ORIGINAL ARTICLE   Open access

European Journal of Physical and Rehabilitation Medicine 2024 Mar 29

DOI: 10.23736/S1973-9087.24.08089-4

Copyright © 2024 THE AUTHORS

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language: English

Graph modeling of relational structures among functioning variables with low back pain: an exploratory analysis based on international classification of functioning, disability and health

Zi-Yan ZHU ^{1, 2}, Hui-Hui SHAN ^{1, 2}, Jin WANG ^{1, 3}, Hong-Jun ZHU ⁴, Shou-Guo LIU ⁵, Feng LIN ^{1, 2, 5} ✉

¹ School of Rehabilitation Medicine, Nanjing Medical University, Nanjing, China; ² Department of Rehabilitation Medicine, Sir Run Run Hospital, Nanjing Medical University, Nanjing, China; ³ Department of Rehabilitation Medicine, The Affiliated Jiangsu Shengze Hospital of Nanjing Medical University, Suzhou, China; ⁴ Department of Rehabilitation Medicine, The First Affiliated Hospital of Soochow University, Suzhou, China; ⁵ Department of Rehabilitation Medicine, The First Affiliated Hospital of Nanjing Medical University, Nanjing, China

BACKGROUND: Given the complex etiology, multidimensional impact, and widespread prevalence of low back pain (LBP), it is crucial to prioritize intervention targets based on understanding the relationships between functional impairments in patients. This prioritization maximizes the physical and psychological benefits for patients, and graph modeling holds promise in achieving these objectives.
AIM: The aim of this study was establishing a graphical model of functioning variables for LBP based on the International Classification of Functioning, Disability, and Health (ICF) to identify the most influential items (i.e., functioning variables) on the physical and mental well-being of patients. Exploring feasible intervention measures by understanding the dysfunction correlations among these variables.
DESIGN: Cross-sectional survey.
SETTING: Nine hospitals in Jiangsu Province, China.
POPULATION: Three hundred and six persons with LBP aged ≥18 years.
METHODS: All patients were assessed using the Comprehensive ICF Core Sets for LBP. The scoring system was converted to dichotomous data, with 1 indicating dysfunction and 0 indicating no dysfunction. In the graphical model, network parameters and the results of Item Response Theory modeling (as detailed in our other article) were used to determine the importance of items, while partial correlations were utilized to estimate the dysfunction correlations between functioning variables.
RESULTS: 1) A total of 56 ICF items were located in the backbone structure of LBP, among which d430 (Lifting and carrying objects) occupied the most central position, followed by b126 (Temperament and personality functions). 2) In the main component of backbone structure, d430 has moderate dysfunction correlation with looking after one’s health (0.6027), social norms, practices and ideologies (0.597), stability of joint functions (0.5759), and emotional functions (0.4078). b126 has moderate dysfunction correlation with basic interpersonal interactions (0.6595).
CONCLUSIONS: d430 and b126 significantly impact the physical and mental well-being of LBP patients. To improve d430, maintaining exercise habits, reducing working hours, enhancing lumbar stability, and overcoming fear-related emotions are recommended. Similarly, improving b126 can be achieved through enhancing interpersonal relationships.
CLINICAL REHABILITATION IMPACT: Through the identification of crucial functioning variables and the associated dysfunctional correlation relationships, graphical model of Comprehensive ICF Core Set for LBP can offer healthcare decision-makers valuable insights into potential treatment targets and pathways aimed at improving the condition of LBP patients.

KEY WORDS: Pain measurement; Functional status; Rehabilitation; Psychometrics; Spine