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Table 3 Mapping the themes identified in coding to the RMDQ items

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

RMDQ - item number and summary

Overarching concept

Theme

Subcode

Note

1 – I stay at home most of the time because of my back

Other

Relationships and Socializing

Missing events/staying at home

Participants reported missing events due to the functional limitations they experience from their CLBP. This is a functional consequence of the physical limitations experienced. Those who engaged in paid work also reported missed work days due to pain.

Activities

Work*

Not able to work or do same job/taking a break at work

2 – I change position frequently

Mobility

Sitting and standing

Changing position to get comfortable

Participants reported having to change positions regularly to reduce their CLBP. This created problems with various activities that require sitting or standing in one position for a long period of time. Thus, this a physical functioning limitation due to CLBP.

Driving and certain types of work are examples of specific activities discussed in relation to this.

Activities

Driving*

Remaining in the same position for long periods of time

Activities

Work*

Not able to work or do same job/taking a break at work

3 – I walk more slowly

Mobility

Walking

Walking more slowly

Participants reported having to walk more slowly because of the pain and need for smaller steps/avoiding tripping. This is a physical functioning limitation due to CLBP.

4 – Not doing jobs around home

Mobility

Lifting

Pain while lifting

Avoiding lifting

Participants reported that they cannot do jobs around the home like they used to because of their pain and other physical limitations due to their CLBP. Participants talked about engaging in a range of chores such as mopping the floor or taking the trash out, as well as the action needed to perform jobs such as lifting things, Thus, this is a physical functioning limitation due to CLBP.

Activities

Chores/housework

Avoiding/not doing as many jobs around the home

Being slower/not getting as much done

5 – I use a handrail to get upstairs

Mobility

Stairs

Using a handrail on stairs/steps

Participants reported having to use a handrail when using stairs/steps because of pain and limited mobility due to CLBP. Thus, this is a physical functioning limitation due to CLBP.

6 – I lie down to rest

Mobility

Lying down

Participants identified this as important during the CD discussion, although this was not spontaneously discussed during CE.

Participants reported lying down to rest because of their pain, and although not directly stated it was implied that this impacts upon functional ability as time spent lying down limits ability to take part fully in other daily activities.

Work was an example of a specific activity impacted by the need to take a break, lie down and rest by those who engaged in paid work.

Activities

Work*

Not able to work or do same job/taking a break at work

7 – Hold on to get out of an easy chair

Mobility

Sitting and standing

Holding something to get in/out of chair

Participants reported needing to hold something to get out of a chair due to pain and limited mobility. This is a physical functioning due to CLBP.

8 – I try and get other people to do things for me

Mobility

Bending and kneeling

Pain while bending

Pain while kneeling

Avoiding bending/kneeling

Participants reported that their inability to do all their usual jobs, for example, because of being unable to lift things, having pain while bending and kneeling, meant that they would now get other people to do things for them. This is an everyday functional consequence of the physical limitations experienced.

Washing (self) and housework are examples of specific activities discussed in relation to this, in addition this also came up for some individuals in relation to tasks that needed to be done whilst at work.

Mobility

Lifting

Pain while lifting

Avoiding lifting

Activities

Chores/housework

Getting other people to do jobs

Activities

Washing*

Difficulties with washing

Activities

Work*

Not able to work or do same job/taking a break at work

9 – I get dressed more slowly

Activities

Dressing

Getting dressed more slowly

Participants reported they took longer to get dressed due to pain and limited mobility. This is a physical functioning limitation caused by CLBP.

10 – I only stand for short periods

Mobility

Sitting and standing

Unable to stand for long periods of time

Participants reported that they could not stand for long periods because of their pain. This is a physical functioning limitation due to CLBP.

11 – I try not to bend or kneel

Mobility

Bending and kneeling

Pain while bending

Pain while kneeling

Avoiding bending/kneeling

Participants reported that they could not bend or kneel because of their pain and so avoided doing this. This is a physical functioning limitation due to CLBP.

Washing (self) and getting in/out of a car are examples of specific activities discussed in relation to this, as well as work for those who usually did work involving this type of action.

Activities

Washing*

Difficulties with washing

Activities

Driving*

Getting in and out of cars

Activities

Work*

Not able to work or do same job/taking a break at work

12 – I find it difficult to get out of a chair

Mobility

Sitting and standing

Difficulty getting out of a chair

Participants reported difficulty with getting out of a chair due to pain and mobility limitations caused by their CLBP. This is a physical functioning limitation of CLBP.

13 – Back is painful most of the time

Pain

Pain

Overall pain

Background pain

Extreme pain

Participants reported that they experienced pain, with some reporting a background pain that was present most of the time as a key symptom of the condition leading to the physical functioning limitations described.

14 – Turn over in bed

Other

Sleep

Cannot get comfortable

Participants reported that because of their pain, they struggled to get comfortable in bed and would toss and turn a lot. This created problems with sleep and is a physical functioning limitation as sleep is a daily function.

15 – Appetite is not very good

Other

Appetite

Participants identified this as important during the CD, although this was not spontaneously discussed during CE.

Participants reported that when they were in pain they could lose their appetite. This is an example of a consequence of pain which could have everyday impact.

16 - Putting on socks (or stockings)

Activities

Dressing

Trouble putting on socks, shoes, and trousers

Participants reported that they had trouble putting on socks, shoes, and trousers because of pain and mobility limitations. This is a physical functioning limitation due to CLBP.

17 – Walk short distances

Mobility

Walking

Can only walk short distances

Participants reported they now can only walk short distances because of pain and mobility limitations. This is a physical functioning limitation due to CLBP.

18 – Sleep less well

Other

Sleep

Hard to fall asleep

Waking up

Participants reported that because of their pain they found it hard to fall asleep and would often wake up during the night. This created problems with sleep and is a physical functioning limitation since sleep is a daily function.

19 – I get dressed with help

Mobility

Bending and kneeling

Pain while bending

Pain while kneeling

Avoiding bending/kneeling

Participants reported that they require help when getting dressed because of pain and mobility limitations. This is an everyday functional consequence of the physical functional limitations experienced.

Bending and kneeling were discussed as one of the direct reasons for needing help (eg, cannot reach feet, pick items off the floor).

Activities

Dressing

Needing help to get dressed

20 – I sit down most of the day

Mobility

Sitting and standing

Sitting down more

Participants reported that they would often sit in a chair more to rest because of their pain. This is a functional limitation due to CLBP.

Some participants also discussed how the need for rest could impact their work.

Activities

Work*

Not able to work or do same job/taking a break at work

21 – I avoid heavy jobs

Mobility

Lifting

Pain while lifting

Avoiding lifting

Participants reported that they would avoid heavy jobs around the home (or for some also at work) because of pain and mobility limitations. Participants discussed that they would avoid undertaking jobs or activities that involved a lot of heavy lifting or movement such as lifting heavy objects, moving plant pots, heavy boxes, moving furniture, etc. This is a physical functioning limitation due to CLBP.

Activities

Chores/housework

Avoiding/not doing as many jobs around the home

Activities

Work*

Not able to work or do same job/taking a break at work

22 – Irritable and bad tempered with people

Others

Mood

Moody, irritable and short-tempered

Participants indicated that because of their pain and physical limitations they would become moodier and more irritable then they were before. This is an emotional consequence of the symptoms and functional limitations experienced.

23 – I go upstairs more slowly

Mobility

Stairs

Go upstairs more slowly

Participants reported that they move upstairs slower than they used to because of pain and mobility limitations. This is a physical functioning limitation due to CLBP.

24 – I stay in bed most of the time

Mobility

Lying down

Participants identified this as important during the CD, although this was not spontaneously discussed during CE.

Participants reported lying down to rest because of their pain and staying in bed when it was at its worst and although not directly stated it was implied that this impacts upon functional ability as time spent staying in bed limits the ability to take part fully in other daily activities.

  1. CD cognitive debriefing, CE concept elicitation, CLBP chronic lower back pain
  2. *Washing, driving and work were identified in the conceptual model but not explicitly captured within the RMDQ as distinct items. These concepts were examples of activities impacted by the functional limitations experienced, and thus relate to a number of items as detailed in the table