title: Key factors in back disability prevention: a consensus panel on their impact and modifiability.
abstract: METHODS
  Modified Delphi panel using Q-methodology.
  
  
  OBJECTIVE
  To reach consensus on the relative impact and modifiability of factors that might prevent participation restrictions in people with back pain as defined by the WHO International Classification of Functioning, Disability and Health.
  
  
  BACKGROUND
  Back disability prevention should focus on factors with large impact that are relatively easy to change and supported by most stakeholders. An evidence-based consensus panel can provide interim direction until definitive evidence is available.
  
  
  METHODS
  Evidence summaries for 32 factors were used by 33 researchers and stakeholders in a 3-round Delphi process to rank the factors' relative impact and modifiability. Consensus was judged as strong (>85% of panel members), moderate (50%-84%), or low (33%-49%).
  
  
  RESULTS
  Most available research focused on return to work and often left unexplored other participation domains and environmental factors at home. The panel had substantial disagreements, particularly on the impact of changes to physical functioning and activities required at work. After 3 rounds, there was strong consensus that care provider reassurance had a high impact. There was moderate consensus that expectation of recovery and decreased fears had a high impact. Back supports, care provider reassurance, and patient knowledge were deemed most modifiable.
  
  
  CONCLUSIONS
  Until definitive evidence is available, back disability prevention interventions will likely need to address multiple factors simultaneously and emphasize efforts to improve care provider reassurance. Consensus findings may vary depending on the panel. Research on nonoccupational participation, environmental factors at home, and reasons for discordant interpretation of evidence is needed.
authors.affiliation: Institute for Work & Health, Toronto, Ontario, Canada.
authors.forename: Jaime
authors.initials: J
authors.lastname: Guzman
authors.forename: Jill
authors.initials: J
authors.lastname: Hayden
authors.forename: Andrea D
authors.initials: AD
authors.lastname: Furlan
authors.forename: J David
authors.initials: JD
authors.lastname: Cassidy
authors.forename: Patrick
authors.initials: P
authors.lastname: Loisel
authors.forename: John
authors.initials: J
authors.lastname: Flannery
authors.forename: Jane
authors.initials: J
authors.lastname: Gibson
authors.forename: John W
authors.initials: JW
authors.lastname: Frank
mesh_terms: D000203:Activities of Daily Living; D001294:Attitude to Health; D001416:Back Pain / Q000503:physiopathology / Q000517:prevention & control*; D003697:Delphi Technique; D004185:Disability Evaluation; D006233:Persons with Disabilities; D019317:Evidence-Based Medicine; D007722:Health Knowledge, Attitudes, Practice; D006282:Health Personnel; D006801:Humans; D011315:Preventive Medicine / Q000379:methods*; D011369:Professional-Patient Relations