title: Perceptions of low back pain in people with lower limb amputation: a focus group study.
abstract: OBJECTIVE
  This study explored the perceptions of people with a lower limb amputation as to important factors contributing to their low back pain (LBP).
  
  
  METHODS
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Centre for Health, Activity and Rehabilitation Research, School of Physiotherapy, University of Otago , Dunedin , New Zealand .
authors.forename: Hemakumar
authors.initials: H
authors.lastname: Devan
authors.forename: Allan B
authors.initials: AB
authors.lastname: Carman
authors.forename: Paul A
authors.initials: PA
authors.lastname: Hendrick
authors.forename: Daniel Cury
authors.initials: DC
authors.lastname: Ribeiro
authors.forename: Leigh A
authors.initials: LA
authors.lastname: Hale
mesh_terms: D000328:Adult; D000368:Aged; D000671:Amputation, Surgical / Q000009:adverse effects*; D005221:Fatigue; D005260:Female; D017144:Focus Groups; D006801:Humans; D017116:Low Back Pain / Q000503:physiopathology* / Q000534:rehabilitation; D035002:Lower Extremity / Q000601:surgery*; D008297:Male; D008875:Middle Aged; D058748:Pain Perception; D010591:Phantom Limb; D010809:Physical Fitness; D004856:Postural Balance; D012648:Self Care; D055815:Young Adult
keywords: Amputation; causal beliefs; low back pain; lower limb; risk factors