A validity-driven approach to the understanding of the personal and societal burden of low back pain: development of a conceptual and measurement model

Buchbinder, Rachelle; Batterham, Roy; Elsworth, Gerald; Dionne, Clermont E; Irvin, Emma; Osborne, Richard H

doi:10.1186/ar3468

Table 2 Clusters, subclusters and representative statements

From: A validity-driven approach to the understanding of the personal and societal burden of low back pain: development of a conceptual and measurement model

Clusters and subclusters	Representative statements
Psychosocial
Loss
Loss of expectations	Limitations on fulfillment of goals in life
Loss of enjoyment	Loss of enjoyment in life
Loss of self-confidence	Low self-esteem, especially from loss of roles
	Feel helpless when people stop you doing things
Negative affect	Irritation, anger and frustration
Worry and negative beliefs about the future	Worry about the future
	Fear that severe back pain will occur again
Global malaise
Secondary health effects	Difficult to address other health issues
	May lead to weight gain
Effort of life/daily grind	Tiredness
	Makes you feel old
	Loss of motivation in life
Executive challenge	Always having to think about what you can and cannot do
Domestic psychosocial challenges
Loss of family and intimate involvement	Left out of family activities
	Difficulty caring for others
Loss of independence	Need to ask for help to do things
Negative reactions^a
Challenged integrity/feeling believed	May be seen as a malingerer
	Wrongly considered lazy by others
Self-worth degraded by how you feel others see you	Always trying to hide pain from family so they do not worry
	Feel like a burden on workmates
Negative/discriminatory actions by others	Bullied by others
	May lose friends
Physical
Functioning outside the home	Makes it hard to travel
	Leisure activities are limited
Specific physical limitations	Daily living is hard including basic self-care
	Difficulty lifting things
	Hard to sit
General physical impact	More and more physically unfit
	Fall easily
Treatment
Treatment services
Frustration of treatment (quality)	Waste time and money on dubious treatments and practitioners
	Unnecessary surgery and the problems this causes
Frustration with healthcare providers	Doctors not understanding there is anything wrong with you
	Back pain can make you distrust the medical profession
Condition burden
Impact on others^b	Need help from carers
Medication	Dependent on more and more medication
	Side-effects
Financial costs/expenses	Costs of treatment and equipment (necessary and unnecessary)
Employment
Challenges when out of work	Difficult to get back to paid employment
	Reduced employment options, now and for the future
Challenges when working^c	Many limitations on what tasks can be done
Effects of employment challenges	Difficult to get health insurance
	Reduced income resulting in poverty

^aSee also Employment. ^bSee also Challenges when working, Psychosocial. ^cSee also Impact on others.

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