The use of an unstructured health diary to describe the experiences of patients with lowback pain, and its potential to predict outcomein new episodes of low back pain presnting inprimary care

• Main Author: Pinnington, Mark A.
• Published: University of Liverpool 2008
• Subjects: 616.7
• Online Access: http://ethos.bl.uk/OrderDetails.do?uin=uk.bl.ethos.502299

The development and use of an unstructured health diary to describe the experiences of patients with low back pain, and its po'tential to predict outcome in new episodes of low back pain presenting in primary care Background: Back pain is among the most common syndromes presenting in primary cafe in the United Kingdom. It has proved to be very costly and complex to treat Recent advances in the knowledge base of the natural history of the condition and the ability to predict which patients are most at risk of not recovering have had little effect in reducing the disability associated with it Recent advances in and the recognition ofqualitative research methods have provided an alternate research design to gain rich insights into how low back pain affects patients. Aims: The aim of this study was to develop an unstructured health diary, describe how back pain affects patients over a one week period from diary entries, and explore the diary's potential usefulness in predicting outcome in patients with new episodes of low back pain presenting in primary care. Methods: Following recruitment into the study, patients were invited to record their experiences of low back pain in an unstructured diary each day during the first week ofthe episode. Measures ofdisability and anxiety/depression were collected at presentation, two weeks post-presentation and six weeks postpresentation, using well validated outcome measures; Roland and Morris Disability Questionnaire (RMDQ) and the Hospital Anxiety and Depression Questionnaire (HAD). Patients were categorised at six weeks into one of three recovery groups; fully recovered (FR), partly recovered (PR) or not recovered (NR) based onRMDQ scores. Diary data was analysed inductively and thematically using well-established conventions for ensuring that the process was grounded in patient data. PreliminaIy and secondary diary data analysis was assisted by the qualitative software package, ATLAS. Diary data was then used to describe the rich accounts of patients experiences of their low back pain, and then tested against recovery group data to search for differences in the frequency of references to individual themes. Aphenomenological framework guided the collection and analysis ofdiary data Findings: Eighty five full data sets (completed questionnaires and diaries) were included in the analysis. The relationship between recovery groups at six weeks and all other quantitative data was analysed. HAD scores and duration of symptoms were the only two variables found to be related to recovery groups. A total of49 preliminaly themes were identified from the diary data during the initial analysis. Ofthese, three (Emotional, Physical and Functional) were categorised as major themes based on the number of times they were refetred to in the diary text. Some individual themes with commonality of meaning were merged to create much broader major themes ('Illness narrative', 'Coping strategies' and 'Relationships & roles~. The frequency of references made to each theme was recorded and tested against recovery groups. Patients who ended up in the FR group made significantly fewer references to negative physical, negative functional and illness narrative issues. This group also made significantly more reference to negative emotional, coping strategies and relationships & roles issues. Rich accounts of how their low back pain had affected them over a one week period also emerged from the diary data Discussion and Conclusions: The findings from the quantitative data support existing knowledge about low back pain; outcomes are not affected by age or gender for example, but are related to anxiety/depression and duration of symptoms. Diary data from patients who end up fully recovering is different to that from those who don't recover. It is proposed that patients who make frequent reference to negative emotional issues in a diary may be 'unburdening' themselves of negative emotions, making the diary a potentially therapeutic tool. It is also proposed that those patients who fully recover make more frequent reference to coping strategies and relationship & roles issues. This may be highlighting that they have better skills with which to cope with low back pain and are more readily given permission to enter the 'sick role' by family members. Temporary exclusion from responsibilities is thought to be a precursor to recovery from illness. These findings are encouraging as certain aspects of qualitative diary data appear to have potential in improving the ability to predict good outcome from low back pain six weeks after onset Further exploration ofboth the predictive and therapeutic potential of diary data is recommended.