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Table 2 Clusters, subclusters and representative statements

From: A validity-driven approach to the understanding of the personal and societal burden of low back pain: development of a conceptual and measurement model

Clusters and subclusters Representative statements
Loss of expectations Limitations on fulfillment of goals in life
Loss of enjoyment Loss of enjoyment in life
Loss of self-confidence Low self-esteem, especially from loss of roles
  Feel helpless when people stop you doing things
   Negative affect Irritation, anger and frustration
   Worry and negative beliefs about the future Worry about the future
  Fear that severe back pain will occur again
   Global malaise  
Secondary health effects Difficult to address other health issues
  May lead to weight gain
Effort of life/daily grind Tiredness
  Makes you feel old
  Loss of motivation in life
Executive challenge Always having to think about what you can and cannot do
   Domestic psychosocial challenges  
Loss of family and intimate involvement Left out of family activities
  Difficulty caring for others
Loss of independence Need to ask for help to do things
   Negative reactionsa  
Challenged integrity/feeling believed May be seen as a malingerer
  Wrongly considered lazy by others
Self-worth degraded by how you feel others see you Always trying to hide pain from family so they do not worry
  Feel like a burden on workmates
Negative/discriminatory actions by others Bullied by others
  May lose friends
   Functioning outside the home Makes it hard to travel
  Leisure activities are limited
   Specific physical limitations Daily living is hard including basic self-care
  Difficulty lifting things
  Hard to sit
   General physical impact More and more physically unfit
  Fall easily
   Treatment services  
Frustration of treatment (quality) Waste time and money on dubious treatments and practitioners
  Unnecessary surgery and the problems this causes
Frustration with healthcare providers Doctors not understanding there is anything wrong with you
  Back pain can make you distrust the medical profession
   Condition burden  
Impact on othersb Need help from carers
Medication Dependent on more and more medication
Financial costs/expenses Costs of treatment and equipment (necessary and unnecessary)
   Challenges when out of work Difficult to get back to paid employment
  Reduced employment options, now and for the future
   Challenges when workingc Many limitations on what tasks can be done
   Effects of employment challenges Difficult to get health insurance
  Reduced income resulting in poverty
  1. aSee also Employment. bSee also Challenges when working, Psychosocial. cSee also Impact on others.