A psychometric profile of patients attending the Durban University of Technology Chiropractic Day Clinic with non-specific low back pain

Abstract

BACKGROUND: Low back pain (LBP) is a major health problem and a leading cause of disability worldwide, accounting for numerous medical and chiropractic consultations. Risk factors for developing as well as perpetuating LBP have been recognised, including psychosocial factors and to a lesser extent organic diseases. There is good evidence for the role of biological, psychological, and social factors in the aetiology and prognosis of back pain. The biopsychosocial model developed by Waddell (1987) has become a dominant consideration in determining the aetiology and prognosis of back pain, and has led to the development and testing of many back pain care interventions. This includes a focus on identifying and treating ‘yellow flags’ which are psychosocial factors that may result in LBP becoming chronic, and incorporating the treatment of these ‘yellow flags’ as a component of LBP care.

AIM: The aim of this study was to determine a psychometric profile of patients attending the Durban University of Technology (DUT) Chiropractic Day Clinic (CDC) with non-specific LBP using the Keele STarT Back Screening Tool (SBST) and Bournemouth Questionnaire (BQ).

METHODOLOGY: Once ethical clearance was obtained to conduct the research study at the DUT CDC, all patients over the age of eighteen presenting to the DUT CDC with non-specific LBP as new patients, or as former or current patients presenting with non-specific LBP as a new complaint, were directly approached by the researcher. The prospective participants were asked a series of screening questions in order to ensure that they qualified for the study. A total of 132 participants completed an informed consent, a pre-validated questionnaire, the SBST and the BQ. The questionnaires took approximately ten to fifteen minutes to complete; participants were given the choice to complete them either before or after their appointment so as not to interrupt the treatment time. All informed consents and completed questionnaires were collected by the researcher and stored in separate sealed ballot boxes. All questionnaires were kept confidential and only seen by the researcher and supervisor. A code was allocated to each questionnaire before data was captured on a spreadsheet for data analysis. The IBM SPSS version 22 was used for data analysis by a biostatistician.

RESULTS: A total of 132 questionnaires were utilised for statistical analysis. Based on the SBST, 47.7% (n = 63) of the total population (N = 132), had a low risk of developing chronic LBP, 28.8% (n = 38) had a medium risk of developing chronic LBP, and 23.5 % (n = 31) had a high risk of developing chronic LBP. The BQ indicated that 63.6% (n = 84) of the total population (N = 132) scored 35 or less and thus had a low risk of developing chronic LBP, while 36.4% (n = 48) scored above 35 and thus had a medium to high risk of developing chronic LBP. A very strong association was found between the SBST and BQ risk groups (p = <0.001). A total of 87.1% (n = 27) of the participants who had a high risk of chronicity according to the SBST (N = 31) also had a high risk of chronicity according to the BQ. The female gender, being a current smoker and partaking in little or no physical activity were found to be statistically significant risk factors for chronic LBP.

CONCLUSION: The results in this study suggest that patients presenting to the DUT CDC supports the notion that chronic LBP is a multifactorial condition with significant psychosocial implications and should be approached as such.