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  • Self-management of acute and chronic low back disorders

Self-management of acute and chronic low back disorders

Chronic low back pain is very common and costly in terms of personal impacts, disability, work loss and healthcare expenditure. National guidelines encourage ‘self-management', but a key challenge may arise when if patients and healthcare providers have different views and understandings of self-management. Therefore the Q-methodology was used to identify the viewpoints of patients and healthcare providers.

Project aims

Q-methodology consists of two parts; 1) a review of the relevant literature and series of discussion groups by patient and healthcare providers to gather accounts related to the topic, and 2) a card-sorting task called Q-sort to capture individual’s personal viewpoints. A total of 60 patients and 60 healthcare providers completed the Q-sort process. The analysis and interpretation of the data was carried out by a team of academic researchers, expert clinicians and patient representatives.

Four different viewpoints emerged:

  1. "I can change" - a strong psychological approach, needing a lifestyle/mind-set change. This was the largest viewpoint, expressed mainly by healthcare providers but also shared by some patients.
  2. "Some things can change"- a strong pragmatic approach guided by accurate information and practical strategies, shared mostly by patients and some healthcare providers.
  3. "Not sure what to / can change"- expressed mostly by patients and few healthcare providers, this concerns the uncertainty in medical diagnosis, with the need for ongoing access to healthcare resources and assistance.
  4. "The others need to change"- expressed only by patients, this concerns the social stigma and negative perception of low back pain being in a chronic condition, with reliance on health professionals to acknowledge and validate their problem.

Project impact

The study findings demonstrate a clear basis to provide better understanding of self-management and encourage effective partnership between patients and healthcare providers. This will help healthcare providers to develop a better approach to how self-management can be utilised with patients on individual basis.

The delivery of the participant-led knowledge translation conference and presenting the findings at local and national conferences have already shown positive impact from both patients and healthcare providers. The findings will add knowledge to the current evidence, which will contribute in future service development and patient education for better and effective management of chronic low back pain.

As part of the project, the research team organised a participant-led knowledge translation conference where all the research participants as well as the local patient and healthcare providers were invited to further discuss the main findings (patient’s and healthcare providers’ viewpoints on self-management in chronic low back pain). The event was structured to encourage the attendees to voice their thoughts during a mixed group discussions on the findings and how this can relate to each individuals (as a patient or a healthcare provider). The discussion and insightful feedback on the viewpoints have provided a strong face validity of the research team’s interpretation of the viewpoints. The attendees’ general feedback on the event was also strongly positive; the majority of the attendees expressed that having participated in a discussion where a mixture of patients and healthcare providers openly discussed the topic “outside their consultation setting” was very beneficial, informative, and educational to really understand the standpoint of the two groups

Research team

Dr Carol McCrum (Consultant in physiotherapy, East Sussex Healthcare NHS Trust, Eastbourne)

Professor Ann Moore (University of Brighton)

Professor Paul Stenner (Professor of Social Psychology, The Open University, Milton Keynes)

Dr Vinette Cross (Senior Research Fellow, University of Brighton)

Dr Janet McGowan (Consultant in pain Management, East Sussex Healthcare NHS Trust, Eastbourne)

Mr Emmanuel Defever (Research Officer, University of Brighton)

Mr Phil Lloyd (Service user)

Mr Robert Poole (Service user)

Output

NIHR Research for Patient Benefit programme final report form (PDF)

Abstract poster (PDF)

Welcome slide from Conference (PDF)

Summary slide (PDF)

Peer reviewed publications (in submission)

  • Stenner, P., Cross, V., McCrum, C.A., McGowan, J.F., Defever, E., Lloyd, P., Poole, R. & Moore, A.P. Patient and healthcare provider viewpoints on the concepts of self-management in the context of chronic low back pain. Social Science & Medicine (Open Access). Submitted.

Poster presentations:

  • McCrum, C.A., McGowan, J.F., Stenner, P., Cross, V. Defever, E., Lloyd, P., Poole, R. & Moore, A.P. Exploring the viewpoints of health professionals and patients on self-management in chronic low back pain: A Q-methodology study. University of Brighton Research Poster Competition (Brighton, February 2014.
  • McCrum, C.A., McGowan, J.F., Stenner, P., Cross, V. Defever, E., Lloyd, P., Poole, R. & Moore, A.P. Exploring the viewpoints of health professionals and patients on self-management in chronic low back pain: A Q-methodology study. East Sussex Healthcare NHS Trust Inaugural Scientific Meeting (Eastbourne, April 2014) *Awarded for best oral presentation.
  • McCrum, C.A., McGowan, J.F., Stenner, P., Cross, V. Defever, E., Lloyd, P., Poole, R. & Moore, A.P. Exploring the perspectives of health professionals and patients on self-management in chronic low back pain: A Q-methodology study. British Pain Society Annual Scientific Meeting (Manchester, May 2014) *Shortlisted for best presented poster award.

In addition, dissemination will also include:

Conference presentations:

  • McCrum, C.A., McGowan, J.F., Stenner, P., Cross, V. Defever, E., Lloyd, P., Poole, R. & Moore, A.P. Changing myself” vs “Others must change”: Q-methodology study exploring viewpoints of self-management in chronic low back pain. Will be presented at Physiotherapy UK (Birmingham, 10th October 2014)
  • Workshop to the Pain Society, 24th November 2014, in London.

Abstract being submitted to the World Confederation of Physical Therapy, 1-4 May 2015, in Singapore.

Funding

NIHR, Research for Patient Benefit (RfPB): £207,500

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