Whilst back pain is not itself life-threatening, it does threaten quality of life. In the absence of
diagnosis and effective treatment, complex enmeshment and interactions can ensue between
chronic LBP, identity, and social roles, having a diverse and pervasive impact of the
condition with life-changing psychological and social consequences. There is little in the data
to suggest that individual characteristics, country, or study setting are associated with
differences in described impact of LBP. There is some suggestion that age is a factor in
determining the impact of perceived threat to career, and one setting in which a back pain
sufferer and his wife were interviewed together, described a more supportive relationship
than was otherwise typical.
The back-specific core sets of outcome measures recommended by Deyo et al in 1998, and
later updated by Bombardier et al in 2000, recommend measurement in the domains of pain,
function, well-being, disability, and work disability [8,9]. WHO made back-specific
recommendations to measure pain, disability, and depression, in 1999 [75]. International
Classifications of functioning (ICF) categories were later proposed, with a core-set of 78
(comprehensive) or 35 (brief) categories being recommended for LBP in 2004 [76]. The brief
set, intended in particular for use in clinical studies, has been criticised for incomplete
coverage [14,76]. Accepting that both the aetiology and management of LBP fits a
biopsychosocial model, and if it follows that outcome measurement coverage should be
associated with this trinity, then the recommended coverage may be incomplete. Whilst the
bio- component is well-represented within recommendations, psychological factors are less
well represented, and the social factors identified by this review are not represented at all in
recommendations; excluding the comprehensive ICF core-set, which is likely to be too large
to be of practical use in clinical studies. Deyo originally suggested that disability (in
parentheses ‘social role’) be measured using the number of days off-work, reduced activities,
or bed rest. The domain was later renamed ‘work disability’ in the Bombardier update, which
with a shifted focus, it was suggested should be measured using the number of days off work,
the number of days of cut-down work, and the time for return-to-work
Whilst back pain is not itself life-threatening, it does threaten quality of life. In the absence ofdiagnosis and effective treatment, complex enmeshment and interactions can ensue betweenchronic LBP, identity, and social roles, having a diverse and pervasive impact of thecondition with life-changing psychological and social consequences. There is little in the datato suggest that individual characteristics, country, or study setting are associated withdifferences in described impact of LBP. There is some suggestion that age is a factor indetermining the impact of perceived threat to career, and one setting in which a back painsufferer and his wife were interviewed together, described a more supportive relationshipthan was otherwise typical.The back-specific core sets of outcome measures recommended by Deyo et al in 1998, andlater updated by Bombardier et al in 2000, recommend measurement in the domains of pain,function, well-being, disability, and work disability [8,9]. WHO made back-specificrecommendations to measure pain, disability, and depression, in 1999 [75]. InternationalClassifications of functioning (ICF) categories were later proposed, with a core-set of 78(comprehensive) or 35 (brief) categories being recommended for LBP in 2004 [76]. The briefset, intended in particular for use in clinical studies, has been criticised for incompletecoverage [14,76]. Accepting that both the aetiology and management of LBP fits abiopsychosocial model, and if it follows that outcome measurement coverage should beassociated with this trinity, then the recommended coverage may be incomplete. Whilst thebio- component is well-represented within recommendations, psychological factors are lesswell represented, and the social factors identified by this review are not represented at all inrecommendations; excluding the comprehensive ICF core-set, which is likely to be too largeto be of practical use in clinical studies. Deyo originally suggested that disability (inparentheses ‘social role’) be measured using the number of days off-work, reduced activities,or bed rest. The domain was later renamed ‘work disability’ in the Bombardier update, whichwith a shifted focus, it was suggested should be measured using the number of days off work,the number of days of cut-down work, and the time for return-to-work
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