Low back pain (LBP) causes more functional disability than any other condition in low- and middle-income populations. Particularly among South Asian populations, years lived with disability (YLD) due to LBP have almost been doubled in last three decades (from 6.01 million in 1990 to 10.79 million in 2017). Females experience 1.3 times more YLD's (6.25 million) than males. The problem of LBP among Pakistanis around the world (the 5th largest population in the world) is not well understood, and imposes substantial burden on economies and healthcare systems. The financial burden attributed to LBP comes from indirect costs (such as productivity loss) and direct costs (such as unnecessary medical scans, not utilizing conservative interventions and non-adherence to treatment guidelines by healthcare professionals). Biopsychosocial approaches (e.g., exercise, cognitive behavioural therapy, pain education, and self-management) are considered the best evidence-based practice for management of LBP in western developed countries, however, the successful implementation of biopsychosocial framework for LBP management in Pakistani population may be influenced by cross-cultural differences and adherence to guidelines by healthcare professionals. The scarcity of literature supporting the applicability of biopsychosocial management of LBP in Pakistani population creates several gaps. Till date, no research has examined or summarized the current state of knowledge regarding LBP in Pakistan. A review of literature is necessary to avoid duplicating efforts by researchers and to conserve limited resources. Further, examination of attitudes, beliefs and practices of Pakistani healthcare professionals and patients is fundamental to understand the constraints to the implementation of biopsychosocial approaches for LBP and barriers in adherence to guidelines by healthcare professionals in clinical practice. Even so, the above information will not be pragmatic without subsequently addressing the influence of cross-cultural differences between western and Pakistani culture for successful implementation of biopsychosocial model of LBP care. Thus, the availability of (i) assessment tools for psychosocial determinants of LBP related disability (i.e., kinesiophobia, catastrophizing, psychological distress, self-efficacy and pain resilience) and (ii) interventional tools (i.e., culturally relevant pain education material in native language) are significant potential limitations to the implementation of biopsychosocial care among Pakistani population. The cross-cultural adaptation of these tools will allow objective investigation of clinical application of biopsychosocial management of LBP in Pakistani population in Pakistan and Australia. Therefore, in my doctoral project I will undertake four research studies to address these gaps in the literature.
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