Back pain beliefs are related to the impact of low back pain in baby boomers in the Busselton Healthy Aging Study

An Exploration of the Influence of Non-Biomechanical Factors on Lifting-Related LBP

Objective: The primary objective was to compare non-biomechanical factors between manual workers with and without a history of LBP related to lifting. A secondary objective was to investigate associations between the change in pain intensity during repeated lifting (termed pain ramp) and non-biomechanical factors tested in the LBP group. Methods: Manual workers currently in lifting occupations with and without a history of lifting-related LBP were recruited (21 LBP and 20 noLBP) and took part in a repeated (100) lift task. A series of non-biomechanical factors, including psychological, work-related, lifestyle, whole health and psychophysical factors, were collected. Psychophysical factors (pressure pain thresholds (PPTs) and fatigue) were also measured at different time points. Associations between pain ramp during lifting and non-biomechanical factors were investigated with linear regression. Results: The LBP group reported worse perceived sleep quality, more musculoskeletal pain sites other than LBP and greater symptoms related to gastrointestinal complaints and pseudo-neurology compared to the group with no history of LBP. The group with LBP were also slightly more worried about the lifting task and felt more fatigued at the end of the lifting task. The feeling of fatigue during lifting was positively associated with pain ramp in the LBP group. Anxiety and gastrointestinal complaints were weakly negatively associated with pain ramp during lifting. Conclusions: The group differences of poorer perceived sleep, greater non-specific health complaints, slightly more worry about the lifting task and more perceived fatigue in the LBP group highlight the complex and multi-factorial nature of LBP related to lifting. The feeling of fatigue was positively associated with pain ramp in the LBP group, suggesting a close relationship with pain and fatigue during lifting that requires further exploration.

Back pain beliefs among Indian migrants in Australia: a cross-sectional study

PURPOSE

One of the largest migrant communities in Australia is the Indian migrant community. Current back pain guidelines recommend assessment of patients' beliefs; however, little is known about these beliefs in Indian communities. We aimed to investigate beliefs about back pain among Indian migrants living in Sydney.

MATERIAL AND METHODS

An online questionnaire with demographic information, participant characteristics, the Back Beliefs Questionnaire (BBQ) and open-ended questions relating to beliefs about causes of back pain and treatment preferences was completed by 386 Indian migrants in Sydney.

RESULTS

The overall BBQ score was 25.1 ± 6.7. We found significant but slightly more positive beliefs among Indian females than Indian males (standardized regression coefficient, β = 0.134, p = 0.014). Presence and severity of pain did not affect back pain beliefs. There seemed to be a belief in physical and structural/anatomical causes of back pain, and a belief in the effectiveness of exercise, medications, and Indian traditional approaches for pain management.

CONCLUSIONS

Beliefs of Indian migrants aligned with a "western traditional" biomedical model for the cause of pain, but with a belief in the effectiveness of both Indian traditional and western treatment approaches. Awareness of these beliefs could enable an effective therapeutic alliance between clinicians and Indian patients.IMPLICATIONS FOR REHABILITATIONBack pain beliefs of Australian Indian migrants are similar to their western counterparts, so the current guidelines for back pain can potentially be implemented without too much adjustment for this migrant community.Awareness of these beliefs is likely to improve the therapeutic alliance between clinician and an Indian migrant patient.

An investigation of implicit bias about bending and lifting

OBJECTIVES

Previous studies in a high-income country have demonstrated that people with and without low back pain (LBP) have an implicit bias that bending and lifting with a flexed lumbar spine is dangerous. These studies present two key limitations: use of a single group per study; people who recovered from back pain were not studied. Our aims were to evaluate: implicit biases between back posture and safety related to bending and lifting in people who are pain-free, have a history of LBP or have current LBP in a middle-income country, and to explore correlations between implicit and explicit measures within groups.

METHODS

Exploratory cross-sectional study including 174 participants (63 pain-free, 57 with history of LBP and 54 with current LBP). Implicit biases between back posture and safety related to bending and lifting were assessed with the Implicit Association Test (IAT). Participants completed paper-based (Bending Safety Belief [BSB]) and online questionnaires (Tampa Scale of Kinesiophobia; Back Pain Attitudes Questionnaire).

RESULTS

Participants displayed significant implicit bias between images of round-back bending and lifting and words representing "danger" (IATD-SCORE: Pain-free group: 0.56 (IQR=0.31-0.91; 95% CI [0.47, 0.68]); history of LBP group: 0.57 (IQR=0.34-0.84; 95% CI [0.47, 0.67]); current LBP group: 0.56 (IQR=0.24-0.80; 95% CI [0.39, 0.64])). Explicit measures revealed participants hold unhelpful beliefs about the back, perceiving round-back bending and lifting as dangerous (BSBthermometer: Pain-free group: 8 (IQR=7-10; 95% CI [7.5, 8.5]); history of LBP group: 8 (IQR=7-10; 95% CI [7.5, 9.0]); current LBP group: 8.5 (IQR=6.75-10; [7.5, 9.0])). There was no correlation between implicit and explicit measures within the groups.

CONCLUSIONS

In a middle-income country, people with and without LBP, and those who recovered from LBP have an implicit bias that round-back bending and lifting is dangerous.

Cross-cultural adaptation, reliability and validity of the Marathi versions of the Back Beliefs Questionnaire and Pain Self-Efficacy Questionnaire in people living with chronic low back pain

PURPOSE

To translate and cross-culturally adapt the Back Beliefs Questionnaire (BBQ) and Pain Self-Efficacy Questionnaire (PSEQ) into Marathi, and to evaluate their clinimetric properties in a native Marathi speaking population with chronic low back pain.

MATERIAL AND METHODS

The BBQ and PSEQ were translated into Marathi using international published guidelines. Fifty native Marathi speakers were recruited. Reliability (n = 43) was evaluated in terms of internal consistency (Cronbach α) and test-retest reliability [intra class correlation coefficient, ICC (2, 1)] and 95% confidence interval (CI). Convergent validity (n = 50) was assessed by correlating the Marathi versions of BBQ and PSEQ with the Marathi version of Roland Morris Disability Questionnaire (RMDQ).

RESULTS

Internal consistency of BBQ (Cronbach α  =  0.67) was good and that for PSEQ (Cronbach α  =  0.93) was high. Test-retest reliability for BBQ (ICC =  0.80; 95% CI: 0.66 to 0.89) was good and PSEQ (ICC = 0.85; 95% CI: 0.74 to 0.92) was excellent. A significant, low negative correlation was found between RMDQ and BBQ scores (r = -0.298; p = 0.036) and PSEQ (r = -0.28; p = 0.049).

CONCLUSIONS

The BBQ and PSEQ were successfully cross-culturally adapted into Marathi. Clinimetric evaluation of these questionnaires in a sample of native Marathi speaking populations with chronic low back pain demonstrated good acceptability, acceptable internal consistency, and high test-retest reliability.Implications for rehabilitationThe Back Beliefs Questionnaire (BBQ) and Pain Self Efficacy Questionnaire (PSEQ) were successfully cross-culturally adapted into Marathi.The Marathi versions of BBQ and PSEQ have good acceptability, acceptable internal consistency, and high test-retest reliability.They can be used by clinicians and researchers to evaluate beliefs about back pain and pain self-efficacy in Marathi speaking patients with chronic low back pain.

Low back pain prevalence, beliefs and treatment-seeking behaviour in multi-ethnic Suriname

Objectives

The aims were to determine, for the first time, the prevalence of low back pain (LBP) in urban and rural communities and to assess back beliefs and treatment-seeking behaviour in Suriname, a multi-ethnic country in the Caribbean community.

Methods

A cross-sectional community-based survey using the Community Oriented Program for the Control of Rheumatic Diseases methodology was performed between April 2016 and July 2017. Information was collected on LBP prevalence and LBP-related treatment seeking, beliefs about LBP [Back Beliefs Questionnaire (BBQ)], level of disability (Oswestry Disability Index) and the risk of developing persistent disabling pain (Start Back Screening Tool).

Results

A total of 541 out of 2902 individuals reported current acute or chronic LBP. It was more prevalent in urban (20.2%) than in rural (13.7%) communities, especially in females and older adults (>55 years of age). Individuals from rural areas [median BBQ = 18.00 (14.00-22.00)] had significantly more negative beliefs than the urban population [median BBQ = 25.00 (19.00-31.00); P < 0.001]. Maroons displayed more negative beliefs than Creole (P = 0.040), Hindustani (P < 0.001), Javanese (P < 0.001) and mixed ethnicity (P < 0.001) groups. At least 75% of the LBP population sought care, especially from a western health-care practitioner. Seeking treatment and having a higher risk of developing persistent disabling pain was significantly associated with more disability (P < 0.001). Age ≥45 years (P < 0.001), Indigenous ethnicity (P < 0.05) and functional disability (P < 0.001) were factors influencing treatment seeking.

Conclusion

Low back pain is a prevalent health problem in the Surinamese urban community, especially in older adults and among females. Most individuals experiencing LBP visited a western health-care practitioner and had more negative beliefs compared with other communities.

Several low back pain-related misbeliefs are still around in 2020: A cross-sectional survey in Belgium

BACKGROUND AND PURPOSE

Low back pain (LBP)-related misbeliefs are known to be among risk factors for LBP chronification and for persistence of chronic pain. The main objective of this study was to investigate the current LBP-related beliefs in the general population in Belgium, considering the fact that the last survey in Belgium about the topic was conducted more than 15 years ago.

METHODS

A cross-sectional study design was used. Belgian adults (>17 years old) were recruited in the three regions of the country by means of non-probabilistic recruitment methods. Participants were invited to fill in a battery of questionnaires including demographic questions as well as questions about their LBP history and the LBP Beliefs Questionnaire (LBPBQ).

RESULTS

A total of 3724 individuals participated in the study. The LBPBQ scores indicated several LBP-related misbeliefs. About 15%-25% of participants still think that imaging tests can always identify the cause of pain and that bed rest is the mainstay of therapy. The majority of the participants think that "unnecessary" movements should be avoided when having LBP (58% of the respondents), and that they should "take it easy" until the pain goes away (69%). Most respondents also had maladaptive/wrong expectations, for example, a systematic worsening with time (65%) and a need for surgery in case of disc herniation (54%).

CONCLUSIONS

The present study suggests that in 2020 several LBP-related misbeliefs are still current in Belgium, particularly regarding the vulnerability of the spine. Therefore, further efforts to improve LBP-related beliefs/knowledge in the general population are necessary.

Do “Myths” of low back pain exist among young Indian college-going adults with a history of low back pain? A cross-sectional study

Background

Low back pain (LBP) is a prominent public health problem which causes disability around the globe. The prevalence of LBP is on the rise in lower to middle-income countries. India has a varied prevalence of LBP among the rural as well as urban population ranging from 6.2 to 92%. There has been a marked increase in young adults getting LBP with a proportion converting to chronic LBP later in life. Beliefs associated with any disorder affect the course, management, and need for imaging studies. Negative beliefs about LBP in any population may lead to unnecessary psychologic distress and an increase in disease burden. Focusing these negative beliefs on the younger population can help curb the chronicity and lessen the disability caused by it. This cross-sectional study explored the presence of myths in 516 college-going Indian young adults from Lovely Professional University.

Results

A total of 516 individuals participated in the study. The mean (SD) age of the participants was 22.69 years (2.417). Among them, 47.5% (245) were females and 52.5% (271) were males. The findings show that a high percentage of college-going young adults have false beliefs in most of the ten domains (myths) explored. The most prevalent myths were “LBP is caused by weak ‘core’ muscles and having a strong core protects against future LBP” (81.2%) and “LBP is caused by poor posture when sitting, standing, and lifting” with 80.6% agreeing to it.

Conclusion

Our study demonstrated that the myths of low back pain are widespread among the studied population. The findings suggest that community education programs must be developed to address these myths, hence reducing the disease burden associated with back pain.

Attitudes and beliefs of older adults with acute low back pain: 12-month results from the Brazilian cohort back complaints in the elders

BACKGROUND

Psychosocial factors have been identified as important predictors of onset, course and persistence of low back pain (LBP) in the general population.

OBJECTIVE

To identify factors associated with attitudes/beliefs in older adults with LBP throughout a 12-month follow-up.

METHODS

A longitudinal investigation was conducted with 500 participants aged ≥60 years reporting a new (acute) episode of nonspecific LBP. Data were obtained at baseline, 6-week, 3-, 6-, 9-, and 12-month interviews. The study variables were: [dependent] LBP-related attitudes/beliefs that were assessed by the Back Beliefs Questionnaire (BBQ); [independent] age; sex; LBP intensity 'at-the-present-time' of interview and 'over-the-past-week' before interview; LBP frequency; LBP-related treatments; disability; mobility; depressive symptoms; self-perceived recovery; expectation of pain improvement; and expectation for returning to activities. Data were analysed by multiple linear regression analysis.

RESULTS

At baseline, 85.7% of the participants were female, had mean age of 69.0 (6.3) years, mean BBQ score of 24.5 (6.5), and 79.6% reported pain complaints after an acute episode of LBP. After 12 months, participants maintained a mean BBQ score of 24.6 (6.6) and 63.3% still reported pain complaints after an acute episode of LBP at baseline. Multivariate analysis showed that disability, advancing age, poor expectation of pain improvement in 3 months, and mobility decline were significantly associated with worse BBQ scores during all follow-ups.

CONCLUSION

Ageing, hopelessness, and physical and functional impairment impact pain-related behaviours among older patients seeking healthcare due to acute LBP complaints. Their screening may assist in strategies to manage symptoms and prevent the persistence of pain.

The Hausa Back Beliefs Questionnaire: Translation, cross-cultural adaptation and psychometric assessment in mixed urban and rural Nigerian populations with chronic low back pain

INTRODUCTION

Negative attitudes and beliefs about low back pain (LBP) can lead to reduced function and activity and consequently disability. One self-report measure that can be used to assess these negative attitudes and beliefs and to determine their predictive nature is the Back Beliefs Questionnaire (BBQ). This study aimed to translate and cross-culturally adapt the BBQ into Hausa and assess its psychometric properties in mixed urban and rural Nigerian populations with chronic LBP.

METHODS

The BBQ was translated and cross-culturally adapted into Hausa (Hausa-BBQ) according to established guidelines. To assess psychometric properties, a consecutive sample of 200 patients with chronic LBP recruited from urban and rural clinics of Nigeria completed the questionnaire along with measures of fear-avoidance beliefs, pain catastrophizing, functional disability, physical and mental health, and pain. One hundred of the 200 patients completed the questionnaire twice at an interval of 7-14 days to assess test-retest reliability. Internal construct validity was assessed using exploratory factor analysis, and external construct validity was assessed by examining convergent, divergent, and known-groups validity. Reliability was assessed by calculating internal consistency (Cronbach's α), intraclass correlation coefficients (ICC), standard error of measurement (SEM), minimal detectable change at 95% confidence interval (MDC95), and limits of agreement using Bland-Altman plots. Reliability (ICC, SEM and MDC95) was also assessed separately for rural and urban subgroups.

RESULTS

The factor analysis revealed a four-factor solution explaining 58.9% of the total variance with the first factor explaining 27.1%. The nine scoring items loaded on the first factor hence supporting a unidimensional scale. The convergent and divergent validity were supported as 85% (6:7) of the predefined hypotheses were confirmed. Known-groups comparison showed that the questionnaire discriminated well for those who differed in education (p < 0.05), but not in age (p > 0.05). The internal consistency and ICC (α = 0.79; ICC = 0.91) were adequate, with minimal SEM and MDC95 (1.9 and 5.2, respectively). The limits of agreements were -5.11 to 5.71. The ICC, SEM and MDC95 for the urban and rural subgroups were comparable to those obtained for the overall population.

CONCLUSIONS

The Hausa-BBQ was successfully adapted and psychometrically sound in terms of internal and external construct validity, internal consistency, and test-retest reliability in mixed urban and rural Hausa-speaking populations with chronic LBP. The questionnaire can be used to detect and categorize specific attitudes and beliefs about back pain in Hausa culture to prevent or reduce potential disability due to LBP.

Managing low back pain in active adolescents

Adolescent low back pain has received limited research attention despite its potentially considerable impact on quality of life. The role of diagnostic triage to identify serious or specific pathology and/or order relevant investigations is considered. An overview of contemporary pain mechanisms is provided, with specific reference to the wide range of risk factors for persistent low back pain. Education and exercise framed within a biopsychosocial framework are the cornerstones of treatment. There is a lack of data on more comprehensive personalized treatment approaches among adolescents. One such approach - Cognitive Functional Therapy - which has shown promise in adults and active adolescents with low back pain, is described and illustrated using a case study. The most promising avenues, in practice and research, may be those that view adolescent low back pain as less of a local structural spinal issue and more of an indication of the general health of the adolescent.

Beliefs about back pain and pain management behaviours, and their associations in the general population: A systematic review

Previous mass media campaigns have aimed to influence how people manage back pain, with mixed success. Campaigns should target beliefs which are related to the behaviours they aim to change. This systematic review brings together research that has measured the prevalence of beliefs about back pain in the general population and factors associated with these beliefs, including future pain‐related outcomes. Five databases were searched up until April 2017. Quantitative studies which reported a measure of agreement with a belief about back pain, cross‐sectional associations, or associations between beliefs and future outcomes were eligible. Eligibility was assessed and data extracted independently by two authors. Results were tabulated and narratively synthesized. Nineteen studies from 10 countries were eligible (median study n [IQR] = 990.5 [524.75–2387.5]). Beliefs were measured using eight questionnaires and 57 stand‐alone items. Beliefs about back pain's negative consequences were common across countries and populations, whereas most samples did not hold fear‐avoidance beliefs. Beliefs about back pain's consequences were associated with pain and disability, but only one study investigated this specific relationship prospectively. No studies investigated whether beliefs are associated with future pain management behaviours. Agreement with certain beliefs (e.g. about negative consequences) was associated with sociodemographic characteristics (e.g. older age) and poorer self‐rated health. Interventions may benefit from targeting beliefs about the perceived negative consequences of back pain in these populations. However, future research should explore how beliefs prospectively influence the management of back pain.

Significance

This review brings together studies which have assessed the prevalence of beliefs about back pain, and factors associated with holding them. It highlights that whether or not these beliefs represent important determinants of how people manage pain remains unknown.

Facilitating patient participation in physiotherapy: Symptom-talk during exercise therapy from an Asian context

Background and purpose: Patient participation is the cornerstone for effective physiotherapy intervention. The aim was to analyze how patients and physiotherapists negotiate symptoms during exercise therapy and describe patients' participation during this process. Methods: Nineteen consultations with sixteen patients and six physiotherapists were video-recorded in two Hong Kong outpatient settings. Conversation Analysis was used to uncover interactional aspects of symptom-talk, focusing on turn-taking, sequence organization, and vocabulary. Results: Physiotherapists explored patients' symptoms only minimally and their frequent use of closed-ended questions allowed limited opportunity for participation. For patient-initiated symptom-talk, less than half elicited actions from physiotherapists, whose minimal acknowledgments were often accepted. Yet, some patients achieved a more substantial contribution through: (1) pausing the exercise-in-progress; (2) gazing at the physiotherapist; (3) pointing at the painful area; and (4) interrupting the physiotherapist, thereby challenging the social order. While discussion about symptoms was often initiated by physiotherapists, some patients participated actively by engaging in certain communicative strategies. Conclusions: Patient participation can be improved by physiotherapists offering a supportive environment (i.e., question design, responding to patients' initiations, and promoting health literacy), and by patients embracing action-engendering communicative strategies. The fine details of interaction shed light onto the subtleties of symptom-talk initiated by patients or physiotherapists in physiotherapy.

Knowledge, beliefs, and attitudes of the Quebec population toward chronic pain: Where are we now?

Background: Many chronic pain (CP) awareness and educational initiatives have been achieved, but it is time to take stock of where we are today.

Aims: The aim of this study was to describe and identify determinants of knowledge, beliefs, and attitudes of different subgroups of the Quebec population regarding CP and especially toward people suffering from this condition.

Methods: A web-based, cross-sectional study was conducted between May and June 2014.

Results: A total of 1958 participants responded, among whom 70.9% reported suffering from CP and 14.4% reported being a health care professional (HCP). Almost half of the participants were not aware that the risk of developing CP is increased after undergoing surgery or that CP affects approximately one in five adults. A minority (10.30%) agreed that HCP are well trained in CP treatment. The two most frequent negative beliefs were that people suffering from CP become dependent on their medications as do drug addicts (16.7%) and that consulting a psychologist is useless unless the person with CP is depressed (16.9%). Multiple regression analysis showed that being a woman, being born in Canada, being unemployed, suffering from CP, and being an HCP were predictors of better knowledge and more positive attitudes toward people suffering from CP (all P values < 0.05). Older age and residing in a remote region were associated with poorer knowledge and more negative attitudes.

Conclusions: Our results underline the importance of continuing the efforts and the need for more education programs, awareness campaigns, and stigma reduction activities about CP for HCP, patients, and the general public.

Understanding Adolescent Low Back Pain From a Multidimensional Perspective: Implications for Management

Synopsis Low back pain (LBP) is the leading cause of disability worldwide. It often begins in adolescence, setting a course for later in life. We have tracked the course of LBP in the Raine Study cohort from the age of 14 years into early adulthood. Our work has found that LBP is already prevalent in individuals at 14 years of age and increases throughout adolescence and into early adulthood. It is often comorbid with other musculoskeletal pain. For some adolescents, LBP has little impact; for others, its impact includes care seeking, taking medication, taking time off from school and work, as well as modifying physical and functional activity. Of concern is the increasing prevalence of LBP with impact across adolescence, reaching adult rates by 22 years of age. The predictors of disabling LBP in adolescence are multidimensional. They include female sex, negative back pain beliefs, poor mental health status, somatic complaints, involvement in sports, and altered stress responses. Genetics also plays a role. Ironically, the factors that we have historically thought to be important predictors of LBP, such as "poor" spinal posture, scoliosis, carrying school bags, joint hypermobility, and poor back muscle endurance, are not strong predictors. This challenges our clinical beliefs and highlights that adolescent LBP needs a flexible and targeted multidimensional approach to assessment and management. In most cases, we recommend a cognitive functional approach that challenges negative LBP beliefs, educates adolescents regarding factors associated with their LBP, restores functional capacity where it is impaired, and encourages healthy lifestyle habits. J Orthop Sports Phys Ther 2017;47(10):741-751. Epub 12 Sep 2017. doi:10.2519/jospt.2017.7376.