Biopsychosocial Model-based Care Versus Routine Physical Therapy in Chronic Back Pain

Chronic low back pain (CLBP) is a complex and persistent condition with multifactorial origins involving physical, psychological, and social dimensions. Traditional physiotherapy management typically emphasizes biomechanical correction through exercises and modalities; however, recent evidence underscores the significant contribution of psychosocial factors-such as maladaptive beliefs, fear-avoidance behaviors, and low self-efficacy-in the persistence of pain and disability. The biopsychosocial (BPS) model of care integrates these dimensions to promote holistic recovery and long-term functional improvement.

This randomized comparative clinical trial aims to determine the effectiveness of BPS model-based care versus routine physical therapy on pain self-efficacy, disability, inflammatory status, and perceived social support in individuals with CLBP. A total of ___ participants meeting the inclusion criteria (age 25-60 years, pain duration ≥12 weeks) will be recruited and randomly assigned into two equal groups.

The Routine Physical Therapy Group will receive:

Baseline care: Moist hot pack and Transcutaneous Electrical Nerve Stimulation (TENS)

Stretching of hamstrings, glutei, iliopsoas, and lumbar extensors

Strengthening/stabilization: abdominal bracing, planks, gluteal isometrics, and bridging exercises

The BPS Model-Based Care Group will receive:

The same baseline treatment as the control group

Maitland mobilization (Grade I-II central posteroanterior)

Sciatic nerve slider

Abdominal bracing and graded functional activities

Cognitive Behavioral Therapy (CBT) sessions focusing on fear-avoidance and coping skills

Pain Neuroscience Education (PNE)

Guided imagery and group exercise therapy to enhance engagement and motivation

Interventions will be administered three times per week for 6 weeks under physiotherapist supervision.

Outcome Measures:

Primary outcomes will include Pain Self-Efficacy (PSEQ), Oswestry Disability Index (ODI), and C-Reactive Protein (CRP) as a biochemical indicator of systemic inflammation. Perceived Social Support (Multidimensional Scale of Perceived Social Support) will be evaluated as a secondary variable reflecting the social dimension of recovery.

Assessments will be conducted at baseline and after 6 weeks of intervention. Data will be analyzed using appropriate statistical tests to compare within- and between-group changes.

This study will provide evidence on the role of integrated biopsychosocial rehabilitation in improving physical, psychological, and social outcomes in chronic low back pain, potentially guiding future physiotherapy practice toward a more holistic model of patient-centered care.

Inclusion criteria

• Diagnosed with non-specific chronic low back pain (pain persisting for more than 12 weeks).
• Pain intensity score of ≥3 on the Visual Analog Scale (VAS).
• Able to read and understand the study instructions and questionnaires (e.g., SF-36, Oswestry Disability Index).
• Not undergoing any current structured physiotherapy or psychological treatment specifically for low back pain.

Exclusion criteria

• o History of specific spinal pathology (e.g., spinal fracture, tumor, infection, or inflammatory diseases like ankylosing spondylitis).

• Presence of neurological deficits (e.g., radiculopathy, cauda equina syndrome).
• Previous lumbar spine surgery.
• Current diagnosis of major psychiatric illness (e.g., severe depression, psychosis) that may interfere with participation.
• Pregnancy or within 6 months postpartum.
• Ongoing treatment with systemic corticosteroids or other medications affecting musculoskeletal health.
• Participation in another clinical trial within the past 3 months.
• Any other medical condition deemed by the investigator to contraindicate participation in the study.