• Michael Di Donato, Ross Iles, Tyler Lane, and Alex Collie.
• Insurance Work and Health Group, Health Services Division, School of Public Health and Preventive Medicine, Faculty of Medicine Nursing and Health Sciences, Monash University, 553 St Kilda Road, Melbourne, Victoria, 3000, Australia. michael.didonato@monash.edu.
• Syst Rev. 2019 Apr 9; 8 (1): 92.

BackgroundLow back pain is the greatest contributor to the global burden of disease and can result in work disability. Previous literature has examined the influence of personal factors, the healthcare system, workplace, and income support systems on work disability due to low back pain. Income support systems may also influence healthcare and the workplace, leading to an impact on healthcare quality and functional capacity. However, there has been little insight as to how or in what contexts this influence occurs. This realist review aims to provide an explanation of how and in what contexts income support systems impact the healthcare quality and functional capacity of people who are unable to work due to low back pain.MethodsRealist reviews are a type of literature review that seek to determine how and in what contexts a social programme such as income support leads to an outcome, rather than simply determining whether or not it works. Five initial theories about how income support systems impact healthcare quality and functional capacity are posited in this protocol. An iterative search of electronic databases for academic literature will be used to acquire and synthesise evidence that may support or refute these initial theories. Grey literature such as policy documents will be identified to characterise income support and healthcare systems and supplement contextual details. Semi-structured interviews with income support, healthcare, and low back pain experts will also be performed to complement literature searching with anecdotal and experiential evidence. At the conclusion of the review, initial theories will be supported or refuted and refined into programme theories that will be explained by evidence in context-mechanism-outcome configurations.DiscussionIncome support and healthcare systems are highly complex and fluid programmes. At the intersection between these systems are those with low back pain. By using realist review methods, we will provide explanatory rather than judgemental findings. The resulting multi-dimensional and contextual understanding of the impact of income support systems on important low back pain outcomes will provide valuable insight for future income support and healthcare policy development.

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