Perceptions of low back pain in people with lower limb amputation: a focus group study

Abstract

Purpose: This study explored the perceptions of people with a lower limb amputation as to important factors contributing to their low back pain (LBP). Method: Semi-structured interviews were conducted (three focus groups and two individual interviews), with 11 participants with lower limb amputation and on-going LBP. The discussions were analysed using the General Inductive Approach. Results: Five major categories were identified with “uneven posture and compensatory movements” of the back perceived to be the main contributor to LBP. “Fatigue” during functional activities and “prosthesis-related factors” may affect the “uneven movements” of the back further leading to LBP. “Multiple pain conditions” (i.e. phantom limb pain, non-amputated limb pain) could influence the pain perceptions contributing to LBP. “Self-management strategies” in the form of maintaining optimal physical fitness and support from health care professionals helped to manage LBP symptoms, thereby assisted in preventing chronicity. Conclusion: The results suggest “uneven movements” of the back affected by “fatigue” and “prosthesis-related factors” may alter the mechanical loading of the spine during functional activities and contribute to LBP. While being physically active helped participants cope with their LBP, identifying and addressing “uneven movements” in the back during the performance of functional activities may be important to devise prevention strategies for LBP.

Implications for Rehabilitation

• People with lower limb amputation perceive uneven posture and compensatory movements of the back as a major contributor to their low back pain (LBP).

• Identifying and addressing uneven mechanical loading of the back during functional activities is important to devise prevention strategies for LBP.

• Advice to stay active and being physically fit helps in positive coping to LBP in people with lower limb amputation.

• Amputation
• causal beliefs
• low back pain
• lower limb
• risk factors

Acknowledgements

We would like to acknowledge Mr Mark MacDowell and Mrs Sue Kennedy from Dunedin Artificial Limb Centre for helping to recruit the study participants. We would also like to thank all the participants for sharing their experience. The University of Otago Ethics Committee approved this study. All participants gave written informed consent before data collection began.

Declaration of interest

This study was supported by New Zealand Artificial Limb Services – A national body providing artificial limb services for persons with amputation.