Self-Management, Fear of Movement, and Pain in Working Adults with Low Back Pain: A Qualitative Longitudinal Study

Minna Roine,1– 3 Eira Karvonen,4 Matti Munukka,1 Ari Heinonen,1 Pirjo Vuoskoski1 1Faculty of Sport and Health Sciences, University of Jyvaskyla, Jyvaskyla, Finland; 2Nursing Research Center, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; 3Internal Medicine and Rehabilitation, University of Helsinki and Helsinki University Hospital, Helsinki, Finland; 4Physiotherapy Consulting Paatelma & Karvonen Ky, Helsinki, FinlandCorrespondence: Minna Roine, Email roinmi@student.jyu.fiPurpose: The present study explored the experiences of working individuals with low back pain regarding self-management, fear of movement and pain during a 12-month follow-up period after receiving either direct access (DA) or conventional physical therapy.Patients and Methods: Data were collected through electronic questionnaires containing open-ended questions on physical therapy, fear of movement and pain. These were administered at baseline (after the initial physical therapy visit) and at 3-, 6-, and 12- month follow-ups. Participants were clients from real-life clinical settings in primary care or emergency departments. Fifteen participants completed all follow-ups; ten from DA and five from conventional physical therapy.Results: Two distinct client types emerged: the pilot, who actively engaged in recovery with support from the physical therapist, and the passenger, who adopted a more passive approach by avoiding pain-inducing activities. These types were reflected in two main categories: 1) “Understanding my pain”, with three subcategories: Nature of my pain, Daily living with my pain, and Knowing the cause of my pain, and 2) “Managing my pain”, with three subcategories: Ownership of my recovery, Courage to be active, and Relieving pain.Conclusion: The findings underscore the individualized nature of self-management, fear of movement and pain experiences over 12 months follow-up. While personal strategies varied, guidance from physical therapist appeared instrumental in supporting the adoption of an active pilot-like role in recovery.Keywords: direct access, qualitative content analysis, physical activity, rehabilitation, musculoskeletal