Re-Examining the Dimensionality of a Disability Assessment Tool Using Exploratory Structural Equation Modeling (ESEM): A Preliminary Study in Low Back Pain

Background: Low back pain (LBP) profoundly impacts daily life, requiring assessment tools that capture its complex effects on the body and mind. This study explores a measurement tool designed to assess LBP disability, testing whether Exploratory Structural Equation Modeling (ESEM) better reveals its multidimensional nature compared to Confirmatory Factor Analysis (CFA). Methods: We analyzed data from 266 LBP patients using CFA and ESEM. The tool, developed from the items from existing scales, included 99 questions on body functions, activities, and participation. Using Mplus 8 software, we compared model fit and item connections. Results: Two main factors; “Body Functions” and “Activity-Participation” identified by CFA were tested using ESEM. While ESEM had slightly better fit compared to CFA model, many items linked across both factors which shows how pain and emotions overlap with daily activities. These results align with the International Classification of Functioning, Disability and Health (ICF) and reflect LBP’s broad impact. Conclusions: ESEM offers a broader understanding of LBP’s multidimensional nature compared with CFA, guiding clinicians to create a holistic management approach that address physical and psychosocial challenges. This preliminary study supports the use of ESEM in disability research, demonstrating its usefulness in identifying the multifaceted nature of LBP, therefore providing a broader perspective for assessment and management. © 2025 by the authors.