A multidimensional conception of disability in the study of low back pain

Multiple dimensions of disability based on domains from the activities and participation chapter of the International Classification of Functioning, Disability and Health (ICF) were examined to identify aspects of disability associated with low back pain. Data from the 1994--1995 National Health Interview Survey -- Disability Supplement was utilized to describe demographics of disability among persons with low back pain in the United States population and to test the utility of this conception in predicting healthcare utilization.;Among adults in the United States, the mobility, self-care, domestic life and major life areas domains as classified by the ICF are more frequently reported as limited for adults with low back pain than those without low back pain. A limitation in the major life areas domain was reported more frequently than limitations in the other domains. Both visiting a physician and receiving physical therapy were better predicted by models which included domains from the activities and participation chapter of the ICF than in models where disability was represented by unidimensional conceptions. Limitations in the mobility, domestic life and major life areas domains had odds ratios significantly greater than 1 for visiting a physician and for receiving physical therapy in the final models. Other need, predisposing and enabling factors examined within the Andersen framework of healthcare utilization were also associated with receiving healthcare by persons with low back pain with need factors contributing more to the final model than predisposing and enabling factors. Different factors however, were better predictors in the final model depending on the type of provider seen.;The results of this study support a multidimensional approach to disability in the study of low back pain by describing specific limitations and identification of the relationship of these limitations with healthcare utilization. The findings underscore the need to consider specific aspects of disability in low back pain research and in the provision of healthcare to persons with low back pain. The ICF provides a framework to expand healthcare professionals understanding of low back pain beyond pathology.