Factors Associated with Disability Level Among Adult Patients with Low Back Pain

Background: Low back pain can restrict functioning through interacting symptoms, beliefs, and contextual demands. Qualitative inquiry can clarify how these influences are experienced. Objective: To explore perceived influences on disability and how they interact to restrict or support everyday functioning among adults with persistent low back pain. Methods: An interpretive qualitative study used purposive maximum-variation sampling to include 18 adults aged 25–66 years. Individual semi-structured interviews explored symptoms, movement, sleep, work, family roles, healthcare, and self-management. Oswestry Disability Index scores informed lower-, moderate-, and higher-disability sampling profiles. Interview material underwent reflexive thematic analysis, including examination of contrasting accounts and author review of interpretations. Results: Participants comprised 10 women and eight men; five had lower, seven moderate, and six higher disability profiles. Five themes were developed: Living with Unpredictable Pain; Fear, Threat, and Shrinking Activity; Caught Between Recovery and Livelihood; Support, Dependence, and Identity; and Clinical Explanations, Confidence, and Control. Accounts connected restrictions with anticipated flares, perceived damage, poor sleep, work and financial pressures, and changing family roles. Contrasting accounts described participation alongside pain when movement felt manageable and support preserved involvement. Conclusion: Disability was experienced within the interaction of symptoms, interpretations, relationships, and practical circumstances. Assessment and rehabilitation should consider barriers to meaningful participation alongside pain. Keywords: low back pain; disability; qualitative research; biopsychosocial factors; fear avoidance; self-efficacy; occupational health.