Reasons of drop-out from rehabilitation in patients of Turkish and Moroccan origin with chronic low back pain in The Netherlands: A qualitative study

Abstract

tion programmes, which are based on physical training and behavioural cognitive training, is to improve the health-related quality of life of patients by coaching them to cope with their pain and its consequences (1). Drop-out from low back pain rehabilitation of non-native patients (28.1%) in the Netherlands has been reported to be twice as high as in native Dutch patients (13.7%); the overall drop-out rate is 18.7% (2). The higher drop-out rate of non-native patients is consistent with a study conducted in mental healthcare. In that study the drop-out rate was significantly higher in ethnic minority patients (52%) compared with native patients (30%) (3). Furthermore, the overall drop-out rate in patients with low back pain (18.7%) (2) is consistent with those of previous studies in patients with (low back) pain, which found drop-out rates ranging from 10% to 42% (4-6).There is, however, limited knowledge of the causes of this higher drop-out rate in non-native patients. In a qualitative study, sources of tension in the interaction between non-native patients and native Dutch physicians in chronic non-specific low back pain rehabilitation treatment have been identified (7). These sources of tension, found directly after the first consultation with the rehabilitation physician, were: patients expecting a specific diagnosis and pain relief as the primary aims of treatment; more explicit symptom presentation of patients; different views on responsibilities with regard to the rehabilitation treatment (physicians implied that patients expected more responsibility to be taken by the physician); lack of trust in the rehabilitation physician; contradicting views given by physicians from the patients' country of origin with regard to the cause and treatment of pain; and communication problems, partly due to shame and embarrassment about patients' limited language proficiency in Dutch. These sources of tension potentially lead to future drop-out.More sick leave days (4, 8, 9), higher pain severity (9, 10), being less active in sports (4), a lower age (9) and the idea that exercise did not help or aggravated pain (11) have been identified as predictors of drop-out in low back pain rehabilitation programmes. A systematic review of qualitative and quantitative studies in patients with low back pain regarding INTRODUCTIONPatients with chronic non-specific low back pain can benefit from rehabilitation programmes. The aim of these rehabilita- 567Reasons for drop-out from rehabilitation their expectations and satisfaction with treatment (12) showed that patients in general (i.e. not specifically selected for a non-native background) are dissatisfied with low back pain treatment for a number of reasons, including: not obtaining a specific diagnosis of the pain; pain relief not being the main aim of treatment; lack of physical examination and diagnostic tests; lack of referrals to other therapy or specialists for further treatment; no possibility of sickness certification. This review study seems to show that patients with low ...

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