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Table 2 Key qualitative themes

From: Measuring the impact of chronic low back pain on everyday functioning: content validity of the Roland Morris disability questionnaire

Theme Example quote Number of participants
Walking Walking more slowly “No. I walk, [I just] I don’t walk as fast” P01–006 21/23
Can only walk short distances “Walking, I can’t walk for long periods of time even though I try. I … that’s what one of my exercises. I try to push myself” P01–002
Stairs Using a handrail on stairs/steps “So I’m just real careful when I walk, and I grab handrails when I go down stairs.” P02–007 10/23
Go upstairs more slowly “I have a hard time going up and down steps … I have to hold the railing and I have to do one step up. One step up. One step [at a time moving slowly]-” P03–004
Sitting and standing* Unable to sit or stand for long periods of time “Yeah, I can’t stand ... I mean, I can’t stand too much, I can’t sit down too much.” P01–007 Sitting 23/23; 8/23 also discussed problems with standing
Changing position to get comfortable “Sitting for a long time and standing up, uh, takes a while to, you know, get to where I can, I’m comfortable moving forward I need to get up … Get the, you know, the soreness out. Because if I, if I sit for a long period, it’s really difficult” P01–001
Holding something to get in/out of a chair “at certain times, when I’m either getting up out of a chair, or sitting in a chair, and that it feels like my back has gone out, then I have to really grab on to something.” P03–007
Difficulty getting out of a chair “I mean sometimes it’s just getting up out of a chair, or sometimes it’s sitting in a chair [which cause pain], you know what I mean?” P03–007
Sitting down more “And sometimes if it’s, you know, a 7 or 8 [pain] day, then I’ll sit in the recliner with the heating pad.” P02–003
Bending and kneeling Pain while bending “it’s just pain like on my lower back. Like, say if I bend over” P01–003 12/23
Pain while kneeling “Um, probably like taking stuff out of the washer, to bend down to put it into the dryer … or clean the litter box, when you’re, you know, when you’re ... kneeling and scooping [are more difficult because of the CLBP]” P02–003
Avoiding bending/kneeling or using assistance “[my wife] Ties my shoes for me. Uh, like, uh, bending over is, uh, hard” P01–005
Lifting Pain while lifting Lifting. I, I occasionally do land-scaping at our house and lifting bags of, uh, mulch, bags of dirt, um, doing those a lot definitely brings on the back pain” P02–004 15/23
Avoiding lifting “Uh, I’ll be honest with you. I don’t do nothing heavy. Anything that’s probably 50 pounds or more, I really stay away from that kind of stuff” P01–005
Lying down Lying down was not spontaneously reported in the concept elicitation section of the interviews, it was highlighted as important and relevant to 23/23 participants during the cognitive debriefing of the RMDQ, and as such was pulled into the conceptual model.
Chores/ housework Avoiding/not doing as many jobs around the home “Sometimes, just when I have severe pain or when I feel an onset coming on......I feel like I can’t function correctly. So, I sometimes just decide not walk my dog, clean the house or wash my car.” P01–008 23/23
Being slower/not getting as much done “You know, so instead of knocking half my list on a weekend I might, just get one project done. Just take my time with it”. P02–001
Getting other people to do jobs “I hire young men with strong backs to do jobs around the home [as I can’t do it now].” P02–007
Dressing Trouble putting on socks, shoes and trousers “I’ve not been able to put on my socks and shoes and struggle mightily with my pants” P02–004 19/23
Needing help to get dressed “my girlfriend puts my socks on for me and my shoes … So she [girlfriend] does the pants, you know” P01–005
Getting dressed more slowly “You give yourself a little bit more time to get dressed once in a while or a little bit more time to go somewhere” P02–008
Washing Difficulties with washing “Um, well, you know, in the shower, again, I’m very conscious about all movements, um luckily we have grab bars and things in there. I utilize those. Um, minimize twisting, uh bending, you know all that sort of thing” P02–001 11/23
Driving Getting in and out of cars “[getting] Out of, out of a car, certain cars … The lower the chair or the, whatever you’re sitting on … the harder” P02–008 9/23
Remaining in the same position long periods of time “once that happens [Pain from CLBP], I am not able to go out to work. Um, just because I, I’ll normally be a long time of period in the car [and I can’t sit for that period of time].” P01–008
Work# Not able to work or do same job/taking a break at work “Um, to the point at work where I actually have to stop working for that little bit of time, to try and ease the pain in my back” P03–007 12/23
“Uh-huh (affirmative), because now, yeah, not working because I always have a pain, so I do the best I can” P01–007
Relationships and socializing Missing events/Staying at home “I mean, family picnics, … we missed Christmas Eve with the family. [we have missed] All kinds of family functions over the years. You know, we’ve been married for, uh, 21 years so there’s been lots of things over the years [we have missed because of the CLBP].” P02–004 17/23
Relationships with children and family “my kids I could never do anything with them. I couldn’t play football, or baseball. I tried to coach little league with my son and I couldn’t do it. It was too much pain. I tried to play softball myself and I couldn’t do it. I had to, I had to quit because I couldn’t run”. P03–006
Sexual activities “Um, I haven’t had sex for over, maybe 15 years. [because of my CLBP]” P03–004
Support system ”I have very strong support system, very strong, um, family ties” P01–002
Mood Moody, irritable and short tempered “Oh, yeah. I think, uh, I feel like I’m more agitated easily. I have mood swings, constantly” P01–008 20/23
Depression and anxiety “Um, I, I get depressed because of, thinking about things that I used to do, that I can’t do, and there’s a whole lot of other things” P03–004
Sleep Hard to fall asleep “Oh, yes. Um, I find it hard to fall asleep sometime” P01–008 20/23
Waking up “It’s, um, say, say when I’m lying in bed sleeping at night … I, I wake up and, and, and I got to ... and I can’t move. I got to get up. I’ve got to sit up and I’ve got to sit there for a minute because it hurts so bad” P03–006
Can’t get comfortable “like I’m tossing and turning. I try to do the lying on the side, put the pillow between my legs for my spine and, uh, I tried the pillows up, raising my feet up. You know, I, I did different things” P01–005
Appetite Appetite was not spontaneously reported in the concept elicitation section of the interviews, it was highlighted as important and relevant to 21/23 participants during the cognitive debriefing of the RMDQ, and as such was pulled into the conceptual model.
  1. *Difficulties with standing were only discussed with difficulties with sitting and as such these topics were combined as an example of similar limitations
  2. #Not all participants engaged in paid work