Abstract
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.
Similar content being viewed by others
References
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.
Maniadakis N, Gray A. The economic burden of back pain in the UK. Pain. 2000;84:95–103.
Osborn M, Smith JA. The personal experience of chronic benign lower back pain: an interpretative phenomenological analysis. Brit J Health Psychol. 1998;3:65–83.
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.
Dean SG, Smith J, Payne S, Weinman J. Managing time: an interpretative phenomenological analysis of patients’ and physiotherapists’ perceptions of adherence to therapeutic exercise for low back pain. Disabil Rehabil. 2005;27:625–36.
Woby SR, Roach NK, Urmston M, Watson PJ. The relation between cognitive factors and levels of pain and disability in chronic low back pain patients presenting for physiotherapy. Eur J Pain. 2007;11:869–77.
Waddell G, Somerville D, Henderson I, Newton M, Main CJ. A fear avoidance beliefs questionnaire (FABQ) and the role of fear avoidance beliefs in chronic low back pain and disability. Pain. 1993;52:157–68.
Vlaeyen J, Linton S. Fear-avoidance and its consequences in chronic musculoskeletal pain: a state of the art. Pain. 2000;85:317–32.
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.
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.
Casserley-Feeney SN, Bury G, Daly L, Hurley D. Physiotherapy for low back pain: differences between public and private healthcare sectors in Ireland, a retrospective study. Man Ther. 2008;13:441–9.
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.
Synder CR, Lopez SJ, editors. Handbook of positive psychology. Oxford: Oxford University Press; 2002.
Dunn DS, Dougherty SB. Prospects for a positive psychology of rehabilitation. Rehabil Psychol. 2005;50:305–11.
Tveito TH, Shaw WS, Huang Y-H, Nicholas M, Wagner G. Managing pain in the workplace: a focus group study of challenges, strategies and what matters most to workers with low back pain. Disabil Rehabil. 2010;32:2035–45.
Coole C, Watson PJ, Drummond A. Staying at work with back pain: patients’ experiences of work-related help received from GPs and other clinicians. A qualitative study. BMC Musculoskelet Disord. 2010;11:190.
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.
Holmberg S, Thelin A, Stiernstrom EL, Svardsudd K. Psychological factors and low back pain, consultations, and sick leave among farmers and rural referents: a population-based study. J Occup Environ Med. 2004;46:993–8.
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.
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.
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.
World Health Organisation. The international classification of functioning, health and disability. Geneva: World Health Organisation; 2001.
Johnson RB, Onwuegbuzie AJ. Mixed methods research: a research paradigm whose time has come. Educ Res. 2004;33:14–26.
Broadbent E, Petrie KJ, Main J, Weinman J. The Brief Illness Perception Questionnaire. J Psychosom Res. 2006;60:631–7.
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.
Moss-Morris R, Weinman J, Petrie KJ, Horne R, Cameron LD, Buick D. The revised illness perception questionnaire (IPQ-R). Psychol Health. 2002;17:1–16.
Bandura A. Self-efficacy: toward a unifying theory of behavioural change. Psychol Rev. 1977;84:191–215.
Taylor WJ, Dean SG, Siegert RJ. Differential association of general and health self-efficacy with disability, health-related quality of life and psychological distress from musculoskeletal pain in a cross-sectional general adult population survey. Pain. 2006;125:225–32.
Luszczynska A, Scholz U, Schwarzer R. The general self-efficacy scale: multicultural validation studies. J Psychol. 2005;139:439–57.
Leganger A, Kraft P, Roysamb E. Perceived self-efficacy in health behaviour research: conceptualisation, measurement and correlates. Psychol Health. 2000;15:51–69.
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.
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.
Nvivo 8. Research software for analysis. QSR International; 2007. Available from: www.qsrinternational.cpm/products_nvivo.aspx.
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.
Taylor WJ. Musculoskeletal pain in the adult New Zealand population: prevalence and impact. N Z Med J. 2005;118(1221):15.
Snelgrove S, Liossi C. An interpretative phenomenological analysis of living with chronic low back pain. Brit J Health Psychol. 2009;14:735–49.
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.
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.
Tiemessen IJ, Hulshof CTJ, Frings-Dresen MHW. An overview of strategies to reduce whole-body vibration exposure on drivers: a systematic review. Int J Ind Ergonom. 2007;37:245–56.
Milosavljevic S, Bergman F, Carman AB, Rehn B. All-terrain vehicle use in agriculture: exposure to whole body vibration and mechanical shocks. Appl Ergon. 2010;41:530–5.
Kennett DJ, O’Hagan FT, Cezer D. Learned resourcefulness and the long-term benefits of a chronic pain management program. J Mix Methods Res. 2008;2:317–38.
Lazarus RS, Folkman S. Stress appraisal and coping. New York: Springer; 1984.
MacEachen E, Kosny A, Ferrier S, Chambers L. The ‘Toxic Dose’ of system problems: why some injured workers don’t return to work as expected. J Occup Rehabil. 2010;. doi:10.1007/s10926-010-9229-5.
Judd F, Jackson H, Fraser C, Murray G, Robins G, Komiti A. Understanding suicide in Australian farmers. Soc Psychiatry Psychiatr Epidemiol. 2006;41(1):1–10.
Larson NC, Dearmont M. Strengths of farming communities in fostering resilience in children. Child Welf. 2002;81:821–35.
Pincus T, Burton AK, Vogel SDO, Field AP. A systematic review of psychosocial factors as predictors of chronicity/disability in prospective cohorts of low back pain. Spine. 2002;27:E109–20.
Roland M, Waddell G, Klaber Moffett J, Burton K, Main C, Cantrell T. The back book. Norwich: The Stationary Office; 1996.
Miller SM, Brody DS, Summerton J. Styles of coping with threat: Implications for health. J Pers Soc Psychol. 1998;45:223–36.
Fadyl J, McPherson K. Understanding decisions about work after spinal cord injury. J Occup Rehabil. 2010;20:69–80.
McCracken LM, Eccleston C. A prospective study of acceptance of pain and patient functioning with chronic pain. Pain. 2005;118:164–9.
Fadyl J, McPherson K. Return to work after injury: a review of evidence regarding expectations and injury perceptions, and their influence on outcome. J Occup Rehabil. 2008;18:362–74.
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.
Lewis JS, Kersten P, McCabe CS, McPherson KM, Blake DR. Body perception disturbance: a contribution to pain in complex regional pain syndrome (CRPS). Pain. 2007;135:111–9.
Hoffmann V, Probst K, Christinck A. Farmers and researchers: how can collaborative advantages be created in participatory research and technology development? Agr Hum Values. 2007;24:355–68.
Acknowledgments
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.
Author information
Authors and Affiliations
Corresponding author
Appendices
Appendix 1: Brief Illness Perception Questionnaire Adapted for Low Back Pain
Appendix 2: Example of Semi-Structured Interview Template with Individual Adaptation (in Italics)
Rights and permissions
About this article
Cite this article
Dean, S.G., Hudson, S., Hay-Smith, E.J.C. et al. Rural Workers’ Experience of Low Back Pain: Exploring Why They Continue to Work. J Occup Rehabil 21, 395–409 (2011). https://doi.org/10.1007/s10926-010-9275-z
Published:
Issue Date:
DOI: https://doi.org/10.1007/s10926-010-9275-z