Contextualizing the lived experiences of patients with low back pain from different countries according to the ICF framework

Ellen Aartun, Iben Axén, Silvano Mior, Yngve Røe, Maria Hondras, Lise Kretz, Pierre Côté, Ellen Aartun, Iben Axén, Silvano Mior, Yngve Røe, Maria Hondras, Lise Kretz, Pierre Côté

Abstract

Objective: To explore perspectives, including social and psychological aspects, of patients seeking manual care for low back pain, in order to understand constructs of functioning that are important across different cultural contexts. The International Classification of Functioning, Disability and Health (ICF) emphasizes the importance of these aspects to describe health-related functioning.

Design: Focus group interviews.

Patients: Patients from Botswana, Canada and Norway seeking manual care for their low back pain.

Methods: Interviews were conducted in the 3 countries, transcribed verbatim, translated into English, and linked to the ICF according to established rules.

Results: Seven focus groups yielded 1,863 meaningful concepts that were linked to ICF categories. The largest proportion of responses linked to the Activities and Participation domain. The most frequently mentioned chapters related to pain and its mental aspects, suggesting that the psychological impact of living with low back pain is important to patients.

Conclusion: Despite cultural differences, patients seeking manual care for low back pain in Botswana, Canada and Norway reported similar experiences of disability across ICF domains. The relatively high ranking of psychosocial factors highlights their importance for patients, in addition to factors of biological origin, and indicates that the contextual nature of the lived experience of low back pain may not be covered in standard examinations used in manual medicine.

Keywords: International Classification of Functioning Disability and Health; disability; health manual therapy; low back pain.

Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Fig. 1
Fig. 1
Components of the International Classification of Function, Disability and Health (ICF) model.

References

    1. Hoy DG, Smith E, Cross M, Sanchez–Riera L, Buchbinder R, Blyth FM, et al. . The global burden of musculoskeletal conditions for 2010: an overview of methods. Ann Rheum Dis 2014; 73: 982–989.
    1. Hartvigsen J, Hancock MJ, Kongsted A, Louw Q, Ferreira ML, Genevay S, et al. . What low back pain is and why we need to pay attention. Lancet 2018; 391: 2356–2367.
    1. Froud R, Patterson S, Eldridge S, Seale C, Pincus T, Rajendran D, et al. . A systematic review and meta-synthesis of the impact of low back pain on people’s lives. BMC Musculoskelet Disord 2014; 15: 50.
    1. Liddle SD, Baxter GD, Gracey JH. Chronic low back pain: patients’ experiences, opinions and expectations for clinical management. Disabil Rehabil 2007; 29: 1899–1909.
    1. Esson SA, Cote P, Weaver R, Aartun E, Mior S. “I stay in bed, sometimes all day.” A qualitative study exploring lived experiences of persons with disabling low back pain. J Can Chiropr Assoc 2020; 64: 16–31.
    1. Toye F, Seers K, Hannink E, Barker K. A mega-ethnography of eleven qualitative evidence syntheses exploring the experience of living with chronic non-malignant pain. BMC Med Res Methodol 2017; 17: 116.
    1. Beliveau PJH, Wong JJ, Sutton DA, Simon NB, Bussieres AE, Mior SA, et al. . The chiropractic profession: a scoping review of utilization rates, reasons for seeking care, patient profiles, and care provided. Chiropr Man Therap 2017; 25: 35.
    1. Pulles A, Koke AJA, Strackke RP, Smeets R. The responsiveness and interpretability of psychosocial patient-reported outcome measures in chronic musculoskeletal pain rehabilitation. Eur J Pain 2020; 24: 134–144.
    1. Nicol R, Yu H, Selb M, Prodinger B, Hartvigsen J, Côté P. How Does the Measurement of Disability in Low Back Pain Map Unto the International Classification of Functioning, Disability and Health?: A Scoping Review of the Manual Medicine Literature. Am J Phys Med Rehabil 2021: 1; 100: 367–395.
    1. Ustun TB, Chatterji S, Bickenbach J, Kostanjsek N, Schneider M. The International Classification of Functioning, Disability and Health: a new tool for understanding disability and health. Disabil Rehabil 2003; 25: 565–71.
    1. Selb M, Kohler F, Robinson Nicol MM, Riberto M, Stucki G, Kennedy C, et al. . ICD-11: a comprehensive picture of health, an update on the ICD-ICF joint use initiative. J Rehabil Med 2015; 47: 2–8.
    1. World Health Organization (WHO) . International classification of functioning, disability and health 2001. Geneva: WHO. 2001, May 22.
    1. Geyh S, Schwegler U, Peter C, Muller R. Representing and organizing information to describe the lived experience of health from a personal factors perspective in the light of the International Classification of Functioning, Disability and Health (ICF): a discussion paper. Disabil Rehabil 2019; 41: 1727–1738.
    1. Stucki G, Cieza A, Ewert T, Kostanjsek N, Chatterji S, Ustun TB. Application of the International Classification of Functioning, Disability and Health (ICF) in clinical practice. Disabil Rehabil 2002; 24: 281–282.
    1. Cieza A, Ewert T, Ustun TB, Chatterji S, Kostanjsek N, Stucki G. Development of ICF Core Sets for patients with chronic conditions. J Rehabil Med 2004. (44 Suppl): 9–11.
    1. Verbeek J, Sengers MJ, Riemens L, Haafkens J. Patient expectations of treatment for back pain: a systematic review of qualitative and quantitative studies. Spine 2004; 29: 2309–2318.
    1. Ferreira ML, Machado G, Latimer J, Maher C, Ferreira PH, Smeets RJ. Factors defining care-seeking in low back pain – a meta-analysis of population based surveys. Eur J Pain 2010; 14: 747 e1–e7.
    1. Hestbaek L, Munck A, Hartvigsen L, Jarbol DE, Sondergaard J, Kongsted A. Low back pain in primary care: a description of 1250 patients with low back pain in danish general and chiropractic practice. Int J Family Med 2014; 2014: 106102.
    1. Central Statistics Office . Botswana population and housing census. Gaborone, 2011.
    1. Cieza A, Oberhauser C, Bickenbach J, Jones RN, Ustun TB, Kostanjsek N, et al. . Health is not just the absence of disease. Int J Epidemiol 2016; 45: 586–587.
    1. Cieza A, Geyh S, Chatterji S, Kostanjsek N, Ustun B, Stucki G. ICF linking rules: an update based on lessons learned. J Rehabil Med 2005; 37: 212–218.
    1. World Health Organization (WHO) . ICF e-learning. [Assessed 2018 Sep 17] Available from: .
    1. McHugh ML. Interrater reliability: the kappa statistic. Biochem Med (Zagreb) 2012; 22: 276–282.
    1. Wong JJ, Cote P, Tricco AC, Rosella LC. Examining the effects of low back pain and mental health symptoms on healthcare utilisation and costs: a protocol for a population-based cohort study. BMJ Open 2019; 9: e031749.
    1. Hondras M, Hartvigsen J, Myburgh C, Johannessen H. Everyday burden of musculoskeletal conditions among villagers in rural Botswana: a focused ethnography. J Rehabil Med 2016; 48: 449–455.
    1. MacNeela P, Doyle C, O’Gorman D, Ruane N, McGuire BE. Experiences of chronic low back pain: a meta-ethnography of qualitative research. Health Psychol Rev 2015; 9: 63–82.
    1. Singh G, Newton C, O’Sullivan K, Soundy A, Heneghan NR. Exploring the lived experience and chronic low back pain beliefs of English-speaking Punjabi and white British people: a qualitative study within the NHS. BMJ Open 2018; 8: e020108.
    1. Lim YZ, Chou L, Au RTM, Seneviwickrama KLMD, Cicuttini FM, Briggs AM, et al. . People with low back pain want clear, consistent and personalised information on prognosis, treatment options and self-management strategies: a systematic review. J Physiother 2019; 65: 124–135.
    1. Bailly F, Foltz V, Rozenberg S, Fautrel B, Gossec L. The impact of chronic low back pain is partly related to loss of social role: a qualitative study. Joint Bone Spine 2015; 82: 437–441.
    1. Henschke N, Lorenz E, Pokora R, Michaleff ZA, Quartey JNA, Oliveira VC. Understanding cultural influences on back pain and back pain research. Best Pract Res Cl Rh 2016; 30: 1037–1049.
    1. Orhan C, Van Looveren E, Cagnie B, Mukhtar NB, Lenoir D, Meeus M. are pain beliefs, cognitions, and behaviors influenced by race, ethnicity, and culture in patients with chronic musculoskeletal pain: a systematic review. Pain Physician 2018; 21: 541–558.
    1. Cieza A, Hilfiker R, Chatterji S, Kostanjsek N, Ustun BT, Stucki G. The International Classification of Functioning, Disability, and Health could be used to measure functioning. J Clin Epidemiol 2009; 62: 899–911.
    1. Roe C, Bautz-Holter E, Cieza A. Low back pain in 17 countries, a Rasch analysis of the ICF core set for low back pain. Int J Rehabil Res 2013; 36: 38–47.
    1. Mullis R, Barber J, Lewis M, Hay E. ICF core sets for low back pain: do they include what matters to patients? J Rehabil Med 2007; 39: 353–357.
    1. Bagraith KS, Hayes J, Strong J. Mapping patient goals to the International Classification of Functioning, Disability and Health (ICF): examining the content validity of the low back pain Core Sets. J Rehabil Med 2013; 45: 481–487.
    1. Lygren H, Strand LI, Anderson B, Magnussen LH. Do ICF core sets for low back pain include patients’ self-reported activity limitations because of back problems? Physiother Res Int 2014; 19: 99–107.
    1. Geyh S, Peter C, Muller R, Bickenbach JE, Kostanjsek N, Ustun BT, et al. . The Personal Factors of the International Classification of Functioning, Disability and Health in the literature – a systematic review and content analysis. Disabil Rehabil 2011; 33: 1089–1102.
    1. Ibsen C, Schiottz-Christensen B, Melchiorsen H, Nielsen CV, Maribo T. Do Patient-reported outcome measures describe functioning in patients with low back pain, using the Brief International Classification of Functioning, Disability and Health Core Set as a reference? J Rehabil Med 2016; 48: 618–624.
    1. Cieza A, Geyh S, Chatterji S, Kostanjsek N, Ustun BT, Stucki G. Identification of candidate categories of the International Classification of Functioning Disability and Health (ICF) for a Generic ICF Core Set based on regression modelling. BMC Med Res Methodol 2006; 6: 36.
    1. Ferreira ML, de Luca K. Spinal pain and its impact on older people. Best Pract Res Cl Rh 2017; 31: 192–202.

Source: PubMed

Sponsors and Collaborators

Medical Conditions

Drug Interventions

3
Subscribe