Background: Persistent low back pain (LBP) disability is associated with psychological (e.g. coping strategies, beliefs) and social (e.g. relationships, patient's environment) factors. Knowledge of these factors can help inform patient management. Culture is known to affect the pain experience through language, beliefs, and attitudes but studies to date have examined social and psychological factors largely in Western settings. Purpose: The purpose of this study was to explore LBP beliefs and experiences of Arabic patients to inform clinicians working within an Arabic cultural context. Methods: A qualitative approach was adopted. Three focus groups of 4 to 8 patients were recruited from three different hospital sites in Bahrain. Groups were stratified by age, duration of LBP and gender. Recordings of the focus groups were transcribed verbatim into Arabic (original language) then translated into English. To corroborate the translation of recordings, an Arabic-speaking physiotherapist reviewed the Arabic text and generated codes independently. Thematic analysis was undertaken with the help of qualitative computer software. The initial codes were independently validated by an external qualitative researcher. Findings were reviewed with a senior physiotherapist and a patient. Results: Eighteen participants attended all three focus groups (14 females and 4 males, age range 25-74, mean 47.44 (SD 11.58). Nine were in full-time employment, 3 retired, 4 housewives, 1 student and 1 unemployed. Participants lived with LBP from 3 months to 20 years. Pain visual analogue scale was mean 5.28 (SD 1.97). Participants preferred to be within same-sex groups. Only one female participant did not contribute to the discussion. Findings are presented within the framework of four main themes that emerged from the qualitative data. 1. Living with long-term LBP (e.g. the nature of pain, relationships with others, loss of independence). 2. The adoption of self-management strategies to cope with LBP (e.g. religious coping, following advice). 3. Experiences with healthcare professionals (e.g. perceptions of healthcare professionals, physiotherapy and medical experiences). 4. Re-engaging with the healthcare system to pursue further treatment options (e.g. seeking information, exploring new treatment options). Conclusion(s): Arab patients from Bahrain live through similar experiences and have comparable expectations of the healthcare system as patients from studies conducted in Western cultures. However, religious coping (e.g. religious expressions, adopting comfortable prayer positions) are not common in Western populations. Additionally, understanding culture-specific social relationships could inform clinicians how to advise patients with pacing activities of daily living, communicate their pain experience and delegate home or work responsibilities. Implications: Addressing individuals' culture-specific psychological and social factors in clinical settings with Arabic patients might improve patients' involvement in treatment in Bahrain, the Middle East, and migrant Arab and Muslim populations.
Maki, D., Critchley, D. J., Watson, P. J., & Lempp, H. (2015). Persistent low back pain in Arab patients: an exploration of experiences, beliefs and expectations in Bahrain. Physiotherapy, 101, e938–e939. https://doi.org/10.1016/j.physio.2015.03.1786