Exploration of changes in understanding and coping strategies among low back pain participants following a short multidisciplinary rehabilitation program with a pain neuroscience education component: a qualitative study alonside a randomized controlled trial

Abstract

Context: A clinical trial was recently conducted to compare the efficacy of pain neuroscience education (PNE) with spinal physiology and ergonomics education as part of a short multidisciplinary rehabilitation program (MRP) in patients with persistent low back pain (LBP). A qualitative study could provide additional context for these results.

Objective: To explore change in understanding and coping strategies in participants with persistent LBP who received PNE as part of a one-week MRP.

Methods: Four medical residents conducted semi-structured interviews of 12 patients with PLBP and who had participated in a one-week multidisciplinary rehabilitation program including a PNE component. Audio recordings were analyzed thematically by three physiotherapists.

Results: The prespecified themes of understanding and coping were present in the data and analyzed with regard to change. Other themes – other forms of learning, other barriers to change, satisfaction and criticisms – also emerged. Pain reconceptualization was frequently associated with new adaptive coping strategies. However conceptual change was found in only half of the participants and does not always appear to be sufficient to lead to changes in coping strategies for pain. Other forms of learning (e.g. experiential learning) and non-educational factors (e.g. motivational ones) also seem to influence conceptual and coping change. Satisfactions (e.g. innovative nature of the approach) and criticisms (e.g. lack of interaction and insufficient connection to everyday life) were reported by certain some participants.

Conclusion: Strategies that promote conceptual change, safety perception, and behavioral change are likely to improve the outcomes of PNE within an MRP.