Contextualizing the lived experiences of patients with low back pain from different countries according to the ICF framework.

OBJECTIVE: To explore perspectives, including social and psychological aspects, of patients seeking manual care for low back pain, in order to understand constructs of functioning that are important across different cultural contexts. The International Classification of Functioning, Disability and Health (ICF) emphasizes the importance of these aspects to describe health-related functioning. DESIGN: Focus group interviews. PATIENTS: Patients from Botswana, Canada and Norway seeking manual care for their low back pain. METHODS: Interviews were conducted in the 3 countries, transcribed verbatim, translated into English, and linked to the ICF according to established rules. RESULTS: Seven focus groups yielded 1,863 meaningful concepts that were linked to ICF categories. The largest proportion of responses linked to the Activities and Participation domain. The most frequently mentioned chapters related to pain and its mental aspects, suggesting that the psychological impact of living with low back pain is important to patients. CONCLUSION: Despite cultural differences, patients seeking manual care for low back pain in Botswana, Canada and Norway reported similar experiences of disability across ICF domains. The relatively high ranking of psychosocial factors highlights their importance for patients, in addition to factors of biological origin, and indicates that the contextual nature of the lived experience of low back pain may not be covered in standard examinations used in manual medicine.