People with low back pain perceive needs for non-biomedical services in workplace, financial, social and household domains: a systematic review

Louisa Chou, Flavia M Cicuttini, Donna M Urquhart, Shane N Anthony, Kaye Sullivan, Maheeka Seneviwickrama, Andrew M Briggs, Anita E Wluka
2018 Journal of Physiotherapy  
Introduction Low back pain (LBP) is the leading cause of disability worldwide 1 and affects approximately 80% of the adult population at some point in their lives, as well as one in five younger people. 2 It impacts many aspects of life and is associated with limitations in: activity and participation; psychosocial distress; workplace absenteeism and presenteeism; and community engagement. 3-5 LBP also disrupts a person's wellbeing and sense of self. 4-7 There is often a significant impact on
more » ... individual's participation, with people with LBP in various societies reporting difficulties maintaining employment [8] [9] [10] [11] or difficulty in participating in important community activities. 12 These impacts are reflected in the staggering indirect costs due to loss of employment amounting to an estimated AUD 2.9 billion lost in annual gross domestic product. 13 With unemployment and costs of required healthcare, this adds to patients' financial insecurities and concerns, 8,14,15 often exacerbating their pain experience. Historically, a biomedical model for LBP aetiology and management has been adopted and promoted based on the assumption of a linear relationship between pathology (usually structural pathology) and the experience of pain. However, a biomedical approach alone does not adequately explain the experience of persistent pain for most people, is costly (AUD 1 billion indirect costs annually) 16 and is not associated with positive outcomes for the majority of patients. 17 Although there is high utilisation of biomedically oriented care, people with LBP continue to experience pain, disability and dissatisfaction 7,15,18 and the prevalence and impacts of LBP continue to rise, suggesting the need for a paradigm shift. 19 LBP, particularly chronic non-specific LBP, is often a complex experience that is affected by multiple, interacting domains Journal of Physiotherapy 64 (2018) 74-83 K E Y W O R D S Low back pain Systematic review Patients Health services needs Health services demand A B S T R A C T Question: What needs of non-biomedical services are perceived by people with low back pain? Design: Systematic review of qualitative and quantitative studies examining perceived needs of non-biomedical services for low back pain, identified through searching of MEDLINE, EMBASE, CINAHL and PsycINFO (1990 to 2016). Participants: Adults with low back pain of any duration. Data extraction and analysis: Descriptive data regarding study design and methodology were extracted. The preferences, expectations and satisfaction with non-biomedical services reported by people with low back pain were identified and categorised within areas of perceived need. Results: Twenty studies (19 qualitative and one quantitative) involving 522 unique participants (total pool of 590) were included in this systematic review. Four areas emerged. Workplace: people with low back pain experience pressure to return to work despite difficulties with the demands of their occupation. They want their employers to be informed about low back pain and they desire workplace accommodations. Financial: people with low back pain want financial support, but have concerns about the inefficiencies of compensation systems and the stigma associated with financial remuneration. Social: people with low back pain report feeling disconnected from social networks and want back-specific social support. Household: people with low back pain report difficulties with household duties; however, there are few data regarding their need for auxiliary devices and domestic help. Conclusion: People with low back pain identified work place, financial and social pressures, and difficulties with household duties as areas of need beyond their healthcare requirements that affect their ability to comply with management of their condition. Consideration of such needs may inform physiotherapists, the wider health system, social networks and the workplace to provide more relevant and effective services. [Chou L, Cicuttini FM, Urquhart DM, Anthony SN, Sullivan K, Seneviwickrama M, Briggs AM, Wluka AE (2018) People with low back pain perceive needs for nonbiomedical services in workplace, financial, social and household domains: a systematic review. Journal of Physiotherapy 64: [74][75][76][77][78][79][80][81][82][83]
doi:10.1016/j.jphys.2018.02.011 pmid:29574167 fatcat:7tj3itrrhzftnloix6xmweu4wi