How low back pain is managed-a mixed methods study in 32 countries. Part 2 of Low Back Pain in Low- and Middle-Income Countries Series

Saurab Sharma; Anupa Pathak; Romy Parker; Leonardo Oliveira Pena Costa; Babita Ghai; Chinonso Igwesi-Chidobe; Prawit Janwantanakul; Fabianna Resende de Jesus-Moraleida; Mulugeta Bayisa Chala; Mohammadreza Pourahmadi; Andrew M Briggs; Edward Gorgon; Clare L Ardern; Karim M Khan; James H McAuley; Consortium for Low Back Pain in Low- and Middle-Income Countries

doi:10.2519/jospt.2024.12406

How low back pain is managed-a mixed methods study in 32 countries. Part 2 of Low Back Pain in Low- and Middle-Income Countries Series

J Orthop Sports Phys Ther. 2024 Apr 11:1-42. doi: 10.2519/jospt.2024.12406. Online ahead of print.

Authors

Saurab Sharma^{1

2}, Anupa Pathak³, Romy Parker⁴, Leonardo Oliveira Pena Costa⁵, Babita Ghai⁶, Chinonso Igwesi-Chidobe^{7

8}, Prawit Janwantanakul⁹, Fabianna Resende de Jesus-Moraleida¹⁰, Mulugeta Bayisa Chala^{11

12}, Mohammadreza Pourahmadi¹³, Andrew M Briggs¹⁴, Edward Gorgon^{15

16}, Clare L Ardern^{17

18}, Karim M Khan^{19

20}, James H McAuley^{1

2}; Consortium for Low Back Pain in Low- and Middle-Income Countries²¹

Affiliations

¹ Department of Exercise Physiology, School of Health Sciences, University of New South Wales, Sydney, Australia.
² Centre for Pain IMPACT, Neuroscience Research Australia, Sydney.
³ Faculty of Medicine and Health, University of Sydney, Sydney, Australia.
⁴ Department of Anaesthesia and Perioperative Medicine, Faculty of Health sciences, University of Cape Town, South Africa.
⁵ Masters and Doctoral Programs in Physical Therapy, Universidade Cidade de São Paulo, Brazil.
⁶ Department of Anaesthesia and Intensive Care, Post Graduate Institute of Medical Education and Research, Chandigarh, India.
⁷ Global Population Health (GPH) Research Group, University of Nigeria, Nsukka, Nigeria.
⁸ School of Allied Health Professions and Midwifery, Faculty of Health Studies, the University of Bradford, United Kingdom.
⁹ Department of Physical Therapy, Faculty of Allied Health Sciences, Chulalongkorn University, Bangkok, Thailand.
¹⁰ Master Program in Physiotherapy and Functioning, Department of Physiotherapy, Universidade Federal do Ceará, Fortaleza, Brazil.
¹¹ Department of Physiotherapy, College of Medicine and Health Sciences, Bahir Dar University, Ethiopia.
¹² The Gray Centre for Mobility and Activity, Parkwood Institute, St. Joseph's Health Care London, ON, Canada.
¹³ Iranian Center of Excellence in Physiotherapy, Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran.
¹⁴ Curtin School of Allied Health, Faculty of Health Sciences, Curtin University, Perth, Western Australia, Australia.
¹⁵ College of Allied Medical Professions, University of the Philippines Manila, Manila, Philippines.
¹⁶ Faculty of Medicine and Health, The University of Sydney, Sydney, Australia.
¹⁷ Department of Physical Therapy, Faculty of Medicine, The University of British Columbia, Vancouver, Canada.
¹⁸ Sport and Exercise Medicine Research Centre, La Trobe University, Melbourne, Victoria, Australia.
¹⁹ Department of Family Practice, University of British Columbia, Vancouver, BC, Canada.
²⁰ Canadian Institutes of Health Research-Institute of Musculoskeletal Health and Arthritis, Vancouver, BC, Canada.
²¹ Members of Consortium for Low Back Pain in Low- and Middle-Income Countries: Alia A. Alghwiri, PhD, The University of Jordan, Jordan; Oluwayomi Abolade Aoko, PhD(c), University of Lagos, Nigeria, Habibu Salisu Badamasi, MPH, Sheik Mohd Jidda General Hospital, Bayero University, Nigeria; Jose A. Calvache, MD, PhD, Universidad del Cauca, Colombia and Erasmus University Medical Center Rotterdam, The Netherlands; Mary Suma Cardosa, FFPMNZCA, Hospital Universiti Kebangsaan Malaysia (HUKM), Malaysia; Shankar Ganesh, MPT, Composite Regional Centre for Skill Development, Rehabilitation, and Empowerment of Persons with Disabilities, Lucknow, India; Moges Gashaw, MSc, University of Gondar, Ethiopia and University of Technology Sydney, Sydney; Johanna Ghiringhelli, MSc, Social Welfare Institute, Paraguay; Santiago Gigena, BSc, Santojanni's Hospital, Argentina; A T M Tanveer Hasan, MD (Rheumatology), Green Life Medical College, Bangladesh; Syed Atiqul Haq, MD, Green Life Center for Rheumatic care and Research, Bangladesh; Emmanuel Ng'wiza Jacob, BScPT, Muhimbili Orthopedic Institute, Tanzania; Dina Christa Janse van Rensburg, DMed, PhD, University of Pretoria, South Africa; Oyéné Kossi, PhD. University of Parakou, Benin; Chang Liu, PhD, Shanghai Jiao Tong University, China and University of Sydney, Australia; Rinkle Malani, PhD(c), MGM School of Physiotherapy, India; Brett James Nairn Mason, MSc, University of Cape Town, South Africa; Charbel Najem, DPT, Antonine University, Lebanon, Ghent University, Belgium and Pain in Motion International Research Group, Belgium; Tania Ines Nava-Bringas, MSc, National Institute of Rehabilitation "Luis Guillermo Ibarra Ibarra", Mexico; Ildephonse Nduwimana, PhD, National Institute of Public Health, Burundi; Romain Perera, PhD, University of Colombo, Sri Lanka; Wajida Perveen, PhD(c), CMH Lahore Medical College & IOD, (NUMS Rawalpindi), Pakistan; Andrés Pierobon, MSc, PhD(c), University of Otago, New Zealand; Emília Pinto, PhD, Eduardo Mondlane University and Higher Institute of sciences and Technologies of Mozambique, Mozambique; Rafael Z. Pinto, PhD, Universidade Federal de Minas Gerais (UFMG), Brazil, University of New South Wales, Australia and Neuroscience Research Australia, Australia; Firmansyah Purwanto, DipPT, Khayra Physio, Indonesia and Dustira Hospital Institute of Health Sciences, Indonesia; Mohammad Dawood Rahimi, MSc, Herat University, Afghanistan; Felipe J. J. Reis, PhD, Federal Institute of Rio de Janeiro, Brazil; Md Abu Bakar Siddiq, MBBS, MSc (Rheumatology), Brahmanbaria Medical College, Bangladesh, University of South Wales, UK; Dipak Shrestha, MS (Orthopedics), Kathmandu University Hospital, Nepal; Monu Tamang, BPT, Central Regional Referral Hospital, Gelephu; Lenny Vasanthan T, MPT, Christian Medical College, India; Carel Viljoen, PhD, University of Pretoria, South Africa.

PMID: 38602844
DOI: 10.2519/jospt.2024.12406

Abstract

BACKGROUND: The Lancet Series of Low Back Pain (LBP) highlighted the lack of LBP data from low- and middle-income countries (LMICs). The study aimed to describe (1) what LBP care is currently delivered in LMICs, and (2) how that care is delivered. METHODS: An online mixed-methods study. A Consortium for LBP in LMICs (n=65) was developed with an expert panel of leading LBP researchers (>2 publications on LBP) and multidisciplinary clinicians and patient partners with five years of clinical/lived LBP experience in LMICs. Quantitative data were analyzed using descriptive statistics. Two researchers independently analyzed qualitative data using deductive and inductive coding and developed a thematic framework. FINDINGS: Forty-seven (85%) of 55 invited panel members representing 32 LMICs completed the survey (38% women; 62% men). The panel included clinicians (34%), researchers (28%), educators (6%), and patient partners (4%). Pharmacotherapies and electrophysiological agents were the most used LBP treatments. The Thematic Framework comprised of eight themes: (1) Self-management is ubiquitous; (2) Medicines are the cornerstone; (3) Traditional therapies have a place; (4) Society plays an important role; (5) Imaging use is very common; (6) Reliance on passive approaches; (7) Social determinants influence LBP care pathway; and (8) Health systems are ill-prepared to address LBP burden. INTERPRETATION: LBP care in LMICs did not consistently align with the best available evidence. Findings will help research prioritization in LMICs and guide global LBP clinical guidelines. FUNDING: The lead author's Fellowship was supported by the International Association for the Study of Pain.

Keywords: Developing countries; Health surveys; Low back pain; Mixed Methods Design; Musculoskeletal pain; Service delivery.