Open Access Open Badges Research article

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

Rachelle Buchbinder12*, Roy Batterham3, Gerald Elsworth3, Clermont E Dionne45, Emma Irvin6 and Richard H Osborne3

Author Affiliations

1 Monash Department of Clinical Epidemiology, Cabrini Hospital, 183 Wattletree Road, Malvern, Victoria 3144, Australia

2 Department of Epidemiology and Preventive Medicine, School of Public Health and Preventive Medicine, Monash University, The Alfred Centre, 99 Commercial Rd, Melbourne, Victoria 3004, Australia

3 Public Health Innovation, Faculty of Health, Deakin University, 221 Burwood Highway, Burwood, Victoria 3125 Australia

4 Population Health Research Unit (URESP), Research Centre of the Laval University Affiliated Hospital, Hôpital du St-Sacrement, 1050 chemin Ste-Foy, Québec, G1S 4L8, Canada

5 Department of Rehabilitation, Faculty of Medicine, Laval University, Hôpital du St-Sacrement, 1050 chemin Ste-Foy, Québec, G1S 4L8, Canada

6 Institute for Work & Health, 81 University Avenue, Suite 800, Toronto, Ontario, M5G 2E9, Canada

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Arthritis Research & Therapy 2011, 13:R152  doi:10.1186/ar3468

Published: 20 September 2011



While the importance and magnitude of the burden of low back pain upon the individual is well recognized, a systematic understanding of the impact of the condition on individuals is currently hampered by the lack of an organized understanding of what aspects of a person's life are affected and the lack of comprehensive measures for these effects. The aim of the present study was to develop a conceptual and measurement model of the overall burden of low back pain from the individual's perspective using a validity-driven approach.


To define the breadth of low back pain burden we conducted three concept-mapping workshops to generate an item pool. Two face-to-face workshops (Australia) were conducted with people with low back pain and clinicians and policy-makers, respectively. A third workshop (USA) was held with international multidisciplinary experts. Multidimensional scaling, cluster analysis, participant input and thematic analyses organized participants' ideas into clusters of ideas that then informed the conceptual model.


One hundred and ninety-nine statements were generated. Considerable overlap was observed between groups, and four major clusters were observed - Psychosocial, Physical, Treatment and Employment - each with between two and six subclusters. Content analysis revealed that elements of the Psychosocial cluster were sufficiently distinct to be split into Psychological and Social, and a further cluster of elements termed Positive Effects also emerged. Finally, a hypothesized structure was proposed with six domains and 16 subdomains. New domains not previously considered in the back pain field emerged for psychometric verification: loss of independence, worry about the future, and negative or discriminatory actions by others.


Using a grounded approach, an explicit a priori and testable model of the overall burden of low back pain has been proposed that captures the full breadth of the burden experienced by patients and observed by experts.