Assessing pain severity and treatment outcomes in patients with low back pain: A Structural equation modeling approach at the center for the rehabilitation of the Paralysed, Bangladesh
Authors: Rahman Mohammad Arifur , Tasnim Sanjida , Hossain Md. Forhad 
Published: May 2024

Objectives
This study aims to observe the associated risk factors of lower back pain and the factors that increase the pain severity. So, the main objective of this research is to identify the factors which may cause the lower back pain and the causal effect on the pain severity and respective treatment. This study also tries to determine the demographical characteristics of the low back pain patients and determine the inter relationship of psychological health, work stress and treatment effect with the pain disability index.

Study design
In this cross-sectional study, 200 patients with lower back pain were interviewed who were taking treatments from the physiotherapy department at the Center for the Rehabilitation of the Paralysed, Savar, Dhaka, Bangladesh.

Methods
A quantitative research model has been performed to observe the relationship between different causes of low back pain effects on the patients. Different statistical analysis including structural equation modeling have been performed to observe their pain severity and treatment effect.

Results
The study found 64% (128) of the total participants as male and 36% (72) as female among 200 patients of low back pain. The study also observed the highest portion of the patients belong to the age group 39 to 45 years (21.5%). On the basis of BMI, obese weight respondents were 26.5% (53), overweight respondents were 37% (74), normal weight respondents were 33% (66), and underweight respondents were only 3.5% (7). Here, sex, body mass index (BMI), living place and educational status have significant association with pain disability index (PDI). On the other hand, smoking tendency of patients has insignificant relationship (p>0.05) with pain disability index (PDI). The path coefficients of the structural equation model identified that all the null hypotheses of no significant relationship have been rejected for 5% level of significance. The hypothesis of psychological health is positively related to pain severity of a patient has an acceptable strength (β = 0.745, p<0.001) and a positive direction. Another hypothesis (Psychological health is positively related to the treatment of a patient) shows an acceptable strength (β = 0.401, p <0.001) and a positive direction. Work stress is also found to be positively related to pain severity of a patient with an acceptable strength (β = 0.544, p < 0.001) and a positive direction. The hypothesis (Work stress is positively related to the treatment of a patient) has an acceptable strength (β = 0.322, p< 0.05) and a positive direction. The hypothesis (pain severity is positively related to the treatment of patients) shows an acceptable strength (β = 0.801, p < 0.001) and a positive direction.

Conclusion
The research found out the psychological health situation and work stress of patients are significantly related with pain severity with acceptable strength. Also, Pain severity is significantly associated with treatment scheme intensity.