What are important consequences in children with non-specific spinal pain? A qualitative study of Danish children aged 9–12 years

Abstract

ObjectivesIt is currently unknown whether children, adolescents and adults experiencing non-specific spinal pain are affected by their pain in a similar manner. It is also unclear whether questionnaires developed for adults can simply be transferred to paediatric populations. The objective of this study was to explore the physical, psychological and social consequences of a life with non-specific spinal pain among Danish children and to compare these consequences with the content of common adult questionnaires.Design and settingA qualitative study based on individual interviews and focus group discussions with participants recruited from two public schools in Denmark.ParticipantsThirty-six children aged 9–12 years with spinal pain were invited to an interview using a purposive sampling strategy with age, pain intensity and frequency, and general well-being status as inclusion criteria. Nineteen (9 girls, 10 boys) accepted to participate.MethodsData were transcribed verbatim and coded by following a thematic approach to elicit key concepts relevant to spinal pain. Subsequently, focus group interviews were conducted, and all codes were assigned categories corresponding to the International Classification of Function, Disability and Health (ICF) for comparison to adult questionnaires.ResultsNineteen interviews were included, and 21 individual codes identified. Across the codes, five themes emerged in relation to children’s experiences of living with spinal pain: ‘Sports and play’, ‘Axial loading’, ‘Coping strategies’, ‘Mood changes’ and ‘Pain anxiety’. Codes and themes were elaborated on by the focus groups. Only approximately 40% of the identified ICF categories were covered by adult spinal questionnaires.ConclusionsThe negative impact of non-specific spinal pain on children aged 9–12 years pivots around codes which are considerably different to adults. Psychological and social factors were more prominent and pain anxiety was dominant in the lived lives of children. New questionnaires should be age specific and include the identified codes within each theme.

The Young Disability Questionnaire-Spine: item development, pilot testing and conceptualisation of a questionnaire to measure consequences of spinal pain in children

“…In step 2, experts in the field were consulted to ensure that all relevant questionnaires were retrieved and included. Step 3 was to compare codes developed in the previous qualitative study of Danish schoolchildren aged 9–12 years old with spinal pain, 12 with the content of the questionnaires identified in steps 1 and 2. Finally, in step 4, all the resulting codes and questionnaire contents were formulated into questionnaire items.…”

“…To create an item pool, codes from the previously conducted qualitative study 12 were entered into a table as reference codes. 13 Items from the included questionnaires concerning the consequences of MSK pain were then linked to the reference codes.…”

“…29 Therefore, the need for a new comprehensive questionnaire was confirmed. The combination of the previously conducted qualitative study 12 and the literature review supplemented by advice from external experts resulted in an item pool of 35 items, which were reduced to 28 items through the process of item formulation and pilot testing. These Changed to: never -once or twiceonce in a while -often -almost all the time.…”

“…This was also found by Kashani et al, 30 who emphasised that children are quite worried about their situation when having spinal pain. The additional section giving relative weight to different domains, which were important for the children in the previous qualitative study, 12 was also considered relevant and comprehensible for the children in the pilot tests.…”

“…The first step in this process was a qualitative investigation to identify which consequences of spinal pain are important to children. 12 Based on the results from that study and on the previous literature, the aim of the present study is to develop a questionnaire (Young Disability Questionnaire-Spine, YDQ-S) to measure relevant consequences of neck, midback and low back pain in schoolchildren aged 9–12 years. The questionnaire will subsequently undergo a field test.…”