Psychosocial factors related to lower back problems in a South African manganese industry

Only two subscales of the Coping Strategies Questionnaire are culturally relevant for people with chronic low back pain in Nigerian Igbo populations: a cross-cultural adaptation and validation study

BACKGROUND

Pain coping strategies are important in the chronicity of low back pain and the associated disability. However, their exact influence is unknown in many African contexts such as rural Nigeria due to lack of outcome instruments with which to measure them. This study aimed to cross-culturally adapt and psychometrically test the Coping Strategies Questionnaire (CSQ) in Igbo populations in Nigeria.

METHODS

The CSQ was forward and back translated by clinical and non-clinical translators; evaluated by an expert review committee. The translated measure was piloted amongst twelve rural Nigerian dwellers with chronic low back pain (CLBP) using the think-aloud cognitive interviewing style. Internal consistency (Cronbach's alpha), test-retest reliability (intra-class correlation coefficient-ICC and Bland-Altman plot), and minimal detectable change were examined amongst 50 people with CLBP in rural and urban Nigerian populations. Construct validity was determined by assessing the correlations between the adapted CSQ and measures of disability, pain intensity, fear avoidance beliefs, and illness perceptions using Spearman's correlation analyses with 200 adults with CLBP in rural Nigeria. Exploratory factor analyses using Kaiser criterion (eigenvalue) and parallel analysis as methods for determining dimensionality were conducted with the same sample.

RESULTS

Fourteen out of 42 items were routinely adopted in this population including all items of catastrophising subscale, and all but one item of praying and hoping subscale. Catastrophising and praying and hoping subscales had the highest Cronbach's alpha. All subscales had high ICCs with Bland-Altman plots that showed good agreement. All coping strategies were positively correlated with self-reported disability and pain intensity with catastrophising subscale having the highest values. Seven-factor and three-factor structures were produced with the Kaiser criterion and parallel analysis, with different items from the original CSQ, except for catastrophising.

CONCLUSIONS

Catastrophising and praying and hoping may be the relevant coping strategies in this population. More culturally relevant measures of pain coping strategies that include adaptive coping strategies may need to be developed for African contexts such as rural Nigeria.

The prevalence of fear avoidance and pain catastrophising amongst patients with chronic neck pain

Background

Cognitive factors impact chronic pain, but the prevalence of fear avoidance (FA) and pain catastrophising (PC) in individuals suffering from chronic neck pain (CNP) has not been investigated in South Africa.

Objectives

To determine the prevalence of FA and PC in patients with CNP at private physiotherapy practices in Johannesburg.

Method

The Tampa Scale for Kinesiophobia-11 (TSK-11) (α = 0.80) and Pain Catastrophising Scale (α = 0.87) self-report questionnaires were used in a cross-sectional study to determine the prevalence of FA and PC, respectively. Descriptive statistics and correlations using Pearson’s or Spearman’s coefficient were conducted between demographic variables and FA and PC. Non-parametric data were tested using the Wilcoxon rank-sum or Kruskal–Wallis test. Cohen’s d-value or r-value measured strength of associations.

Results

A sample of 106 CNP patients with a mean age of 48.7 years (± 14.8) from 25 randomly selected private practices participated in the study. Of the participants, 81% were women (n = 86). Fear avoidance and PC had a prevalence of 25.5% (n = 27) and 15.1% (n = 16), respectively. A positive correlation was found between FA-11-Total and PC-Total (r = 0.684; p = 0.0001) and between FA (TSK-11-Total and TSK-SF (somatic focus)) and PC and its subscales (r ≥ 0.602; p = 0.0001). Participants with a secondary education (26.0 ± 3.4) showed a higher FA than those with tertiary education (21.9 ± 1.5). Effect size was moderate (Cohen’s d = 0.60). Pain intensity correlated positively with both FA (Pearson’s correlation: r = 0.33; p = 0.001) and PC (Spearman’s correlation; r = 0.39; p = 0.0001).

Conclusion

FA and PC affect a number of patients with CNP. A lower level of education was associated with FA and a higher pain intensity was associated with higher FA and PC.

Clinical implications

Identifying FA and PC in patients with CNP is important to facilitate holistic management.

An update on the prevalence of low back pain in Africa: a systematic review and meta-analyses

BACKGROUND

Low back pain (LBP) remains a common health problem and one of the most prevalent musculoskeletal conditions found among developed and developing nations. The following paper reports on an updated search of the current literature into the prevalence of LBP among African nations and highlights the specific challenges faced in retrieving epidemiological information in Africa.

METHODS

A comprehensive search of all accessible bibliographic databases was conducted. Population-based studies into the prevalence of LBP among children/adolescents and adults living in Africa were included. Methodological quality of included studies was appraised using an adapted tool. Meta-analyses, subgroup analyses, sensitivity analyses and publication bias were also conducted.

RESULTS

Sixty-five studies were included in this review. The majority of the studies were conducted in Nigeria (n = 31;47%) and South Africa (n = 16;25%). Forty-three included studies (66.2%) were found to be of higher methodological quality. The pooled lifetime, annual and point prevalence of LBP in Africa was 47% (95% CI 37;58); 57% (95% CI 51;63) and 39% (95% CI 30;47), respectively.

CONCLUSION

This review found that the lifetime, annual and point prevalence of LBP among African nations was considerably higher than or comparable to global LBP prevalence estimates reported. Due to the poor methodological quality found among many of the included studies, the over-representation of affluent countries and the difficulty in sourcing and retrieving potential African studies, it is recommended that future African LBP researchers conduct methodologically robust studies and report their findings in accessible resources.

TRIAL REGISTRATION

The original protocol of this systematic review was initially registered on PROSPERO with registration number CRD42014010417 on 09 July 2014.

The Global Spine Care Initiative: a narrative review of psychological and social issues in back pain in low- and middle-income communities

PURPOSE

The purpose of this review was to describe psychological and social factors associated with low back pain that could be applied in spine care programs in medically underserved areas and low- and middle-income countries.

METHODS

We performed a narrative review of cohort, cross-sectional, qualitative and mixed methods studies investigating adults with low back pain using Medline and PubMed were searched from January 2000 to June 2015. Eligible studies had at least one of the following outcomes: psychological, social, psychosocial, or cultural/ethnicity factors. Studies met the following criteria: (1) English language, (2) published in peer-reviewed journal, (3) adults with spinal disorders, (4) included treatment, symptom management or prevention.

RESULTS

Out of 58 studies, 29 were included in this review. There are few studies that have evaluated psychological and social factors associated with back pain in low- and middle-income communities, therefore, adapting recommendations from other regions may be needed until further studies can be achieved.

CONCLUSION

Psychological and social factors are important components to addressing low back pain and health care providers play an important role in empowering patients to take control of their spinal health outcomes. Patients should be included in negotiating their spinal treatment and establishing treatment goals through careful listening, reassurance, and information providing by the health care provider. Instruments need to be developed for people with low literacy in medically underserved areas and low- and middle-income countries, especially where psychological and social factors may be difficult to detect and are poorly addressed. These slides can be retrieved under Electronic Supplementary Material.

Povezave med izbranimi dejavniki tveganja in pojavnostjo bolečine v križu pri zdravstvenem osebju

Uvod: Bolečina v lumbalnem predelu predstavlja pogosto zdravstveno težavo med zdravstvenim osebjem. Z raziskavo smo želeli ugotoviti, kako pogosto se bolečine v križu pojavljajo pri zdravstvenem osebju, in sicer v povezavi z izbranimi dejavniki tveganja. Metode: Raziskava temelji na neeksperimentalni kvantitativni metodi empiričnega raziskovanja. Uporabili smo vprašalnik zaprtega tipa o bolečini v križu, ki ga je izpolnilo 89 zdravstvenih delavcev v Splošni bolnišnici Jesenice in domu upokojencev na področju Gorenjske. Za ugotavljanje statistično značilnih razlik med skupinami smo uporabili test χ2 in enofaktorsko analizo variance. Rezultati: Bolečina v križu se pri 40,4 % zdravstvenega osebja pojavlja večkrat na mesec, najpogosteje pri bolničarjih (p = 0,001) in zaposlenih na negovalnem oddelku (p = 0,006). Povprečno traja manj kot en teden (43,8 %). Dejavnik, ki je z njo najbolj povezan, je dvigovanje in prenašanje bremen (x = 4,5). Glede izobraževanj s področja bolečine v križu in pravilnega dvigovanja bremen obstajajo statistično značilne razlike med poklicnimi skupinami (p < 0,010). Diskusija in zaključek: Z bolečino so najbolj povezani dejavniki, ki nastanejo zaradi neposrednega fizičnega dela s pacientom. Potrebna so nadaljnja raziskovanja na reprezentativnih vzorcih, treba bi bilo izvesti tudi izobraževanja za zaposlene in uvesti nove pripomočke, ki bi jih zdravstveno osebje uporabljalo pri svojem delu s pacientom.

Validity and reliability of the Fear-Avoidance Beliefs Questionnaire (FABQ) in workers with upper extremity injuries

INTRODUCTION

Fear Avoidance Beliefs (FAB) have been associated with increased pain, dysfunction and difficulty returning to work in Upper Extremity (UE) injures. The FABQ is used to assess FAB, but its measurement properties have not been established in UE. The purpose of this study is to evaluate the reliability and validity of the FABQ to screen UE compensated injured workers for FAB.

METHODS

Consenting workers attending a specialty clinic completed a modified FABQ, QuickDASH (Disability), SPADI Pain Score and von Korff Chronic Pain Grade (Pain), SF-36v2 (General Health), and Work Instability Scale (Job Instability). A sub-sample of workers (n = 48) completed the FABQ 2 weeks later for test-retest reliability.

RESULTS

187 workers; 54.0% male; mean age 45.2 (sd 9.68); 56% were currently working. Mean subscale scores (FABQ-Work [FABQ-W]/FABQ-Physical Activity [FABQ-PA]) were 35/42 and 20/24. Ceiling effects (23%/38%) existed in both subscales. Cronbach's alphas were 0.75/0.78. Test-retest analysis (ICC(2,1)) was lower than desired (0.52/0.59). Construct validation was supported by a moderate correlation between FABQ-W/FABQ-PA and QuickDASH Work Module (0.51/0.42) and WIS (0.46/0.38) in those currently working. Low correlations were found between the subscales measures of pain (SPADI: 0.24/0.23; Chronic Pain Grade: 0.25/0.25), and SF-36 MCS (-0.25/-0.30).

CONCLUSIONS

Although FAB is an important concept to measure in compensated UE injured workers, the FABQ had limitations in this population as there was a high ceiling effect, and lower than desired reliability for individual discrimination. A priori hypotheses around construct validity were rejected for 16/22 concepts tested.

A systematic review of instruments for the assessment of work-related psychosocial factors (Blue Flags) in individuals with non-specific low back pain

In individuals with low back pain (LBP) psychosocial factors can act as obstacles to return to work. A coloured Flags Framework has been conceptualised, in which Blue Flags represent work-related psychosocial issues. This systematic review was conducted to appraise available instruments for the assessment of Blue Flags in working age adults with non-specific LBP. The Ovid versions of MEDLINE, EMBASE, PsycINFO, AMED and CINAHL databases were searched from inception until the first week of March 2010; additionally, experts and study authors were contacted. Two authors independently selected studies, extracted data and assessed methodological quality. Eight studies (recruiting 5630 participants) met the review inclusion criteria, reporting six instruments: the Back Disability Risk Questionnaire (BDRQ); Occupational Role Questionnaire (ORQ); Obstacles to Return to Work Questionnaire (ORTWQ); Psychosocial Aspects of Work Questionnaire (PAWQ); Vermont Disability Prediction Questionnaire (VDPQ); and Modified Work Adaptation, Partnership, Growth, Affection and Resolve. Limited psychometric testing had been performed on the instruments, and solely by the original developers. None of the instruments, in their current stage of development, can be recommended as Blue Flags assessment instruments. The ORTWQ was the only instrument that showed adequate psychometric properties but was not considered clinically feasible in its present format. Future research should focus on further psychometric development of the ORTWQ.

The effect of low back pain on work absenteeism among soldiers on active service

STUDY DESIGN

A prospective longitudinal study.

OBJECTIVE

To identify factors that influence absenteeism among soldiers with acute low back pain (ALBP).

SUMMARY OF BACKGROUND DATA

Recommendations for the treatment of low back pain include continuing physical activity. Ninety-seven percent of patients return to work within 1 month.

METHODS

This was a prospective longitudinal study using a questionnaire to assess morbidity from ALBP and the job being carried out by the soldier at the time of referral to the army clinic and 6 weeks later. Potential associations were investigated between prolonged absenteeism and variables including disease indexes, use of healthcare services, the soldier's army job, and their satisfaction with it. RESULTS.: The study population consisted of 160 soldiers with uncomplicated ALBP. Eighty-six percent of the participants returned to their job within 6 weeks. The rates of improvement in pain, the mental functioning under pain, satisfaction with jobs, and having combat status were higher among soldiers who returned to their jobs as compared with those who did not. Those who did not return to their jobs had higher rates of utilization of healthcare services.

CONCLUSION

Nondisease factors are associated with the duration of absenteeism among soldiers with ALBP. Absenteeism is directly related to use of healthcare services.

The prevalence of low back pain in Africa: a systematic review

Background

Low back pain (LBP) is the most prevalent musculoskeletal condition and one the most common causes of disability in the developed nations. Anecdotally, there is a general assumption that LBP prevalence in Africa is comparatively lower than in developed countries. The aim of this review was to systematically appraise the published prevalence studies conducted on the African continent to establish the prevalence of LBP in Africa.

Methods

A comprehensive search was conducted in April 2006. The following databases PEDro, Psychinfo, Science Direct, SportsDiscus, PubMed, CINAHL, Biblioline Pro-African Wide NiPAD and SA ePublications were individually searched using specifically developed search strategies for epidemiological research conducted on LBP amongst the African population. Two reviewers independently evaluated the methodological quality of the studies reviewed.

Results

A total of 27 eligible epidemiological studies were included in this review. The majority of the studies (63%) were conducted in South Africa (37%) and Nigeria (26%). The most common population group involved workers (48%), while scholars comprised 15% of the population. 67% of the studies were found to be methodologically sound, and the LBP prevalence of these were analyzed. The mean LBP point prevalence among the adolescents was 12% and among adults was 32%. The average one year prevalence of LBP among adolescents was 33% and among adults was 50%. The average lifetime prevalence of LBP among the adolescents was 36% and among adults was 62%.

Conclusion

The findings support the global burden of disease of LBP, in addition to suggesting that LBP prevalence among Africans is rising and is of concern. Further research into the most effective strategies to prevent and manage LBP in Africa is warranted.