Abstract
Purpose: To develop a qualitative health diary for patients with low back pain to record their LBP experience over a seven day period; to classify patients at two and six weeks by quantitative function and anxiety questionnaires; and to thematically analyse diary data for predictive validity on outcome. Background: The diary has been traditionally used as a tangible record of everyday process. In the medical setting, diaries have been used to help patients document symptoms and feelings, but usually in a peripheral role as a quantitative adjunct rather than a main study instrument. As a qualitative tool, the health diary exhibits many of the advantages of an in-depth interview in that it yields a personal and subjective account of illness far richer than can be gained by quantitative techniques. Health diaries may allow patients to reveal aspects of their individual illness experience, especially emotional distress, which may otherwise remain hidden. The importance of being able to predict the outcome of LBP in the early stages of an episode is well documented, given its prevalence and drain on healthcare resources. The condition lends itself well therefore to a diary study.
Method: All adults consulting their GP for a new episode of low back pain in three general practices were given a pack containing: a seven-day unstructured, free-text health diary, Roland & Morris Disability Questionnaire (RMDQ), Hospital Anxiety & Depression Questionnaire (HAD) and a General Information questionnaire. Patients were asked to complete the three questionnaires, invited to record their LBP experience over the ensuing 7 days in the diary, and return by post to the researcher. Patients were asked to complete a second and third RMDQ and HAD at two and six weeks following GP consultation. Data collected at the three different time points enabled patients to be categorised at six weeks into one of three groups; fully-recovered, partly-recovered, or not-recovered. Diary entries are being analysed thematically using well-established methods of qualitative thematic analysis to search for predictive validity of diary data.
Results: Preliminary coding of diary entries has so far identified the emergence of 11 primary themes; physical/pain, employment, reflection, emotional, functional, coping, temporality, expectations, social, role/ duties, medication. A number of secondary themes have also been noted from this data. To date, 35 completed diaries have been returned (89% completion rate). We aim to collect 100 data sets before an in-depth thematic and predictive validity analysis can be completed.
Conclusions: No conclusions can be made at this stage, but the emergence of such a rich set of primary themes from the unstructured diaries is encouraging. We hope that in-depth analysis of diary entries will identify themes common to those patients who have not recovered from their LBP at 6 weeks, and who may be at greatest risk of chronicity. The 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 P Dolan. Correspondence should be addressed to him at the British Orthopaedic Association, Royal College of Surgeons, 35-43 Lincoln’s Inn Fields, London WC2A 3PN.
