Unconventional Practitioners’ Causal Beliefs and Treatment Strategies for Chronic Low Back Pain in Rural Nigeria

Abstract Background Pain coping strategies are important in the chronicity of low back pain and the associated disability. However, their exact influence is unknown in many African contexts such as rural Nigeria due to lack of outcome instruments with which to measure them. This study aimed to cross-culturally adapt and psychometrically test the Coping Strategies Questionnaire (CSQ) in Igbo populations in Nigeria. Methods The CSQ was forward and back translated by clinical and non-clinical translators; evaluated by an expert review committee. The translated measure was piloted amongst twelve rural Nigerian dwellers with chronic low back pain (CLBP) using the think-aloud cognitive interviewing style. Internal consistency (Cronbach’s alpha), test–retest reliability (intra-class correlation coefficient—ICC and Bland–Altman plot), and minimal detectable change were examined amongst 50 people with CLBP in rural and urban Nigerian populations. Construct validity was determined by assessing the correlations between the adapted CSQ and measures of disability, pain intensity, fear avoidance beliefs, and illness perceptions using Spearman’s correlation analyses with 200 adults with CLBP in rural Nigeria. Exploratory factor analyses using Kaiser criterion (eigenvalue) and parallel analysis as methods for determining dimensionality were conducted with the same sample. Results Fourteen out of 42 items were routinely adopted in this population including all items of catastrophising subscale, and all but one item of praying and hoping subscale. Catastrophising and praying and hoping subscales had the highest Cronbach’s alpha. All subscales had high ICCs with Bland–Altman plots that showed good agreement. All coping strategies were positively correlated with self-reported disability and pain intensity with catastrophising subscale having the highest values. Seven-factor and three-factor structures were produced with the Kaiser criterion and parallel analysis, with different items from the original CSQ, except for catastrophising. Conclusions Catastrophising and praying and hoping may be the relevant coping strategies in this population. More culturally relevant measures of pain coping strategies that include adaptive coping strategies may need to be developed for African contexts such as rural Nigeria.

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Qualitative exploration of non-specific chronic low back pain in rural Nigeria: towards evidence-informed physiotherapy practice

Physiotherapy ◽

10.1016/j.physio.2015.03.3466 ◽

2015 ◽

Vol 101 ◽

pp. e636-e637 ◽

Cited By ~ 5

Author(s):

C.N. Igwesi-Chidobe ◽

S. Kitchen ◽

I.O. Sorinola ◽

E. Godfrey

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

Low Back ◽

Physiotherapy Practice ◽

Rural Nigeria ◽

Qualitative Exploration

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Efficiency of three treatment strategies on occupational and quality of life impairments for chronic low back pain patients: is the multidisciplinary approach the key feature to success?

Clinical Rehabilitation ◽

10.1177/0269215517691086 ◽

2017 ◽

Vol 31 (10) ◽

pp. 1364-1373 ◽

Cited By ~ 9

Author(s):

Yoann Ronzi ◽

Ghislaine Roche-Leboucher ◽

Cyril Bègue ◽

Valerie Dubus ◽

Luc Bontoux ◽

...

Keyword(s):

Quality Of Life ◽

Low Back Pain ◽

Back Pain ◽

Sick Leave ◽

Chronic Low Back Pain ◽

Treatment Strategies ◽

Low Back ◽

Social Ability ◽

Outpatient Program

Objective: To compare the effectiveness of three treatment strategies for chronic low back pain with varying biomechanical intensity and multidisciplinary approach. Methods: A monocentric randomized controlled trial with a 12-months follow-up, conducted in the French Valley Loire region from May 2009 to April 2013. Participants were working-aged patients with chronic low back pain referred to a French chronic low back pain care-network to support medical and occupational issues. Three treatment strategies, each for five weeks were compared: (i) intensive and multidisciplinary program conducted in a rehabilitation center; (ii) less intensive outpatient program conducted by a trained private physiotherapist; (iii) mixed strategy combining the same outpatient program associated with a weekly multidisciplinary intervention. The effects of treatment conditions were compared using an “intention to treat” approach: Number of days’ sick leave during the 12-months following treatment, and quality of life and social ability assessed by auto-questionnaires. Results: A total of 159 patients (58.9% men, 41.5 ± 10.3 years old, median duration of sick leave = 221.0 days (127.5–319.0)) were included. Sick leave duration significantly decreased during the 12-months following treatment in the three groups. There was no significant difference for the evolution of participants’ quality of life, social ability, and personal beliefs between the three groups. Conclusion: This study confirms that disparate treatments might show similar effectiveness because they could all work through concomitant changes in beliefs, attitudes, and coping mechanisms. The original mixed strategy can treat a larger number of chronic low back pain patients, at a lower cost and provide local community-based care. Clinical Trial registration: NCT02030171

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