Ellen Aartun, Iben Axén, Silvano Mior, Yngve Røe, Maria Hondras, Lise Kretz, Pierre Côté
Department of Interdisciplinary Health Sciences, University of Oslo , Oslo, Norway.
DOI: 10.2340/16501977-2819

Objective: To explore perspectives, including social and psychological aspects, of patients seeking manual care for low back pain, in order to understand constructs of functioning that are important across different cultural contexts. The International Classification of Functioning, Disability and Health (ICF) emphasizes the importance of these aspects to describe health-related functioning.
Design: Focus group interviews.
Patients: Patients from Botswana, Canada and Norway seeking manual care for their low back pain.
Methods: Interviews were conducted in the 3 countries, transcribed verbatim, translated into English, and linked to the ICF according to established rules.
Results: Seven focus groups yielded 1,863 meaningful concepts that were linked to ICF categories. The largest proportion of responses linked to the Activities and Participation domain. The most frequently mentioned chapters related to pain and its mental aspects, suggesting that the psychological impact of living with low back pain is important to patients.
Conclusion: Despite cultural differences, patients seeking manual care for low back pain in Botswana, Canada and Norway reported similar experiences of disability across ICF domains. The relatively high ranking of psychosocial factors highlights their importance for patients, in addition to factors of biological origin, and indicates that the contextual nature of the lived experience of low back pain may not be covered in standard examinations used in manual medicine.

The aim of our study was to understand the experiences of people living with low back pain in three countries. We explored perspectives to understand aspects of functioning across different cultural contexts. Seven focus groups with 31 patients seeking manual care for their low back pain in Botswana, Canada and Norway were recorded, transcribed, and coded using the International Classification of Functioning, Disability and Health linking rules to categories. More than 1800 meaningful concepts were linked to categories, with the largest proportion linked to Activities and Participation. Participants from all three countries most frequently mentioned issues related to the pain and mental aspects of health-related functioning, suggesting the psychological impact of living with low back pain is important to patients, regardless of cultural context. While patients seeking manual care are commonly assessed for pain and function, it is also important to capture the lived experiences associated with low back pain.