Clinicians' views about the experience of disability due to low back pain. Results from a focus group study.

PURPOSE: For clinicians, treating the cause of non-pathological low back pain (LBP) is central. For patients, it is how LBP limits their activities of daily living. Little is known about clinicians' understanding of disability and the patient's perspective. We conducted a qualitative study to examine how clinicians involved in the care of patients with BP describe and define disability, its associated changes, and rehabilitation.

METHODS

Two focus groups (FGs) were conducted with spine specialists including eleven confirmed orthopedic surgeons and neurosurgeons, ten advanced residents, and five other clinicians. Participants were questioned about their views on disability, what it means to them and to the patients. Responses were collected by two independent observers using Metaplan techniques. Large stickers were used to collect participants' responses/ideas; the stickers were posted on billboards so the FGs could check them during the discussion. Metaplan was used to aggregate responses.

RESULTS

Disability was viewed as a major source of physical limitations, difficulties in performing daily activities, associated with emotional distress, and raising legitimacy issues. Changes in roles engaged the social component. Considered from the patients' perspective, negative emotions and social issues were emphasized, along with the patients' resources. For rehabilitation, the participants emphasized patient-centered care, teamwork, and objectives for care.

CONCLUSION

The participants pointed to disability as an umbrella term for impairments, activity limitations, and participation restrictions. They underlined the necessity for clinicians to help patients define their level of optimal functioning when faced with BP, utilizing adaptation and teamwork within the therapeutic relationship.