Key factors in back disability prevention: a consensus panel on their impact and modifiability

STUDY DESIGN: Modified Delphi panel using Q-methodology. OBJECTIVE: To reach consensus on the relative impact and modifiability of factors that might prevent participation restrictions in people with back pain as defined by the WHO International Classification of Functioning, Disability and Health. SUMMARY OF BACKGROUND DATA: Back disability prevention should focus on factors with large impact that are relatively easy to change and supported by most stakeholders. An evidence-based consensus panel can provide interim direction until definitive evidence is available. METHODS: Evidence summaries for 32 factors were used by 33 researchers and stakeholders in a 3-round Delphi process to rank the factors' relative impact and modifiability. Consensus was judged as strong (>85% of panel members), moderate (50%-84%), or low (33%-49%). RESULTS: Most available research focused on return to work and often left unexplored other participation domains and environmental factors at home. The panel had substantial disagreements, particularly on the impact of changes to physical functioning and activities required at work. After 3 rounds, there was strong consensus that care provider reassurance had a high impact. There was moderate consensus that expectation of recovery and decreased fears had a high impact. Back supports, care provider reassurance, and patient knowledge were deemed most modifiable. CONCLUSIONS: Until definitive evidence is available, back disability prevention interventions will likely need to address multiple factors simultaneously and emphasize efforts to improve care provider reassurance. Consensus findings may vary depending on the panel. Research on nonoccupational participation, environmental factors at home, and reasons for discordant interpretation of evidence is needed