INTRODUCTION
Back pain is a prevalent condition that is predicted to increase in the future. Despite that, diagnosing and treating back pain is a complicated task. Therefore, social support and help from family members are essential to back pain patients. While the burden on family members of other diseases, such as mental health and cancer, has been studied before, no research has explored how back pain burdens family members. The "Family Reported Outcome Measurement-16" (FROM-16) tool can be used to measure the burden on family members regardless of the disease.
We aimed to investigate whether FROM-16 was applicable for back pain and to provide an initial overview of how back pain affects the burden on family members.
METHODS
To determine the applicability of using FROM-16, we recruited adult family members who accompanied patients visiting the Spine Centre of Southern Denmark. This outpatient specialized department receives approximately 12,000 patients in the medical department and 3,000 patients in the surgical department on a yearly basis. Flyers and secretaries invited participants from the shared waiting room. Family members who agreed to participate completed FROM-16, and participated in semi-structured interviews.
A cross-sectional cohort was used to explore the burden of low back pain experienced by family members. Specifically, we recruited family members accompanying back pain patients to complete FROM-16 and provide their demographic information. Demographic and clinical data from back pain patients were acquired through our clinical registry. We assessed associations between burden and a-priori selected variables through univariable and multivariable linear regression. The analysis plan used in this study was uploaded to OSF (URL) a priori.
RESULTS
The applicability of FROM-16 to back pain was assessed on 12 family members. All participants understood all FROM-16 items. Some participants considered some items irrelevant (e.g., sex life for non-partners). However, other participants felt most items were relevant.
We had available data on 237 family members. While some participants experienced much burden, others experienced little. Worry, family activities, and frustration were the most common high-burden items, while expenses, work/study, eating habits, and anger showed little burden.
We found an association between the burden of back pain and family members for the following: age (higher age, less burden) and relation (partners had the highest burden). Small but statistically significant associations were found for patient factors related to pain intensity and distress. Family burden was mostly associated with patients' disability, with a 3.1% increase in burden for every 10% increase in the Oswestry Disability Index.
DISCUSSION
To the best of our knowledge, this study is the first to assess the burden of family members on patients with back pain. Back pain does negatively impact family members but to varying degrees. Age, partnership, and disability appear to drive the burden. While FROM-16 captures it to a certain level, a more precise questionnaire is needed. Recruitment was based on convenience and initiative, leading to potential selection bias.