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Understanding the Self-management of Chronic Low Back Pain

CCIG's research is leading to grounbreaking improvements in health care.
January 2012 - August 2015

Self-management is a core feature of contemporary forms of governance and it is central to current health strategy around chronic low back pain. Its concept and meaning for those involved, however, need to be better understood if it is to be successful. CCIG’s Professor Paul Stenner is currently working on developing new solutions and methods for meeting the challenges of chronic low back pain.

Chronic low back pain is very prevalent and is often described as costly in terms of personal impacts, disability, work-loss and healthcare expenditure. In the last few years there has been a significant move towards encouraging self-management as a strategy for reducing these impacts. The societal context to this strategy is the transition to an older population characterised by long-term health problems in a climate of rising healthcare costs, limited state funding, and austerity. This context has hastened a shift from a ‘medical model’ towards the ‘empowerment’ of service users who are encouraged to proactively manage their own health issues. In this context of a shift in the balance of health-responsibility from the state to the individual, it becomes increasingly important to attend to what it is that self-management means to people in actual practice. To this end, a technique called Q-methodology was used to identify the viewpoints of patients and healthcare providers.

Professor Paul Stenner was a co-applicant and methodological adviser for the £200,000 grant. The  research team was headed by Dr Carol McCrum (Consultant in physiotherapy, East Sussex Healthcare NHS Trust, Eastbourne) and including Professor Ann Moore (University of Brighton), Dr Vinette Cross (Senior Research Fellow, University of Brighton), Dr Janet McGowan (Consultant in pain Management, East Sussex Healthcare NHS Trust, Eastbourne), Mr Emmanuel Defever (Research Officer, University of Brighton), Mr Phil Lloyd (Service user) and Mr Robert Poole (Service user). The research was funded by the NIHR, Research for Patient Benefit programme and was entitled ‘an exploration of self-care in chronic low-back disorder from the perspective of practitioners and patients: a Q methodological study’ (PB-PG-0909-20039). The project started in January 2012, with active research finishing in August 2015. Further publications are expected in due course.

In a first phase, the relevant literature was reviewed and a series of discussion groups was held with patient and healthcare providers. In this way a large number of statements were gathered, each expressing a viewpoint on the nature of self-management. In a second phase, 60 of these statements were given to a total of 60 patients and 60 healthcare providers who sorted them in ways which neatly expressed their personal viewpoints. 120 such ‘Q sorts’ were then statistically analysed in order to identify any distinctive viewpoints.

In this way, four distinct and shared viewpoints on self-management were identified.   Each viewpoint construes self-management in a distinctive way. Identifying the similarities and differences among them holds great potential for enhancing communication between patients and healthcare providers and hence for improving self-management in practice.  The four different viewpoints are summarised as follows:

  • "I can change" - a strong psychological approach, needing a lifestyle/mind-set change. This was the largest viewpoint, expressed mainly by healthcare providers but also shared by some patients.
  • "Some things can change"- a strong pragmatic approach guided by accurate information and practical strategies, shared mostly by patients and some healthcare providers.
  • "Not sure what to / can change"- expressed mostly by patients and few healthcare providers, this concerns the uncertainty in medical diagnosis, with the need for ongoing access to healthcare resources and assistance.
  • "The others need to change"- expressed only by patients, this concerns the social stigma and negative perception of low back pain being in a chronic condition, with reliance on health professionals to acknowledge and validate their problem.

The study findings provide a good basis for health professionals and service users alike to arrive at an understanding of the real complexities of self-management. They can help to encourage effective partnership between patients and healthcare providers.

The results were disseminated in an innovative participant-led knowledge translation conference in which all the research participants as well as the local patient and healthcare providers were invited to further discuss the main findings. The findings have also been presented at local and national conferences. The key paper “Self-management of chronic low back pain: Four viewpoints from patients and healthcare providers” has been published in the journal health psychology open. It is freely available here.


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Learn more about the research programme: Psychosocial