Public Perceptions of the Consequences and Management of Lower Back Pain: A National Cross-Sectional Survey in Saudi Arabia

Abstract

Background: Low back pain (LBP) is a leading cause of musculoskeletal disabilities worldwide. Psychosocial and behavioral factors contribute to the transition from acute pain to chronic disability, and public beliefs regarding LBP may influence treatment outcomes and functional statuses. Objectives: To assess public beliefs regarding LBP in Saudi Arabia using the Back Beliefs Questionnaire (BBQ), evaluate disability among participants with persistent LBP using the Oswestry Disability Index (ODI), and examine the association of these measures with demographic characteristics. Materials and Methods: A cross-sectional survey was conducted in Saudi Arabia between December 2019 and December 2020. A total of 4,052 participants were recruited, of whom 850 submitted incomplete questionnaires and were excluded from the subgroup analyses. The remaining participants completed the Back Beliefs Questionnaire to assess their demographic characteristics and beliefs regarding LBP. Participants with persistent LBP symptoms for > 6 weeks completed the Oswestry Disability Index. The associations between beliefs, disability, and demographic variables were analyzed using chi-square tests. Results: The population demonstrated a combination of evidence-based beliefs and persistent misconceptions regarding LBP. Most participants recognized the benefits of exercise and rejected highly pessimistic beliefs, such as inevitable wheelchair dependence or the inability of doctors to help them. However, many participants believed that LBP would result in lifelong pain and functional limitations. Persistent LBP was reported by 41.7% of the respondents. Among the affected individuals, most had minimal (44.3%) or moderate (25%) disabilities. Significant associations were observed between beliefs and disability levels, as well as between beliefs and demographic variables, including age, educational level, and occupation (all p < 0.05). Participants with more negative beliefs regarding the long-term consequences of LBP demonstrated higher levels of disability. Conclusion: Public beliefs regarding LBP in Saudi Arabia are influenced by misconceptions that may contribute to disability. These findings highlight the importance of evidence-based public education and awareness strategies that address the psychosocial aspects of LBP management.