Low back pain beliefs are associated to age, location of work, education and pain-related disability in Chinese healthcare professionals working in China: a cross sectional survey

Abstract

BackgroundLow back pain (LBP) is the leading cause of disability worldwide. Evidence pointing towards a more efficacious model of care using a biopsychosocial approach for LBP management highlights the need to understand the pain-related beliefs of patients and those who treat them. The beliefs held by healthcare professionals (HCPs) are known to influence the treatment advice given to patients and consequently management outcomes. Back pain beliefs are known to be influenced by factors such as culture, education, health literacy, place of work, personal experience of LBP and the sequelae of LBP such as disability. There is currently a knowledge gap among these relationships in non-western countries. The aim of this study was to examine the associations between LBP-related beliefs among Chinese HCPs and characteristics of these HCPs.MethodsA convenience sample of 432 HCPs working in various health settings in Shanghai, China, completed a series of questionnaires assessing their demographic characteristics, LBP status, pain-related disability and their beliefs about their own LBP experience, using the Back beliefs Questionnaire (BBQ) and the Fear Avoidance Beliefs Questionnaire (FABQ).ResultsYounger Chinese HCPs (20–29 years) held more negative beliefs and attitudes related to LBP compared to older HCPs (>40years; BBQ mean difference [95% CI]: 2.4 [0.9 - 3.9], p = 0.001). HCPs working outside tertiary hospitals had poorer beliefs concerning the inevitable consequences of LBP (BBQ mean difference [95% CI]: −2.4 [−3.8 - −1.0], p = 0.001). HCPs who experienced LBP had higher level of fear avoidance beliefs when experiencing high LBP-related disability (FABQ-physical mean difference [95% CI]: 2.8 [1.5 - 4.1], p < 0.001; FABQ-work mean difference [95% CI]: 6.2 [4.0 - 8.4], p < 0.001)) and had lower level of fear avoidance beliefs if they had completed postgraduate study (FABQ-physical mean difference [95% CI]: 2.9 [−5.8 - 0.0], p = 0.049).ConclusionThis study suggests that LBP-related beliefs and attitudes among Chinese HCPs are influenced by age, location of work, level of LBP-related disability and education level. Understanding back pain beliefs of Chinese HCPs forms an important foundation for future studies into the condition and its management in China.

How do people in China think about causes of their back pain? A predominantly qualitative cross-sectional survey

“…Although the reasons for these differences across the populations are not known, two possible explanations are that; 1) the study may represent a population with less severe symptoms than the Australian study; and 2) stoicism (meaning showing no emotions when encountering pleasure or pain) is considered as a positive trait in Chinese culture (56). In contrast to our ndings about patients living in China, other research suggests that Chinese healthcare professionals (57,58) show higher levels of fear avoidance beliefs related to physical activities than Western physicians (59) and medical specialists (60), and Chinese nurses have pessimistic views about LBP as many nurses experiencing LBP planned to quit their job due to their back pain (57). However, we suggest that these comparisons (57-60) should be viewed with caution as those other studies used variables developed from Western ways of thinking to quantify pain-related beliefs (34).…”

“…Confucianism has been identi ed as a cultural barrier to the Chinese population receiving pain interventions (56). However, Chinese healthcare professionals have been held negative beliefs about LBP (57,58) and could negatively in uence pain related beliefs of patients. Confucianism might be considered positive for people in China with LBP by avoiding unhelpful medical help.…”

How do people in China think about causes of their back pain? A predominantly qualitative cross-sectional survey

“…Although the reasons for these differences across the populations are not known, two possible explanations are that; 1) the study may represent a population with less severe symptoms than the Australian study; and 2) stoicism (meaning showing no emotions when encountering pleasure or pain) is considered as a positive trait in Chinese culture (51). In contrast to our ndings about patients living in China, other research suggests that Chinese healthcare professionals (52,53) show higher levels of fear avoidance beliefs related to physical activities than Western physicians (54) and medical specialists (55), and Chinese nurses have more pessimistic views about LBP consequences and higher levels of fear avoidance beliefs and LBP disability than Australian nurses (56). However, we suggest that these comparisons (53)(54)(55)(56) should be viewed with caution as those other studies used variables developed from Western ways of thinking to quantify pain-related beliefs (30).…”

Cross-cultural adaptation and psychometric evaluation of the Yoruba version of the Back beliefs questionnaire among patients with chronic low-back pain

“…Chronic LBP beliefs and its interpretation are influenced by cultural upbringing, sociocultural environment, previous pain experiences and health literacy [37]. For instance, beliefs about LBP may be under-reported in the African settings due to cultural or religious reasons.…”