Cross-sectional survey of attitudes and beliefs about back pain in New Zealand

Abstract

Objectives: To explore the prevalence of attitudes and beliefs about back pain in New Zealand and compare certain beliefs based on back pain history or health professional exposure.

Design: Population-based cross-sectional survey.

Setting: Postal survey.

Participants: New Zealand residents and citizens aged 18 years and above. 1000 participants were randomly selected from the New Zealand Electoral Roll. Participants listed on the Electoral Roll with an overseas postal address were excluded. 602 valid responses were received.

Measures: Attitudes and beliefs about back pain were measured with the Back Pain Attitudes Questionnaire (Back-PAQ). The interaction between attitudes and beliefs and (1) back pain experience and (2) health professional exposure was investigated.

Results: The lifetime prevalence of back pain was reported as 87% (95% CI 84% to 90%), and the point prevalence as 27% (95% CI 24% to 31%). Negative views about the back and back pain were prevalent, in particular the need to protect the back to prevent injury. People with current back pain had more negative overall scores, particularly related to back pain prognosis. There was uncertainty about links between pain and injury and appropriate physical activity levels during an episode of back pain. Respondents had more positive views about activity if they had consulted a health professional about back pain. The beliefs of New Zealanders appeared to be broadly similar to those of other Western populations.

Conclusions: A large proportion of respondents believed that they needed to protect their back to prevent injury; we theorise that this belief may result in reduced confidence to use the back and contribute to fear avoidance. Uncertainty regarding what is a safe level of activity during an episode of back pain may limit participation. People experiencing back pain may benefit from more targeted information about the positive prognosis. The provision of clear guidance about levels of activity may enable confident participation in an active recovery.

Keywords: Epidemiology; Pain Management; Primary Care; Rehabilitation Medicine.

Figure 1

Scatter plot with density to display the correlation between item 1: ‘Your back is one of the strongest parts of your body’ and item 6: ‘It is easy to injure your back’. The blocks represent the proportion of respondents who selected the same response options to these two items. The dashed line represents congruent beliefs (ie, the item directions are reversed). This demonstrates that the largest proportion of respondents had incongruent beliefs, that is, they believed their back to be strong (right hand side of the figure), but also easy to injure (top part of the figure).

Figure 2

Scatter plot with density to display the correlation between item 25: ‘If you have back pain you should avoid exercise’ and item 26: ‘When you have back pain the risks of vigorous exercise outweigh the benefits’. This demonstrates that many individuals (circa 10%) who believed that they should not avoid exercise if they have back pain also believed that the risks of vigorous exercise outweighed the benefits (ie, top left of the figure), whereas very few believed the reverse. This indicates that although most do not believe exercise should be avoided, they still view it as being a risky behaviour.

Figure 3

Response distribution by back pain history for item 6: ‘It is easy to injure your back’.

Figure 4

Response distribution by back pain history for item 32: ‘Once you have had back pain there is always a weakness’.

Figure 5

Response distribution by back pain history for item 33: ‘There is a high chance that an episode of back pain will not resolve’.

Figure 6

Response distribution by healthcare professional (HCP) exposure for item 27: ‘If you have back pain you should try to stay active’.