What factors do clinicians, coaches and athletes perceive are associated with recovery from low back pain in elite athletes? A Concept Mapping study.

OBJECTIVE: Identify factors that elite sport clinicians, coaches, and athletes perceive are associated with low back pain (LBP) recovery. DESIGN: Concept mapping methodology. METHOD: Participants brainstormed, sorted (thematically) and rated ("5-point Likert scales": importance and feasibility) statements in response to the prompt: What factors are associated with the recovery of an elite athlete from low back pain? Data cleaning, analysis (multidimensional scaling, hierarchical cluster analysis and descriptive statistics) and visual representation (cluster map and go-zone graph) were conducted following concept mapping guidelines. RESULTS: Participants (brainstorming, n=56; sorting, n=34 and rating, n=33) comprised 75% clinicians, 15% coaches and 10% athletes and represented 13 countries and 17 sports. 82 unique and relevant statements were brainstormed. Sorting resulted in six LBP recovery-related themes: 1) coach and clinician relationships, 2) inter-disciplinary team factors, 3) athlete psychological factors, 4) athlete rehabilitation journey, 5) athlete non-modifiable risk factors and 6) athlete physical factors. Participants rated important recovery factors as: athlete empowerment and psychology, coach-athlete and athlete-clinician relationships, care team communication, return to sport planning, and identifying red flags. CONCLUSIONS: Factors perceived as important to LBP recovery in elite athletes align with the biopsychosocial model of community LBP management. Clinicians should consider that an athlete's psychology, relationships, care team communication and rehabilitation plan may be as important to their LBP recovery as the formulation of a diagnosis, or the medications, or exercises prescribed.