Factors Associated with Disability Level Among Adult Patients with Low Back Pain

Gao Linfeng; Sulaiman Delrizal; Dewi Asih

doi:10.61919/q9hj9x35

Authors

Gao Linfeng Universitas Prima Indonesia Author
Sulaiman Delrizal Universitas Prima Indonesia Author
Dewi Asih Universitas Prima Indonesia Author

DOI:

https://doi.org/10.61919/q9hj9x35

Keywords:

low back pain, disability, qualitative research, biopsychosocial factors

Abstract

Background: Low back pain can restrict functioning through interacting symptoms, beliefs, and contextual demands. Qualitative inquiry can clarify how these influences are experienced. Objective: To explore perceived influences on disability and how they interact to restrict or support everyday functioning among adults with persistent low back pain. Methods: An interpretive qualitative study used purposive maximum-variation sampling to include 18 adults aged 25–66 years. Individual semi-structured interviews explored symptoms, movement, sleep, work, family roles, healthcare, and self-management. Oswestry Disability Index scores informed lower-, moderate-, and higher-disability sampling profiles. Interview material underwent reflexive thematic analysis, including examination of contrasting accounts and author review of interpretations. Results: Participants comprised 10 women and eight men; five had lower, seven moderate, and six higher disability profiles. Five themes were developed: Living with Unpredictable Pain; Fear, Threat, and Shrinking Activity; Caught Between Recovery and Livelihood; Support, Dependence, and Identity; and Clinical Explanations, Confidence, and Control. Accounts connected restrictions with anticipated flares, perceived damage, poor sleep, work and financial pressures, and changing family roles. Contrasting accounts described participation alongside pain when movement felt manageable and support preserved involvement. Conclusion: Disability was experienced within the interaction of symptoms, interpretations, relationships, and practical circumstances. Assessment and rehabilitation should consider barriers to meaningful participation alongside pain. Keywords: low back pain; disability; qualitative research; biopsychosocial factors; fear avoidance; self-efficacy; occupational health.

References

1. GBD 2021 Low Back Pain Collaborators. Global, regional, and national burden of low back pain, 1990-2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol. 2023;5(6):e316-e329. doi:10.1016/S2665-9913(23)00098-X.

2. World Health Organization. WHO guideline for non-surgical management of chronic primary low back pain in adults in primary and community care settings. Geneva: World Health Organization; 2023.

3. George SZ, Fritz JM, Silfies SP, Schneider MJ, Beneciuk JM, Lentz TA, et al. Interventions for the management of acute and chronic low back pain: revision 2021. J Orthop Sports Phys Ther. 2021;51(11):CPG1-CPG60. doi:10.2519/jospt.2021.0304.

4. Otero-Ketterer E, Peñacoba-Puente C, Pinheiro-Araujo CF, Valera-Calero JA, Ortega-Santiago R. Biopsychosocial factors for chronicity in individuals with non-specific low back pain: an umbrella review. Int J Environ Res Public Health. 2022;19(16):10145. doi:10.3390/ijerph191610145.

5. Alhowimel AS, Alotaibi MA, Alenazi AM, Alqahtani BA, Alshehri MA, Alamam D, et al. Psychosocial predictors of pain and disability outcomes in people with chronic low back pain treated conservatively by guideline-based intervention: a systematic review. J Multidiscip Healthc. 2021;14:3549-3559. doi:10.2147/JMDH.S343494.

6. Wong JJ, Tricco AC, Côté P, Liang CY, Lewis JA, Bouck Z, et al. Association between depressive symptoms or depression and health outcomes for low back pain: a systematic review and meta-analysis. J Gen Intern Med. 2022;37(5):1233-1246. doi:10.1007/s11606-021-07079-8.

7. Alamam DM, Leaver A, Alsobayel HI, Moloney N, Lin J, Mackey MG. Low back pain-related disability is associated with pain-related beliefs across divergent non-English-speaking populations: systematic review and meta-analysis. Pain Med. 2021;22(12):2974-2989. doi:10.1093/pm/pnaa430.

8. Chang JR, Wang X, Lin G, Samartzis D, Pinto SM, Wong AYL. Are changes in sleep quality/quantity or baseline sleep parameters related to changes in clinical outcomes in patients with nonspecific chronic low back pain? A systematic review. Clin J Pain. 2022;38(4):292-307. doi:10.1097/AJP.0000000000001008.

9. Karran EL, Fryer CE, Middleton JW, Moseley GL. Exploring the social determinants of health outcomes for adults with low back pain or spinal cord injury and persistent pain: a mixed methods study. J Pain. 2022;23(9):1461-1479. doi:10.1016/j.jpain.2022.04.001.

10. Pottkotter K, Hazlett M, Mansfield CJ, Rethman K, Fritz JM, Quatman-Yates CC, et al. Understanding social determinants of health and physical therapy outcomes in patients with low back pain: a scoping review. Musculoskeletal Care. 2024;22(2):e1888. doi:10.1002/msc.1888.

11. Feldman DE, Nahin RL. Disability among persons with chronic severe back pain: results from a nationally representative population-based sample. J Pain. 2022;23(12):2144-2154. doi:10.1016/j.jpain.2022.07.016.

12. Caeiro C, Moore A, Price L. Clinical encounters may not be responding to patients' search for meaning and control over non-specific chronic low back pain: an interpretative phenomenological analysis. Disabil Rehabil. 2022;44(22):6593-6607. doi:10.1080/09638288.2021.1966679.

13. Kahere M, Hlongwana K, Ginindza T. Exploring patients' lived experience of the barriers to accessing low back pain health services. Afr J Prim Health Care Fam Med. 2022;14(1):e1-e10. doi:10.4102/phcfm.v14i1.3523.

14. Bonfim IDS, Corrêa LA, Nogueira LAC, Meziat-Filho N, Reis FJJ, de Almeida RS. 'Your spine is so worn out' - the influence of clinical diagnosis on beliefs in patients with non-specific chronic low back pain - a qualitative study. Braz J Phys Ther. 2021;25(6):811-818. doi:10.1016/j.bjpt.2021.07.001.

15. Maier CDR, de Avila CS, de Souza J, Meziat-Filho N, Koerich MHAL. Posture and pain: beliefs and attitudes of patients with chronic low back pain. Musculoskeletal Care. 2024;22(4):e70016. doi:10.1002/msc.70016.

16. Rizzo RRN, Wand BM, Leake HB, O'Hagan ET, Traeger AC, Gustin SM, et al. Why might fears and worries persist after a pain education-grounded multimodal intervention for chronic back pain? A qualitative study. Pain Rep. 2024;9(6):e1197. doi:10.1097/PR9.0000000000001197.

17. Ali M, Peiris CL, Ford JJ, Hossain A, Hahne AJ. Perceptions of low back pain and the role of physiotherapy in Bangladesh: a qualitative study. Musculoskeletal Care. 2025;23(3):e70159. doi:10.1002/msc.70159.

18. Kurz R, Hebron C. Finding a new normal: the lived experience of persons' journey towards coping with persistent low back pain. Physiother Theory Pract. 2024;40(5):983-998. doi:10.1080/09593985.2022.2144782.

19. Cheung CKC, Cheung ETC, Schoeb V, Opsommer E, Chong DYK, Lee JLC, et al. Lived experiences of older adults with chronic low back pain and implications on their daily life: a metasynthesis of qualitative research. Arch Rehabil Res Clin Transl. 2025;7(2):100456. doi:10.1016/j.arrct.2025.100456.

20. Kent P, Haines T, O'Sullivan P, Smith A, Campbell A, Schutze R, et al. Cognitive functional therapy with or without movement sensor biofeedback versus usual care for chronic, disabling low back pain (RESTORE): a randomised, controlled, three-arm, parallel group, phase 3, clinical trial. Lancet. 2023;401(10391):1866-1877. doi:10.1016/S0140-6736(23)00441-5.

21. Fairbank JC, Pynsent PB. The Oswestry Disability Index. Spine (Phila Pa 1976). 2000;25(22):2940-2952; discussion 2952. doi:10.1097/00007632-200011150-00017.

22. Saunders CH, Sierpe A, von Plessen C, Kennedy AM, Leviton LC, Bernstein SL, et al. Practical thematic analysis: a guide for multidisciplinary health services research teams engaging in qualitative analysis. BMJ. 2023;381:e074256. doi:10.1136/bmj-2022-074256.

23. Braun V, Clarke V. Supporting best practice in reflexive thematic analysis reporting in Palliative Medicine: a review of published research and introduction to the Reflexive Thematic Analysis Reporting Guidelines (RTARG). Palliat Med. 2024;38(6):608-616. doi:10.1177/02692163241234800.

24. Yang J, Lo WLA, Zheng F, Cheng X, Yu Q, Wang C. Evaluation of cognitive behavioral therapy on improving pain, fear avoidance, and self-efficacy in patients with chronic low back pain: a systematic review and meta-analysis. Pain Res Manag. 2022;2022:4276175. doi:10.1155/2022/4276175.

25. Sidiq M, Muzaffar T, Janakiraman B, Masoodi S, Vasanthi RK, Ramachandran A, et al. Effects of pain education on disability, pain, quality of life, and self-efficacy in chronic low back pain: a randomized controlled trial. PLoS One. 2024;19(5):e0294302. doi:10.1371/journal.pone.0294302.

26. Gomes LA, Rodrigues AM, van der Windt D, Pires D, Afreixo V, Canhão H, et al. Minimal intervention of patient education for low back pain: a systematic review with meta-analysis. J Orthop Sports Phys Ther. 2024;54(2):107-119. doi:10.2519/jospt.2023.11865.

27. Shin S, Kim H. Carryover effects of pain neuroscience education on patients with chronic lower back pain: a systematic review and meta-analysis. Medicina (Kaunas). 2023;59(7):1268. doi:10.3390/medicina59071268.

28. Ma X, Chen R, Li W, Huang P. A systematic review and meta-analysis of pain neuroscience education for chronic low back pain: short-term outcomes of pain and disability. Physiother Theory Pract. 2024;40(9):2130-2149. doi:10.1080/09593985.2023.2232003.

29. Fleckenstein J, Floessel P, Engel T, Krempel L, Stoll J, Behrens M, et al. Individualized exercise in chronic non-specific low back pain: a systematic review with meta-analysis on the effects of exercise alone or in combination with psychological interventions on pain and disability. J Pain. 2022;23(11):1856-1873. doi:10.1016/j.jpain.2022.07.005.

30. Prat-Luri A, de Los Rios-Calonge J, Moreno-Navarro P, Manresa-Rocamora A, Vera-Garcia FJ, Barbado D. Effect of trunk-focused exercises on pain, disability, quality of life, and trunk physical fitness in low back pain and how potential effect modifiers modulate their effects: a systematic review with meta-analyses. J Orthop Sports Phys Ther. 2023;53(2):64-93. doi:10.2519/jospt.2023.11091.

31. Hochheim M, Ramm P, Amelung V. The effectiveness of low-dosed outpatient biopsychosocial interventions compared to active physical interventions on pain and disability in adults with nonspecific chronic low back pain: a systematic review with meta-analysis. Pain Pract. 2023;23(4):409-436. doi:10.1111/papr.13198.