Clinicians’ views on factors that trigger a sudden onset of low back pain

Abstract

Purpose Little is known about what triggers an episode of low back pain (LBP) in those presenting to primary care. Previous studies of risk factors have focused on specific occupational settings and work conditions. No study has asked primary care clinicians to consider what triggers an episode of sudden-onset LBP in patients presenting to them for care. The purpose of this study, therefore, was to describe the short-and long-term factors that primary care clinicians consider important in triggering a sudden episode of acute LBP. Methods One hundred and thirty-one primary care clinicians who were recruiting patients with LBP to a large observational study were invited to participate. A questionnaire was designed to obtain information about the clinician's characteristics, profession and clinical experience. We also asked clinicians to nominate the five shortand five long-term exposure factors, most likely to trigger a sudden episode of acute LBP, based on their experience. Descriptive statistics and frequency distributions were used to describe clinician's characteristics and the frequencies of the main risk factor categories were reported. Results Based on the views of 103 primary care clinicians, biomechanical risk factors appear to be the most important short-term triggers (endorsed by 89.3 % of clinicians) and long-term triggers (endorsed by 54.2 % of clinicians) for a sudden episode of acute LBP. Individual risk factors were endorsed by 39 % of clinicians as important long-term triggers, while only 6.4 % of clinicians considered them important short-term triggers. Other risk factors, such as psychological/psychosocial and genetic factors, were not commonly endorsed as risk factors for an episode of LBP by primary care clinicians. Conclusions This study shows that primary care clinicians believe that biomechanical risk factors are the most important short-term triggers, while biomechanical and individual risk factors are the most important long-term triggers for a sudden onset of LBP. However, other risk factors, such as psychological/psychosocial and genetic, were not commonly endorsed as risk factors for an episode of LBP by primary care clinicians. Results of this study are based on primary care clinicians' views and further investigation is needed to test the validity of these suggested risk factors.

Individuals’ explanations for their persistent or recurrent low back pain: a cross-sectional survey

“…Parsons, Harding, Breen, Foster, Tamar, Vogel and Underwood [ 26 ] reviewed 22 qualitative studies concluding that physician’s beliefs about painful musculoskeletal conditions were primarily biomedical and, in a cross-sectional study of 453 musculoskeletal physiotherapists, Bishop and Foster [ 27 ] highlighted that while these clinicians often recognised the importance of psychosocial factors they contradicted evidence based best practice guidelines by frequently highlighting biomedical over psychosocial factors of LBP cases. Observational studies show clinicians and patients consider risk factors for a sudden onset of LBP to be mainly biomechanical and rarely endorse psychosocial risk factors [ 28 , 29 ]. Little research has considered why these beliefs and practices persist regarding LBP despite evidence this view is outdated and inaccurate.…”

Analysis of epidemiology, lifestyle, and psychosocial factors in patients with back pain admitted to an orthopedic emergency unit

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The evolving role of physical therapists in the long-term management of chronic low back pain: longitudinal care using assisted self-management strategies

“…During this time the patient and PT work closely to determine if the patient’s goals, attitudes, and beliefs are consistent with self-management 107 , 108 . The emphasis of the treatment approach is focused upon the long-term management of symptoms through positive ideation of pain, reduction of modifiable triggers (Table 2) 109 and maximization of loading tolerance using patient-preferred physical activities (Figure 1). If successful, this approach dovetails with the “healthy lifestyle” approach that has had positive effects on many other conditions 24 and will become an important selling point to all stakeholders.…”