Physical, Psychophysical and Psychological Predictors of Persistent or Recurrent Non-Specific Low Back Pain: A
Kanya Wongwitwichote1, Cho Wai Geoffrey Yu1, Valter Devecchi1
1Centre of Precision Rehabilitation for Spinal Pain, School of Sport, Exercise and Rehabilitation Sciences, University of Birmingham, Birmingham, UK.
Background And Objective:
Non-specific low back pain (LBP) frequently becomes persistent or recurrent. This systematic review and meta-analysis determined whether physical, psychophysical or psychological variables can predict persistent or recurrent non-specific LBP.
Database And Data Treatment:
Studies investigating physical, psychophysical or psychological predictors of persistent/recurrent LBP, pain intensity or disability were included. MEDLINE, EMBASE, APA PsycINFO, PubMed, CINAHL Plus, Web of Science, Scopus, ZETOC and OpenGrey were searched until January 2025. Risk of bias of individual studies was assessed using QUIPS and the certainty of evidence using GRADE.
Results:
Fifteen studies were included, all addressing persistent LBP, examining one physical predictor domain (trunk kinematics), one psychophysical predictor domain (pain sensitivity) and seven psychological domains (depression-distress, anxiety, fear avoidance, catastrophising, somatisation, pain coping strategy, pain self-efficacy). Depression and distress significantly predicted persistent LBP and disability (n = 15,778; β = 0.28, 95% CI: 0.04 to 0.53, p = 0.024), and fear avoidance also significantly predicted persistent LBP and disability (n = 1105; β = 0.24, 95% CI: 0.00 to 0.49, p = 0.049), albeit both with low certainty of evidence. Enhanced temporal summation of pain was not a significant predictor of pain outcomes (n = 192; β = 0.10, 95% CI: -0.37 to 0.57), with very low certainty of evidence. Physical predictors showed limited and inconclusive evidence. Overall, the certainty of evidence ranged from very low to low across all predictor domains.
Conclusion:
Psychological factors, particularly depression-distress and fear avoidance, may predict LBP persistence, although higher quality studies are needed.
Significance Statement:
Depression-distress and fear avoidance are significant predictors of persistent non-specific low back pain, while evidence for physical predictors remains limited. These findings emphasize the need for early identification of modifiable psychological risk factors.
Trial Registration:
PROSPERO (Registration number CRD42024599514).
