Perceptions of Low Back Pain and the Role of Physiotherapy in Bangladesh: A Qualitative Study.

BACKGROUND

Low back pain (LBP) is a leading global cause of disability, with the most significant burden now observed in low- and middle-income countries (LMICs). Despite the growing availability of physiotherapy, cultural perceptions and systemic factors may hinder its utilisation in Bangladesh. This study explores how patients with chronic LBP in Bangladesh perceive their condition and the role of physiotherapy.

METHODS

Using interpretative phenomenological analysis, we conducted in-depth semi-structured interviews with 20 Bangladeshi adults (mean age 41.9 years) with chronic LBP (median duration 30 months). Participants were purposively sampled to capture diverse sociodemographic perspectives. Transcripts were thematically analysed to explore lived experiences with LBP and its management.

RESULTS

Four interrelated themes emerged: (1) there was limited understanding of the causes of LBP; (2) physician authority strongly influenced perceptions of physiotherapy, reinforcing passive treatment approaches; (3) friends and family, social media, and the internet shaped expectations; and (4) cultural and spiritual beliefs promoted traditional remedies over evidence-based care. As a result of these perceptions, physiotherapy was often viewed as a last resort and was typically limited to passive modalities.

CONCLUSION

Improving LBP care in Bangladesh may require culturally sensitive multilevel strategies, such as public education, upskilling of physiotherapists in active evidence-based interventions, and health policy reforms, to promote the availability of direct physiotherapy access. These strategies could help align patient expectations with contemporary care models and reduce LBP-related disability in LMICs.