Key factors in back disability prevention: what influences the choice of priorities

STUDY DESIGN: Survey, subgroup analysis, Q-analysis, and analysis of e-mail exchanges. OBJECTIVE: To assess what influences the choice of priorities for interventions to prevent back-related disability. SUMMARY OF BACKGROUND DATA: Back-related disability results from interaction of physical, psychological, occupational, and social factors. However, opinions differ on which factors should be targeted by interventions aimed at preventing disability. METHODS: A Delphi panel (14 researchers and 19 occupational health stakeholders) attempted to reach consensus about the relative impact and modifiability of 32 factors involved in back-related disability. Data gathered during the panel were analyzed using 4 methods: (1) a survey asking panel members what influenced their rankings, (2) subgroup analysis to compare differences in rankings according to members' backgrounds and affiliations, (3) Q-analysis to identify views shared by members, and (4) qualitative analysis of e-mail exchanges during the panel process. RESULTS: Besides research evidence about a factor, we found that the greatest influence was the personal experience of panel members, which included diverse views about the nature of back disability, expectations about how interventions would be implemented, the typical workers or patients seen by them, and their values and principles. The member's educational background and current affiliation played a lesser role in their choice of priorities. The choice of priorities was also influenced by difficulties in separating the impact of a factor from its modifiability, whether the panel member considered occupational or nonoccupational disability, and the intricate linkages between the factors. CONCLUSIONS: This study suggests the choice of priorities is primarily influenced by different views about disability and other components of personal experience. Secondary influences included process difficulties in making a choice. The person's background and affiliation had a weak association with the views and choice of priorities