Are Tailored Interventions to Modifiable Psychosocial Risk Factors Effective in Reducing Pain Intensity and Disability in Low Back Pain? A Systematic Review With Meta-Analysis of Randomized Trials

OBJECTIVE: To determine whether tailored interventions based on patients' psychological profiles enhanced the outcomes of interventions in people with non-specific low back pain (NSLBP), compared to usual care. DESIGN: 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 (RCTs) that compared psychological interventions to any alternatives without psychological components in patients with NSLBP 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 short (MD -0.22, 95% confidence interval [CI] -0.41, -0.02) and mid-term (MD -0.37, 95% CI -0.57, -0.16). For disability, there was a larger improvement with psychological interventions versus usual care at short- (SMD -0.17; 95% CI -0.32, -0.02), mid- (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.