Abstract
The aim of this study was to develop a qualitative health diary with predictive validity on outcome in patients with new episodes of low back pain.
Diaries have been used as a tangible record of everyday process. In the medical setting, diaries have been used to help patients document symptoms and feelings. As a qualitative tool, health diaries exhibit many of the advantages of in-depth interviews, in that they yield a personal account of illness. far richer than by quantitative techniques. The importance of predicting outcome of LBP in the early stages is well documented, given its prevalence and drain on health-care resources. The condition lends itself well therefore to a diary study.
New episodes of low back pain consulting their GP in three general practices completed a 7 day free-text health diary and a series of validated questionnaires, designed to measure function (RMDQ), anxiety/depression (HAD) and general demographics. Questionnaires were repeated at 2 and 6 weeks. Patient outcome was then categorised into one of 3 groups: fully-recovered, partly-recovered, or not-recovered based on RMDQ scores. Diary entries are now being analysed thematically using well-established methods of qualitative thematic analysis to search for predictive validity of diary data.
At 6 weeks, 47 patients had fully recovered, 26 had partly recovered and 12 had not recovered. Preliminary coding of diary entries has identified the emergence of 11 primary themes. Physical/pain, employment, reflection, emotional, functional, coping, temporality, expectations, social, rolelduties, medication. Findings to date suggest that patients who don’t recover at six weeks make reference to far more emotional and negative physical/coping/functional discourse in their diaries than those patients who recover partly or fully.
There is evidence of the emergence of themes common to patients who have not recovered at 6 weeks and who may be at greatest risk of chronicity. If further qualitative analysis confirms this trend, the free-text health diary may prove to be an easily administered, cost-effective and valid predictor of outcome in the very early stages of an episode of LBP.
The abstracts were prepared by Dr C Pither. Correspondence should be addressed to him at the British Orthopaedic Association, Royal College of Surgeons, 35–43 Lincoln’s Inn Fields, London WC2A 3PN
