Back on track

Background and Objective: Recent systematic reviews show promising effects for multidisciplinary biopsychosocial (biopsychosocial) interventions in patients with chronic low back pain (CLBP).Nowadays, biopsychosocial interventions have also been developed for primary care physiotherapy settings.Our aim was to systematically review the evidence on the effectiveness of primary care biopsychosocial interventions in improving functional disability, pain and work status for patients with CLBP.Secondly, we aimed to provide an overview of biopsychosocial intervention designs, physiotherapist-training programmes and process-related factors (practical implementation).Databases and Data Treatment: We searched in scientific databases and reference lists.Randomised Controlled Trials (RCTs) evaluating primary care physiotherapist-led biopsychosocial interventions in adults (≥ 18 years) with non-specific CLBP (≥ 12 weeks) were included.Results: Searches resulted in 943 references; 7 RCTs were finally included (1,426 participants).Results show moderate quality evidence (3 trials; 991 participants) that a biopsychosocial intervention is more effective than education/advice for reducing disability and pain in the short, medium, and long term.Low quality evidence (4 trials; 435 participants) was found for no difference with physical activity treatments.Conclusions: biopsychosocial interventions seem more effective than education/advice, and as effective as physical activity interventions in patients with CLBP.biopsychosocial interventions with a clear focus on psychosocial factors (understanding pain, unhelpful thoughts, coping styles, and goal-setting) seem most promising.Sufficient delivery of biopsychosocial elements is expected when physiotherapist receive training programmes with extensive support prior and during delivery (manual, supervision, and informative resources).Future studies of sufficient quality are expected to add significant information.