Exploring potential family factors influencing work participation in persistent back pain: a pilot study of significant others' illness beliefs

Background
The costs of reduced work capacity due to persistent back pain (PBP) greatly outweigh direct medical costs. It is acknowledged that psychosocial factors influence work outcomes in PBP, but influences in the home environment remain largely unexplored. The aims of this pilot study were to explore in-depth beliefs held about PBP by both patients and their significant others, and to identify potential associations between these beliefs and differences in patients' work participation outcomes.

Methods
The Illness Perception Questionnaire (IPQ-R; Moss-Morris et al., 2002) was used as a guide to construct interviews carried out with 10 patients with comparable PBP and their significant others. Five patients were still in employment, five had ceased work due to their PBP. Data were analysed using Template Analysis (e.g. King, 2012).

Findings
There were clear differences between groups in terms of beliefs about causality, recurrence and condition management. Issues around social acceptance of ill health and beliefs about appropriate roles and responsibility in terms of condition management emerged as key themes.

Discussion
Findings illustrate the complexity of long-term chronic health conditions such as PBP and provide an insight into some of the wider social influences that may impact on functional outcomes. Significant others share, and may reinforce, some important beliefs held by PBP patients about their condition. Identifying potentially unhelpful cognitions and behavioural responses could help in the design of family intervention programmes aimed at improving work participation outcomes in PBP.