Abstract
Background and Purpose
Chronic low back pain (CLBP) can be constant or episodic. Fluctuations are common. We present two different pictures of the CLBP experience; timelines illustrating back pain over time and ‘web diagrams’ showing a snapshot of a phase in time.
Methods
Semi structured interviews from 34 participants from the UK BeST trial included timelines drawn collaboratively by the researcher and participant. Symptoms, events, treatment and consultations were arranged chronologically along a timeline. Initial thematic analysis on 63 interviews gave bio-psychosocial themes that were spoken about in an integrated way. Further analysis explored these interactions between themes. Interactions were classified as; helpful to recovery, unhelpful or mixed. Web diagrams were drawn for each interview and classified as Dense- mostly unhelpful interactions, Open – a combination of helpful and unhelpful interactions and Sparse – mostly helpful interactions.
Results
Timelines were easy to compile and helped participants to describe their CLBP history. Timelines elicited rich data and promoted comparisons within and between cases aiding reflexivity. Web diagrams graphically illustrated the complexities of a person's LBP experience at that time. Dense webs showed a complex ‘locked in’ presentation. Open webs showed some helpful and less unhelpful interactions suggesting change may be easier to facilitate and sparse webs suggested that the participant was managing their own recovery.
Conclusions
Timelines are a useful tool to assist history taking and facilitate discussion. Web diagrams illustrate the complex presentations often found in CLBP. Identifying patterns of unhelpful as well as helpful interactions between bio psychosocial factors may aid clinicians in their treatment approaches.
Conflicts of interest: No conflicts of interest
Sources of funding: Funded by the Health Technology Assessment Programme
