Comparison of the repercussions of cLBP in four French-speaking countries.
BACKGROUND
Sociocultural factors may influence the impact of chronic low back pain (cLBP) on patients. The goal of this study was to compare pain and disability levels, and psychobehavioural parameters in four French-speaking countries in patients with cLBP.


METHODS
Two hundred and seventy-eight patients were included: 83 in France, 36 in Morocco, 75 in the Ivory Coast and 84 in Tunisia. Demographic data were collected; pain was assessed using a visual analogue scale (VAS), disability with the Quebec scale, psychobehavioural factors by the hospital anxiety depression scale (HAD), the fear and avoidance beliefs questionnaire (FABQ) and the coping strategy questionnaire (CSQ). A Student t-test was used to compare means. Anova (covariance) was used to test for a "Country Effect", i.e. the incidence of country on outcomes.


RESULTS
There was no difference in disability levels between countries. A "country effect" was found (p<0.001) for pain (F=2.707), anxiety (F=3.467), depression (F=5.137), fear and avoidance beliefs regarding professional activity (F=1.974) and physical activity (F=5.076), strategy of distraction, dramatization, efforts to ignore pain, prayer, seeking social support and reinterpretation (p<0.01). Pain level was higher in Morocco (p<0.05); anxiety, depression, fear and avoidance beliefs about physical activities were higher in Tunisia (p<0.05) and fear and avoidance beliefs about professional activities were higher in the Ivory Coast (p<0.01). Among the coping strategies used, distraction, dramatization, prayer and search for social support were used more in the Ivory Coast; reinterpretation in Tunisia; seeking social support was less common in France.


CONCLUSIONS
In this population of patients with cLBP, despite similar disability levels across the four French-speaking countries, there were considerable variations in pain level and psychobehavioural repercussions.
Genêt
F
F
Service de médecine physique et de réadaptation, hôpital maritime de Berck, groupe hospitalier Raymond-Poincaré, 104, boulevard Raymond-Poincaré, 92380 Garches, France. francois.genet@rpc.aphp.fr
Autret
K
K
Roche
N
N
Lapeyre
E
E
Schnitzler
A
A
Mandjui
B
B
Manou
B
B
Dziri
C
C
Helleuch
H
H
Rejeb
N
N
Oudghiri
N
N
Revel
M
M
Poiraudeau
S
S
D000223:Adaptation, Psychological; D000328:Adult; D000368:Aged; D000704:Analysis of Variance; D001007:Anxiety / Q000208:ethnology; D001294:Attitude to Health / Q000208:ethnology*; D001362:Avoidance Learning; D002908:Chronic Disease; D017281:Cost of Illness; D007560:Cote d'Ivoire / Q000453:epidemiology; D003431:Cross-Cultural Comparison; D003863:Depression / Q000208:ethnology; D006233:Persons with Disabilities / Q000523:psychology / Q000706:statistics & numerical data; D005239:Fear / Q000523:psychology; D005260:Female; D005602:France / Q000453:epidemiology; D006801:Humans; D015994:Incidence; D007802:Language; D017116:Low Back Pain / Q000150:complications / Q000175:diagnosis / Q000208:ethnology* / Q000517:prevention & control; D008297:Male; D008875:Middle Aged; D009018:Morocco / Q000453:epidemiology; D010147:Pain Measurement; D011446:Prospective Studies; D011795:Surveys and Questionnaires; D014416:Tunisia / Q000453:epidemiology