‘My Back on Track, My Future’ Project
Researcher: Assistant Professor Ivan Lin, Kym Ryder
Formative research for this project explored low back pain (LBP) in Aboriginal Australians. Up until then, the limited research that had been undertaken suggested that low back pain is highly prevalent in Aboriginal populations, but is however not disabling because of cultural beliefs about pain. CUCRH’s preliminary research encompassed a qualitative study in one regional and two remote areas in Western Australia. It consisted of interviewing of and yarning with Aboriginal people about their low back pain.
Findings from this research exercise contradicted existing literature and indicated that persistent LBP was substantially disabling for some Aboriginal people with impacts on activities in daily life, employment, sport and family participation, and emotional and cultural well-being.
This preliminary evidence challenged established ideas about how Aboriginal people perceive LBP. Even patients in remote areas showed pejorative biomedical oriented beliefs about the cause of pain (e.g. “bone crunchin’ on bone”) and nurtured a darker future in living with the condition (e.g. “he told me I’d end up in a wheelchair”). These beliefs were more common to those who were more disabled, and originated from health care practitioners such as doctors (in particular medical specialists), physiotherapists and chiropractors. Beliefs were often related to findings on spinal radiological imaging.
This study highlights the pervasive biomedical approaches to LBP and their potential negative impact on disability. This reflects recent concerns about biomedical oriented beliefs in LBP care in other settings.
The “My Back on Track, My Future” project aims to enhance chronic low back pain (CLBP) care at the Geraldton Regional Aboriginal Medical Service (GRAMS), specifically to:
Increase health care practitioner (HCP) awareness of the impact of CLBP beliefs on disabling CLBP and the impact HCPs have on patient CLBP beliefs.
- Improve assessment and management of patient beliefs in CLBP care.
- Improve back pain beliefs of Aboriginal people.
Using a research translation framework four intervention strategies are being implemented:
1. An audit and feedback of LBP care.
2. Small group education workshops for GRAMS health care practitioners (HCP) - primarily GPs and physiotherapists.
3. Development of a GRAMS LBP clinic protocol.
4. Development of culturally appropriate patient information.
Funding for the project originates from Dr Lin’s NHMRC Translating Research into Practice (TRIP) Fellowship. While estimated project completion is scheduled for May 2014, the evolution and dynamism of interactions at work through this study may lead to new possibilities for appropriate ways to deliver health education to Aboriginal people, facilitate knowledge exchange between practitioners and Aboriginal people and areas for further research continue to emerge.