Early development of a web-based resource for individuals with non-specific chronic low back pain: An action research-inspired approach
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Permanent link to Research Bank record:http://hdl.handle.net/10652/1749
Background: Non-specific chronic low back pain (CLBP) is costly to both individuals and society. It is a difficult condition to treat, as there is no readily identifiable pathological explanation for the pain individuals experience. In addition, no definitive treatment exists, since most treatments have limited impact on the condition. Appropriate management has the potential to reduce the number of people with disabling long-term CLBP, and so reduce its personal, social and economic impact. This is especially true in chronic conditions such as CLBP, where individuals, rather than health-care practitioners, make the day-to-day decisions about how to manage their conditions. To address the need to self-manage conditions, the latest guidelines recommend a combination approach to treatment, which includes a biopsychosocially based educational component. This educational component may aim to provide self-management strategies or address common misconceptions surrounding what CLBP is and how best to manage it. The problems associated with providing an educational component within private practice include the time and costs involved, as well as the need for specialist training in how to provide the education. One approach to overcoming these obstacles is to provide the educational component through a web-based medium. The internet is increasingly being favoured as a medium for the delivery of health-related education topics due to its versatility and the low costs associated with delivery. Purpose: This study conducted an initial exploration into what content should be included in a web-based educational resource for individuals affected by non-specific CLBP. In addition, a preliminary investigation into the design of the presentation of the resource was performed. Methods: An action research-inspired method was used. Interviews were conducted using a semi-structured interview approach. Three groups were interviewed: ‘expert practitioners’, ‘experts in on-line education and web design’ and ‘individuals with non-specific CLBP’. Expert practitioners were interviewed until data saturation was reached, while the latter two groups were interviewed until repetition occurred. Due to time and resource constraints, it was not possible to conduct all interviews until data saturation. The interview responses were instrumental in constructing what material should be included in the content of a web-based resource, as well as providing a starting point for how the content should be presented. Results and discussion: Content: The main issue identified was the need to reconceptualise the purpose of treatment. In chronic pain, treatment focuses on ‘management’ rather than ‘cure’. Two main components of education were identified: self-management and reconceptualising pain. The expert practitioners identified a number of techniques that they considered to be useful in assisting an individual to self-manage their CLBP. These included techniques such as sleep management, relaxation techniques, activity management, and medications management. Reconceptualising the meaning and purpose of pain was viewed as necessary to correct common misconceptions surrounding pain. Barriers to self-management were also identified, including motivation, psychosocial aspects (such as depression) and lack of practitioner knowledge. It remains unclear whether the resource should aim to address some of these barriers. Presentation: Functionality, or fulfilling the purpose for which it was designed, was identified as the most important aspect of designing a web-based resource. Presentation features were discussed, such as a strong preference for video-over text-based presentation formats. Lastly, emerging technological trends that could impact on the design and use of a web-based resource were identified. For example, the increasing use of ‘smart phones’ will potentially impact on the content design and presentation. Conclusion and directions for future research: A wide array of content would need to be included in a web-accessible educational resource for individuals with CLBP. Further investigation is needed to find out whether some of the identified barriers to self-management could be addressed by a web-based educational resource. More information is needed regarding the impact of technological trends, the depth of information individuals desire, how to address barriers to treatment and the best formats to present different types of content. Further investigation is also needed to establish when, why and how individuals choose to access the internet for health information.