Rural Workers’ Experience of Low Back Pain: Exploring Why They Continue to Work
Introduction Many New Zealand rural workers have repeated low back pain (LBP) episodes yet continue to work. We wanted to find out why, given that other manual workers with LBP often end up on long term sick leave or permanently disabled. Methods Our primarily qualitative approach used mixed methods to investigate rural workers with non-specific LBP. Participants (n = 33) were surveyed for demographic data, the Brief Illness Perception Questionnaire and the General Self Efficacy Scale followed by one-to-one semi-structured interviews. Analysis ranged from descriptive content to detailed qualitative Interpretative Phenomenological Analysis. Results Participants had high self efficacy scores, positive perceptions about LBP but strong beliefs that LBP is lifelong. Four distinct themes emerged. “Thinking with my head before my back” and “Knowing the risks” described participants’ innovation regarding job modifications. “Just carry on” and “Love of the land” related to stoical resilience and commitment to something more than employment. Conclusions This rural workforce adopts a ‘can do’ attitude to work, managing LBP within the context of having job control and flexible work practices. Implications: Rehabilitation interventions promoting job control and targeting positive attitudes towards getting on with work, whilst accepting LBP as part of everyday life, may have merit for other workers with LBP.
KeywordsLow back pain Workers Psychology Interpretative phenomenological analysis Mixed methods research
Funding support for conducting the study was provided by a University of Otago NZ, Research Grant and the lead author’s time is now supported by funding from the National Institute for Health Research UK, in connection with her role within the Peninsula Collaboration for Leadership in Applied Health Research and Care.
- 1.Waddell G, Main CJ. A new clinical model of low back pain and disability. In: Waddell G, editor. The back pain revolution. Edinburgh: Churchill Livingstone; 1998. p. 265–81.Google Scholar
- 4.Kendall NAS, Linton SJ, Main CJ. Guide to assessing yellow flags in acute low back pain. Wellington: Accident Rehabilitation and Compensation Insurance Corporation and the National Health Committee; 2003.Google Scholar
- 9.Waddell G, Feder G, Lewis M. Systematic reviews of bed rest and advice to stay active for acute low back pain. Brit J Gen Pract. 1997;47:647–52.Google Scholar
- 10.Burton AK, Balague F, Cardon G, Eriksen HR, Henrotin Y, Lahad A, et al. European guidelines for prevention in low back pain, on behalf of the COST B13 Working Guidelines for the Prevention of Low Back Pain. 2004. Available from: www.backpaineurope.org.
- 12.Croft PR, Macfarlane GJ, Papegeorgiou AC, Thomas E, Silman AJ. Outcome of low back pain in general practice: a prospective study. BMJ. 1998;3:1356–9.Google Scholar
- 13.Synder CR, Lopez SJ, editors. Handbook of positive psychology. Oxford: Oxford University Press; 2002.Google Scholar
- 17.Firth H, Herbison P, McBride D, Feyer A-M. Low back pain among farmers in Southland. J Occup Health Saf Aust NZ. 2002;18:167–71.Google Scholar
- 19.Hoskins W, Pollard H, Daff C, Odell A, Garbutt P, McHardy A, Hardy K, Dragasevic G. Low back pain status in elite and semi-elite Australian football codes: a cross sectional study of football (soccer), Australian rules, rugby league, rugby union and non-athletic controls. BMC Musculoskelet Disord. 2009;10:38.PubMedCrossRefGoogle Scholar
- 20.Statistics New Zealand. Urban-rural profiles/defining urban-rural NZ. Wellington (NZ): Statistics Government; 2008. Available from: http://www.stats.govt.nz/urban-rural-profiles/default.htm.
- 21.Lovelock K, Cryer C. Effective occupational health interventions in agriculture—Summary Report no.5. Dunedin (NZ): Injury Prevention Unit, University of Otago, Occasional Report OR 072: 2009.Google Scholar
- 22.World Health Organisation. The international classification of functioning, health and disability. Geneva: World Health Organisation; 2001.Google Scholar
- 23.Johnson RB, Onwuegbuzie AJ. Mixed methods research: a research paradigm whose time has come. Educ Res. 2004;33:14–26.Google Scholar
- 25.Schwarzer R, Jerusalem M. Generalized self-efficacy scale. In: Weinman J, Wright S, Johnston M, editors. Measures in health psychology: a user’s portfolio. Causal and control beliefs. Windsor: NFER Nelson; 1995. p. 35–7.Google Scholar
- 31.Dean SG, Smith JA, Payne S. Low back pain: exploring the meaning of exercise management through interpretative phenomenological analysis. In: Finlay L, Ballinger C, editors. Qualitative research for allied health professionals: challenging choices. Chichester: Wiley; 2006. p. 139–55.Google Scholar
- 32.Smith JA. Semi-structured interviewing and qualitative analysis. In: Smith JA, Harre R, Van Langenhove L, editors. Rethinking methods in psychology. London: Sage; 1995. p. 9–26.Google Scholar
- 33.Nvivo 8. Research software for analysis. QSR International; 2007. Available from: www.qsrinternational.cpm/products_nvivo.aspx.
- 34.Smith JA, Osborn M. Interpretative phenomenological analysis. In: Smith JA, editor. Qualitative psychology: a practical guide to research methods. London: Sage; 2003. p. 51–80.Google Scholar
- 35.Taylor WJ. Musculoskeletal pain in the adult New Zealand population: prevalence and impact. N Z Med J. 2005;118(1221):15.Google Scholar
- 37.Fathallah FA, Miller BJ, Miles JA. Low back disorders in agriculture and the role of stooped work: scope, potential interventions, and research needs. J Agr Saf Health. 2008;14:221–45.Google Scholar
- 38.Wai EK, Roffey DM, Bishop P, Kwon BK, Dagenais S. Causal assessment of occupational bending or twisting and low back pain: results of a systematic review. Spine J. 2009. Published on-line: 27 July 2009. doi: 10.1016/j.spineee.2009.06.005.
- 42.Lazarus RS, Folkman S. Stress appraisal and coping. New York: Springer; 1984.Google Scholar
- 45.Larson NC, Dearmont M. Strengths of farming communities in fostering resilience in children. Child Welf. 2002;81:821–35.Google Scholar
- 47.Roland M, Waddell G, Klaber Moffett J, Burton K, Main C, Cantrell T. The back book. Norwich: The Stationary Office; 1996.Google Scholar
- 48.Miller SM, Brody DS, Summerton J. Styles of coping with threat: Implications for health. J Pers Soc Psychol. 1998;45:223–36.Google Scholar
- 52.Ferrie JE (editor). Work stress and health: the Whitehall II study. London: Public and Commercial Services Union for the Council for Civil Service Unions/Cabinet Office 2004; p. 4.Google Scholar