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P03 What do people in the general population think about back pain – and does it matter? a systematic review
  1. L Morton1,2,3,4,
  2. M de Bruin3,4,
  3. GJ Macfarlane1,2,4
  1. 1Epidemiology Group, University of Aberdeen, Aberdeen, UK
  2. 2Aberdeen Centre for Arthritis and Musculoskeletal Health, University of Aberdeen, Aberdeen, UK
  3. 3Health Psychology Group, University of Aberdeen, Aberdeen, UK
  4. 4Arthritis Research UK/MRC Centre for Musculoskeletal Health and Work, University of Southampton, Southampton, UK


Background Mass media campaigns have aimed to change the public’s beliefs about back pain to ultimately change behaviours like healthcare utilisation. Most campaigns demonstrated shifts in beliefs without concomitant changes in behaviours. This raises the question of whether the beliefs targeted by campaigns were prevalent and related to the behaviours they tried to change. The objectives of this review were to: i) describe the prevalence of particular beliefs about back pain, ii) identify any cross-sectional relationships between these beliefs and other (e.g. sociodemographic) factors, and iii) assess the evidence for beliefs about back pain to predict future back pain-related outcomes within the general population.

Methods A systematic review of the literature was carried out using searches for ‘back pain’, ‘beliefs’ and ‘general population’ in five literature databases (MEDLINE, PsycINFO, Embase, ISI Web of Science, CINAHL). Articles were screened, data was extracted and quality was assessed by two reviewers. Results across the three aims were tabulated and narratively synthesised.

Results 4480 unique records were identified and 30 articles were included. Beliefs about back pain were measured using eight questionnaire instruments and 57 unique items. These represented beliefs about: consequences, fearing and avoiding pain/activities, catastrophising, and other specific beliefs. Where a given construct was assessed by more than one study, most samples agreed, on average, with beliefs about negative consequences of back pain (8/12), while most disagreed with fear avoidance beliefs about activity (4/5). Negative beliefs about consequences were consistently associated with being older, unemployed, having completed less education, lower self-rated health, and more pain and disability; they were predictive of future back pain-related outcomes.

Discussion Most samples agreed with beliefs about back pain’s negative consequences and these beliefs predicted some back pain-related outcomes. However, based on current evidence, we cannot say whether these beliefs impact future management behaviours. The relationships between other belief constructs and future management behaviours has not been investigated in the general population. Previous campaigns’ mixed success could, in part, be due to not targeting beliefs which were related to behaviours they hoped to change. Existing evidence suggests that this relationship has not been assessed in the general population; it must be elucidated prior to developing future campaigns.

  • illness beliefs
  • back pain
  • systematic review

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