What’s the low back pain problem represented to be? An analysis of discourse of the Australian policy directives

Abstract

Purpose

Low back pain (LBP) directives provide information about how LBP should be managed, communicated and navigated in complex health systems, making them an important form of policy. This study aimed to examine how LBP is problematised (represented) in Australian directives.

Materials and methods

We employed an analysis of discourse of LBP directives drawing on Bacchi’s “What’s the problem represented to be?” policy problematisation approach.

Results

Our analysis suggests that LBP is problematised as a symptom that tends to improve when individuals take responsibility for themselves, but may require care at times. The way in which LBP is represented in the directives excludes important aspects, such as the uncertainties of scientific knowledge, paradigms other than (post)positivist, multimorbidity, social and structural determinants of health.

Conclusion

LBP directives may benefit from problematisations of LBP that consider the ongoing nature of LBP and broader contextual factors that impact on both LBP outcomes and care, beyond individual responsibility. Consideration of a wider range of paradigms and expanded evidence base may also be beneficial, as these are likely to enable individuals, clinicians and the Australian healthcare system to address LBP while dealing with its complexities, enabling real-world changes to lessen the LBP burden.

IMPLICATIONS FOR REHABILITATION

• Healthcare professionals who work with people who experience low back pain (LBP) may benefit from critically reflecting about discourses embedded in policy directives.

• Healthcare professionals may consider engaging in policy changes processes to expand the discourses on which LBP policy directives rely.

• Healthcare professionals’ ability to enact policy recommendations may be enhanced by consideration of the fluctuating nature of LBP, uncertainties, multimorbidity and determinants of health.

Keywords:

• Low back pain
• “What’s the problem represented to be?” analysis
• directives
• policy
• healthcare system

Disclosure statement

No potential conflict of interest was reported by the author(s).

Correction Statement

This article has been republished with minor changes. These changes do not impact the academic content of the article.

Additional information

Funding

This research is funded by the National Health and Medical Research Council of Australia grant APP1171459 (NHMRC Centre for Research Excellence).