What is the Effectiveness of a Biopsychosocial Approach to Individual Physiotherapy Care for Chronic Low Back Pain?

Abstract
A systematic review of randomized controlled trials was conducted to investigate the effectiveness of a biopsychosocial approach to management for chronic low back pain when applied by individual physiotherapists. Eight primary databases and three secondary databases were searched electronically. A manual reference search was also performed. To be eligible, trials had to provide treatment according to biopsychosocial principles in primary care or comparable settings. This approach is a holistic intervention that addresses social, psychological, and biological aspects of chronic pain. Included trials defined chronic low back pain as of greater than eight weeks duration. Primary outcome measures were reductions in pain or improvement in function. Nine trials were identified that provided a biopsychosocial intervention evaluated qualitatively by evidence of a combined approach of education and empowerment of the patient, neurobiological conditioning, and graded exposure. Comparison treatments included exercise alone, cognitive behavioral therapy alone, usual care, and no treatment. Data from these trials were extracted for comparison and the findings synthesized against research evidence quality dimensions to evaluate the effectiveness of a biopsychosocial approach applied by physiotherapists. Five trials found strong evidence for the effectiveness of a biopsychosocial approach to individual physiotherapy care, three trials found moderate evidence, and one trial found limited evidence. This review supports the use of biopsychosocial approaches for chronic low back pain and informs clinical practice. The findings may have particular relevance for physiotherapists working in professional or geographical isolation.