OBJECTIVE: To determine whether tailored interventions based on patients' psychological profiles enhanced the outcomes of interventions in people with nonspecific low back pain, compared to usual care. DESIGN: Intervention systematic review with meta-analysis. LITERATURE SEARCH: Embase, Cochrane, Medline, Web of Science, CINAHL, and PsycINFO were searched from their inception until November 2, 2023. STUDY SELECTION CRITERIA: We included randomized clinical trials that compared psychological interventions to any alternatives without psychological components in patients with nonspecific low back pain who were stratified based on their psychological risk factors using the cutoff of the questionnaires measuring a psychological construct. DATA SYNTHESIS: The outcomes were pain intensity and disability. The revised Cochrane risk-of-bias tool for randomized trials was used to evaluate the risk of bias. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to judge certainty of evidence. RESULTS: Twenty-nine trials were included, most presenting some concerns for the risk of bias. The certainty of evidence was mostly low, with moderate to substantial heterogeneity. Using psychological stratification, individuals who received a psychological intervention (versus usual care) reported lower pain intensity at the short term (MD, -0.22; 95% confidence interval [CI]: -0.41, -0.02) and midterm (MD, -0.37; 95% CI: -0.57, -0.16). For disability, there was a larger improvement with psychological interventions versus usual care at short-term (SMD, -0.17; 95% CI: -0.32, -0.02), midterm (SMD, -0.16; 95% CI: -0.28, -0.05), and long-term (SMD, -0.17; 95% CI: -0.29, -0.04) follow-ups. CONCLUSIONS: Psychological interventions had a positive impact, although small, on reducing pain intensity and disability in patients with low back pain and psychological risk factors. J Orthop Sports Phys Ther 2025;55(2):1-20. Epub 3 January 2025. doi:10.2519/jospt.2025.12777.
| Discipline Area | Score |
|---|---|
| Psychologist |  |
| Physician |  |
Physician rater
This review does not show anything new compared with previous studies and shows a small effect. However, the researchers present opinions that are not based on this review (e.g., the interventions are low-cost and well-accepted by patients as a practical addition to standard care). Most patients with low-back pain are not interested in psychosocial interventions, so the study populations are often selected.
Physician rater
This review suggests that patients with non-specific LBP and psychological factors that may influence pain and disability should receive tailored psychological interventions (e.g. cognitive behavioural therapy or acceptance and commitment techniques) alongside conventional physiotherapy. However, the effect sizes of these customized interventions and the certainty of the evidence for pain intensity and disability outcomes are mostly low due to methodological limitations and heterogeneity between studies. Also, the economic impact of tailored psychological interventions should also be assessed.
Psychologist rater
This is an important study. It is well-conducted and rigorous. It serves to emphasize that one discipline alone (i.e., psychology or any other single discipline) is insufficient to treat the complexity of chronic pain.
Psychologist rater
This meta-analysis found small and often transient effects of "psychological" interventions on pain intensity and disability. However, in many cases, the treatment was provided by allied health professionals, such as PT's. Additional research is recommended, as the existing evidence was graded as low quality.
Psychologist rater
This useful article provides evidence-based recommendations for a psychological component in multi-disciplinary pain management.
, McMaster University