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Title: The development of a physiotherapist-led pain management programme for low back pain in Bahrain
Author: Maki, Dana Mohamed Ali Khalil Ebrahim
ISNI:       0000 0004 5991 2055
Awarding Body: King's College London
Current Institution: King's College London (University of London)
Date of Award: 2016
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Background: Low back pain (LBP) is associated with pain-related beliefs, coping strategies and anxiety and depression. Culture is known to affect the pain experience through language, beliefs, and attitudes. Most investigations into the effectiveness of pain management programmes (PMP) that aim to reduce emotional distress and unhelpful beliefs, encourage activity and participation and promote long-term self-management have been carried out in Western countries. This has implications for implementing PMPs for LBP in Bahrain. Methods: Five studies were conducted: 1) a systematic review of studies assessing for determinants and predictors of self-reported LBP disability in non-Western cultures. In Bahrain 2) translation, cross-cultural adaptation and psychometric testing of the Roland-Morris Disability Questionnaire (RMDQ), Back Beliefs Questionnaire (BBQ) and Pain Coping Strategies Questionnaire (CSQ); 3) a cross-sectional survey of factors associated with LBP disability; and 4) a qualitative exploration of beliefs and experiences of patients living with LBP were carried out to inform 5) feasibility and acceptability testing of a physiotherapist-led PMP. Results: 1) The systematic review identified 12 studies from eight non-Western countries. Evidence was strong for fear-avoidance beliefs having a low association with LBP disability. Evidence was moderate for a moderate association between LBP disability and pain intensity, and no association with symptom duration. 2) The translated and cross-culturally adapted Arabic RMDQ, BBQ and CSQ were comprehensible, acceptable, valid and reliable self-report outcome measures. Their psychometric properties were comparable to other versions. 3) The cross-sectional survey (n=199) showed age, gender, pain intensity, back pain-related beliefs, fear-avoidance beliefs, ability to ignore pain, control pain and decrease pain, depression and anxiety explained 34.7% of the variance in LBP. 4) Five themes emerged from the qualitative study (n=18); i) loss of independence and change of identity causes distress; ii) beliefs and attitudes towards low back pain; iii) trying to cope with LBP; iv) experiences within the healthcare system; and v) participants’ assessments of their needs. 5) Feasibility testing of the PMP (n=23) showed 16 participants completed the programme, and 9 (60.0%) were retained at 6 months. Participants found the intervention credible and acceptable. At 6 months, LBP disability, pain intensity, back-pain beliefs, the ability to reinterpret pain sensations, fear-avoidance beliers about work and depression scores indicated better outcomes. However 6 month scores also indicated higher catastrophising, fear-avoidance beliefs about physical activity and anxiety levels. Conclusions: The experiences of Bahraini patients with LBP were similar to findings reported in the Western literature; however some factors differed due to the influence of Muslim Arab culture. The results encourage the use of a culturally-modified biopsychosocial approach to pain management in Bahrain, and other cultures. Therefore, culturally-specific factors such as differences in the LBP experiences between genders, culturally-specific examples and activities, religious coping strategies, and use of catastrophic expressions were taken into consideration when designing the PMP. Participants found the intervention credible and acceptable, but as in Western PMPs, there were high attrition rates. Changes such as the incorporation of value-based goals and the use of booster phone calls are suggested to improve adherence and facilitate behaviour change. The results of this thesis warrant further investigation into the effectiveness the physiotherapist-led PMP in Bahrain for LBP.
Supervisor: Critchley, Duncan John Sponsor: Not available
Qualification Name: Thesis (Ph.D.) Qualification Level: Doctoral
EThOS ID:  DOI: Not available