 2015; 31: 621-632
- Illness representations of restricting back pain: the older person's perspective.Pain Med. 2014; 15: 938-946
- Chronic low back pain patients' perceptions on self-management, self-management support, and functional ability.Pain Manag Nurs. 2014; 15: 258-264
- Experiences of living with chronic back pain: the physical disabilities.Disabil Rehabil. 2007; 29: 587-596
- A longitudinal study of patients' experiences of chronic low back pain using interpretative phenomenological analysis: changes and consistencies.Psychol Health. 2013; 28: 121-138
- 'I am absolutely shattered': the impact of chronic low back pain on Australian Aboriginal people.Eur J Pain. 2012; 16: 1331-1341
- An updated overview of clinical guidelines for the management of non-specific low back pain in primary care.Eur Spine J. 2010; 19: 2075-2094
- New Zealand acute low back pain guide.Accident Compensation Corp, Wellington2004
- Early management of persistent non-specific low back pain: summary of NICE guidance.BMJ. 2009; 338: b1805
- Physical exercise interventions to improve disability and return to work in low back pain: current insights and opportunities for improvement.J Occup Rehabil. 2005; 15: 491-505
- Evidence-based risk assessment and recommendations for physical activity: arthritis, osteoporosis, and low back pain.Appl Physiol Nutr Metab. 2011; 36: S49-79
- ‘I am afraid to make the damage worse’—fear of engaging in physical activity among patients with neck or back pain—a gender perspective.Scand J Caring Sci. 2014; 28: 146-154
- Easy to harm, hard to heal: patient views about the back.Spine (Phila Pa 1976). 2015; 40: 842-850
- The enduring impact of what clinicians say to people with low back pain.Ann Fam Med. 2013; 11: 527-534
- Interpretive description: a noncategorical qualitative alternative for developing nursing knowledge.Res Nurs Health. 1997; 20: 169-177
- A study of the natural history of back pain. Part I: development of a reliable and sensitive measure of disability in low-back pain.Spine (Phila Pa 1976). 1983; 8: 141-144
- Kinesiophobia: a new view of chronic pain behavior.Pain Manag. 1990; 3: 35-43
- Strengths and challenges in the use of interpretive description: reflections arising from a study of the moral experience of health professionals in humanitarian work.Qual Health Res. 2009; 19: 1284-1292
- The analytic challenge of interpretative description.Int J Qual Methods. 2004; 3: 1-11
- Individuals with low back pain: how do they view physical activity?.Fam Pract. 1999; 16: 39-45
- Injured workers' construction of expectations of return to work with sub-acute back pain: the role of perceived uncertainty.J Occup Rehabil. 2012; 22: 1-14
- The fear-avoidance model of musculoskeletal pain: current state of scientific evidence.J Behav Med. 2007; 30: 77-94
- Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art.Pain. 2000; 85: 317-332
- Lives on hold: a qualitative synthesis exploring the experience of chronic low-back pain.Clin J Pain. 2013; 29: 907-916
- Workers’ perspectives on low back pain recurrence: “It comes and goes and comes and goes, but it’s always there.”.Pain. 2011; 152: 204-211
- Daily occupations with or without pain: dilemmas in occupational performance.OTJR (Thorofare N J). 2004; 24: 144-150
- Managing time: an interpretative phenomenological analysis of patients' and physiotherapists' perceptions of adherence to therapeutic exercise for low back pain.Disabil Rehabil. 2005; 27: 625-636
- An explorative, qualitative study into patients' satisfaction with physiotherapy.Physiotherapy. 2001; 87: 10-20
- Chronic low back pain: patients' experiences, opinions and expectations for clinical management.Disabil Rehabil. 2007; 29: 1899-1909
- Cross-sectional survey of attitudes and beliefs about back pain in New Zealand.BMJ Open. 2014; 4: e004725
- Motivational interviewing: helping people change.3rd ed. Guilford Pr, New York2013
- Acute low back pain management in general practice: uncertainty and conflicting certainties.Fam Pract. 2014; 31: 723-732
- Physiotherapists' pain beliefs and their influence on the management of patients with chronic low back pain.Spine (Phila Pa 1976). 2004; 29: 783-795
- Managing time: an interpretative phenomenological analysis of patients' and physiotherapists' perceptions of adherence to therapeutic exercise for low back pain.Disabil Rehabil. 2005; 27: 625-636
- Epidemiology of adolescent spinal pain: a systematic overview of the research literature.Spine (Phila Pa 1976). 2007; 32: 2630-2637
- Keeping pain in mind: a motivational account of attention to pain.Neurosci Biobehav Rev. 2010; 34: 204-213
- Oxford guide to behavioral experiments in cognitive therapy.Oxford Univ Pr, Oxford2005
References
- Interpretive description: a noncategorical qualitative alternative for developing nursing knowledge.Res Nurs Health. 1997; 20: 169-177
- Strengths and challenges in the use of interpretive description: reflections arising from a study of the moral experience of health professionals in humanitarian work.Qual Health Res. 2009; 19: 1284-1292
- The analytic challenge of interpretative description.Int J Qual Methods. 2004; 3: 1-11
- Evaluative criteria for qualitative research in health care: controversies and recommendations.Ann Fam Med. 2008; 6: 331-339
- A study of the natural history of back pain. Part I: development of a reliable and sensitive measure of disability in low-back pain.Spine (Phila Pa 1976). 1983; 8: 141-144
- Kinesiophobia: a new view of chronic pain behavior.Pain Manag. 1990; 3: 35-43
Article Info
Publication History
Published online: October 12, 2015
Footnotes
Supported by a Searchwell Grant from the Wellington Branch of Physiotherapy New Zealand. S.Dean's involvement was supported by the National Institute for Health Research Collaboration for Leadership in Applied Health Research and Care South West Peninsula. The views expressed are those of the author(s) and not necessarily those of the National Health Service, the National Institute for Health Research, or the Department of Health.
Disclosures: none.
Identification
Copyright
© 2016 American Congress of Rehabilitation Medicine. Published by Elsevier Inc. All rights reserved.
