title: Foot orthoses for the management of low back pain: a qualitative approach capturing the patient's perspective.
abstract: BACKGROUND
  The onset of non specific low back pain is associated with heavy lifting, age, female gender, and poor general health, with psychological factors being predictors of it becoming chronic. Additionally, it is thought that altered lower limb biomechanics are a contributory factor, with foot orthoses increasingly being considered as an appropriate intervention by physiotherapists and podiatrists. However, research into the effect of foot orthoses is inconclusive, primarily focusing on the biomechanical effect and not the symptomatic relief from the patient's perspective. The aim of this study was to explore the breadth of patients' experiences of being provided with foot orthoses and to evaluate any changes in their back pain following this experience.
  
  
  METHODS
  Following ethical approval, participants (n = 25) with non-specific low back pain associated with altered lower limb biomechanics were provided with customised foot orthoses. At 16 weeks after being provided with the foot orthoses, conversational style interviews were carried out with each patient. An interpretivistic phenomenological approach was adopted for the data collection and analysis.
  
  
  RESULTS
  For these participants, foot orthoses appeared to be effective. However, the main influence on this outcome was the consultation process and a patient focussed approach. The consultation was an opportunity for fostering mutual understanding, with verbal and visual explanation reassuring the patient and this influenced the patient's beliefs, their engagement with the foot orthoses (physical) and their experience of low back pain (psychological).
  
  
  CONCLUSIONS
  Clinicians need to adopt 'psychologically informed practice' in relation to the provision of foot orthoses. Likewise, researchers should consider all the influencing factors found in this study, both in relation to their study protocol and the outcomes they plan to measure.
authors: Orthotics and Podiatry, Brian Blatchford Building, University of Salford, Salford, M6 6PU, UK.
authors: Anita E
authors: AE
authors: Williams
authors: (Foot & Ankle) Royal Bolton Hospital NHS Foundation Trust, Elective Orthopaedics Service, Bolton, UK.
authors: Lindsay A
authors: LA
authors: Hill
authors: School of Health Sciences, University of Salford, Frederick Road, Salford, M6 6PU, UK.
authors: Christopher J
authors: CJ
authors: Nester
keywords: Foot orthoses; Information; Low back pain; Qualitative research
references: Spine (Phila Pa 1976). 2009 Apr 20;34(9):924-33
references: 19359999
references: J Med Econ. 2012;15(2):245-52
references: 22136441
references: Gait Posture. 2003 Oct;18(2):81-91
references: 14654211
references: Eur Spine J. 2011 Jun;20(6):826-45
references: 21221663
references: Chirurgia (Bucur). 2012 Mar-Apr;107(2):213-7
references: 22712351
references: J Chiropr Med. 2005 Winter;4(4):177-81
references: 19674659
references: J Am Podiatr Med Assoc. 1999 Mar;89(3):109-17
references: 10095332
references: Spine (Phila Pa 1976). 1995 Sep 1;20(17):1889-94
references: 8560337
references: Man Ther. 2008 Feb;13(1):12-28
references: 17658288
references: Phys Ther. 2011 May;91(5):820-4
references: 21451091
references: J Psychosom Res. 2012 Jun;72(6):452-6
references: 22656442
references: Prosthet Orthot Int. 2013 Oct;37(5):384-90
references: 23327838
references: Spine (Phila Pa 1976). 1983 Mar;8(2):141-4
references: 6222486
references: Eur Spine J. 2011 Jan;20(1):19-39
references: 20640863
references: BMC Musculoskelet Disord. 2012 Jun 15;13:104
references: 22703639
references: Clin Biomech (Bristol, Avon). 2006 Jan;21(1):89-98
references: 16182419
references: BMJ. 1999 Jun 19;318(7199):1662-7
references: 10373170
references: Pain. 2012 Jan;153(1):27-32
references: 21978663
references: BMJ. 1998 May 2;316(7141):1356-9
references: 9563990
references: Clin Rehabil. 2012 Oct;26(10):952-9
references: 22275462
references: J Chiropr Med. 2006 Winter;5(4):123-7
references: 19674683
references: J Back Musculoskelet Rehabil. 2009;22(4):219-22
references: 20023353
references: Physiotherapy. 2012 Jun;98(2):110-6
references: 22507360
references: Phys Ther. 2011 May;91(5):804-19
references: 21451098