Table 1

Respondent interpretations of themes relating to training and education, LDDD definition, impact and future management

Themes	Items	Descriptors	Responses (n)	Response rate (%)
Training and education	Years of postgraduate experience	0–2 years	1	2.6
		3–5 years	0	0
		6–8 years	5	13.2
		9+ years	32	84.2
	Country of graduation	UK	33	86.8
	Country of graduation	Other	5	13.2
Definition of LDDD	Definition of LDDD	Dehydrated disc	17	44.7
		Change in disc integrity	26	68.4
		Intervertebral changes	7	18.4
		Disc height reduction	7	18.4
		Symptomatic	13	34.2
		Asymptomatic	4	28.9
		Multifactorial causes	19	50.0
		Do not use this term	2	5.3
		Not a disease	7	18.4
	LDDD prevalence in clinic	0–10%	5	13.2
		10–30%	9	23.7
		30–50%	5	13.2
		50% +	14	36.8
		Unsure	1	2.6
		Not applicable	4	10.5
	LDDD cause	Genetics	13	33
		Posture	6	15
		Movement patterns	7	18
		Smoking	9	23
		Unsure	2	4
		Other (comorbidities)	8	21
	Signs associated with LDDD	Weakness	6	17
		Joint hypermobility	2	6
		Joint stiffness	10	26
		Pain	11	30
		Paraesthesia	5	14
		Unsure	2	4
		Other (stenosis, spondylolisthesis, reduced lordosis)	4	10
LDDD assessment	Confirmation of diagnosis	MRI	36	94.7
		Physical assessment	21	55.3
		None of the above	0	0
		Other (medical history)	17	44.7
	MRI findings are associated with LDDD	Osteophytes	25	65.8
		Annular tear	28	73.7
		Disc bulges	32	84.2
		Disc herniations	28	73.7
		Reduction in disc height	35	92.1
		Evidence of disc dehydration	34	90
		Unsure	1	2.6
		Other (Modic or end plate changes)	12	31.6
	Classification system used for grading LDDD	Modic grading system	18	47.4
		Pfirrmann grading system	9	23
		Modified Pfirrmann grading	2	5.3
		None of the above	10	26.3
		Other (do not use classification systems)	7	18.4
	Why degenerative change is often not proportional to presenting symptoms	Pyschosocial factors	9	23
		Pain perception/interpretation	5	13
		Pain mechanisms	6	16
		Physical factors	8	21
		Ability to adapt	4	11
		Infection	1	3
		Genetics	1	3
		Don't know	6	16
		DLDD is not the cause	3	8
	Use of functional tests as part of assessment	Yes	34	89.5
	Use of functional tests as part of assessment	No	4	10.5
	Most effective functional tests used in LDDD assessment	Gait	19	50
		Double leg stand (eyes open and eyes shut)	6	15.8
		Single leg stand (eyes open and eyes shut)	8	21.1
		Double leg squat	5	13.2
		Single leg squat	6	15.8
		Lunge	3	7.9
		Sit to stand	14	36.8
		All of the above	4	10.5
		None of the above	5	13.2
		Other (repeated movement and range of movement)	13	34.2
	Muscles most commonly affected	Calf	1	2.6
		Ankle dorsiflexors	1	2.6
		Quads	1	2.6
		Hamstrings	1	2.6
		Gluteus medius	4	10.5
		Gluteus maximus	4	10.5
		Extensors	10	26.3
		Erector spinae	10	26.3
		Multifidus	15	39.5
		Abdominals	4	10.5
		TVA	7	18.4
		Psoas	1	2.6
		Quadratus lumborum	2	5.3
		Lat dorsi	1	2.6
		Unsure	5	13.2
LDDD impact and future	Impact of LDDD with recurrent pain on quality of life	Serious	6	15.8
		Significant	22	57.9
		Minimal	2	5.3
		None	0	0
		Unsure	8	21.1
	Impact of psychosocial factors on LDDD and recurrent pain	Serious	8	21.1
		Significant	25	65.8
		Minimal	1	2.6
		None	0	0
		Unsure	4	10.5
	Future improvements in care	Inclusive communication	13	35.1
		Stratified treatment	9	24.3
		Effective patient education	14	37.8
		Encourage self-management	4	10.8
		Realistic goals and expectations	3	8.1
		Evidence-based management	9	24.3
		Consideration of long term	1	2.7
		Holistic approach	3	8.1
		Early intervention and service access	5	13.5
		Specific diagnosis	1	2.7
		MDT approach	2	5.4

LDDD, lumbar degenerative disc disease; MDT, multidisciplinary team; TVA, transversus abdominus.