Patients' interpretations of a counselling intervention for low back pain: a narrative analysis

Low back pain often becomes a chronic condition and causes physical, psychological, social, and occupational impairment. Despite huge allocations of resources into the healthcare system and the labour market for treating and preventing low back pain, problems related to low back pain persist. A Danish randomised controlled trial identified an effective counselling intervention on low back pain patients' physical function, bodily pain and sick leave. Counselling addressed experienced workplace barriers and physical activity.

The objective of the present study was to achieve a deeper understanding of how the patients interpreted the explanatory resources that were made available to them during the intervention, and how they integrated these resources into their personal biographies.

The present study was a qualitative analysis of a purposive sample of transcripts of status interviews performed during the randomised controlled trial's intervention.

Between two individual counselling sessions, all 110 participants were interviewed about their perspectives on adhering to their individual plans for reaching specific goals for adjustments at their workplace and for enhancing physical activity. These plans were developed and agreed upon by the participants and the counsellor. A sample (n=20) of these interviews was analysed in the present study using the three steps in Ricoeur's method for text analysis. Bury's concept of chronic illness as a biographical disruption was used as a theoretical framework for further interpretations of the dataset.

The participants valued the counsellor's open inquiry into the problems they had with their back. The participants' active engagement in creating new explanatory systems was crucial for their benefits from the intervention. If participants managed to change their health behaviour, it assisted them in transforming from being passive victims of pain into becoming active and in control. Participants who did not feel that they were sufficiently able to adhere to the treatment plan felt increasingly stigmatised, because they understood themselves to be in a position of disgrace in their own eyes and in the eyes of the system that offered them help.

The counsellor's assistance in crafting the first possible and manageable steps towards returning to work and enhancing exercising supported the participants' commitment to the treatment plan.