PSiM IV – Pain Practice: A PhD research plan: Cultural adaptation and implementation of Pain Education program for Chinese Chronic Low Back Pain Population in a Chinese physiotherapeutic environment

Introduction
This project aims to culturally adapt and implement a pain education (PE) program for chronic-low-back-pain (CLBP) patients in a Chinese physiotherapeutic environment. PE is a clinical treatment to cultivate patients’ understanding of biopsychosocial view of pain and to promote active pain-coping-strategies. It has considerable clinical improvement on pain and disability during the treatment of chronic pain. However, due to the variations of pain perceptions1 and treatments2 in China, culturally adapting and implementing a non-native PE-program should be studied before implementation.

Methods
The project originates from a suggested cultural-adaptation-framework3, including two qualitative studies and one quantitative study :
1) Conduct in-depth and semi-structured individual interviews to explore Chinese physiotherapists’ comprehension about pain, PE and the implementation of PE in clinical practices. We will account the interview results into our preliminary PE-program.
2) Organize focus groups with Chinese physiotherapists and CLBP patients to discuss our preliminary program. The results will reflect in the final construct of the PE-program.
3) Perform a randomized-controlled-trial to assess the PE-program’s effect on disability (primary outcome), pain, illness perceptions, pain catastrophizing, kinesiophobia and self-efficacy in Chinese CLBP patients.

“Results”
This project constructs a culturally-sensitive PE-program and emphasizes systematic adaption by considering the environmental factors that influence the program implementation and people involved.

Conducting this project itself, e.g., balancing the expectation of the European research team and Chinese partners, is a cultural adaptation.

Conclusion
Based on current interview results, educating pain neuroscience to Chinese physiotherapists is necessary.

References
1.Li Y, Coppieters MW, Setchell J, et al. How do people in China think about causes of their back pain? A predominantly qualitative cross-sectional survey. BMC musculoskeletal disorders 2020; 21(1): 1-1.
2.Yuan QL, Guo TM, Liu L, et al. Traditional Chinese medicine for neck pain and low back pain: a systematic review and meta-analysis. PLoS One 2015; 10(2): e0117146.
3.Barrera Jr M, Castro FG, Strycker LA, et al. Cultural adaptations of behavioral health interventions: a progress report. Journal of consulting and clinical psychology 2013; 81(2): 196.