369: Physical & Psychological Predictors of Persistent/Recurrent LBP: Systematic Review & Meta-Analysis

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic primary musculoskeletal pain, Psychology, Assessment and Measurement of Pain/Nociception, Epidemiology

Background and Aims: While most cases of low back pain (LBP) resolve naturally, approximately one-third develop persistent or recurrent LBP (1), leading to substantial disability (2). Physical and psychological impairments may be important risk factors for developing persistent or recurrent LBP (3, 4), impacting quality of life and creating a burden on individuals and healthcare systems (5). However, the predictive value of specific physical and psychological factors remains unclear. This systematic review aimed to evaluate whether physical and psychological factors predict persistent or recurrent non-specific LBP.

Methods: This review included studies that examined at least one physical or psychological predictor of persistent or recurrent LBP intensity or disability, prospectively registered on PROSPERO (CRD4202459951). A comprehensive search of MEDLINE, EMBASE, APA PsycINFO, PubMed, CINAHL Plus, Web of Science, Scopus, ZETOC, and OpenGrey was conducted up until January 2025. Two reviewers independently screened studies, with disagreements resolved by a third reviewer. Fifteen studies met the inclusion criteria. Study characteristics, predictors, and outcomes were independently extracted. Meta-analysis using a random-effects model was conducted. Risk of bias and the certainty of evidence were evaluated using the QUIPS tool and GRADE, respectively.

Results: Data from 15 studies were synthesized, all focusing on predicting persistent LBP. Meta-analysis of seven studies revealed depression-distress significantly predicted persistent LBP and disability (n=15,778; β=0.28, 95% CI: 0.04–0.53, p=0.024), with low certainty of evidence. Fear avoidance also significantly predicted persistent LBP and disability (n=1,105; β=0.24, 95% CI: 0.00–0.49, p=0.049), with substantial heterogeneity and low certainty. Enhanced temporal summation showed a weak, non-significant association with pain, based on very low certainty. Decreased trunk flexion and extension velocity and acceleration were positive predictors of LBP in individual studies, but the certainty of this evidence was also very low.

Conclusions: Psychological factors, particularly depression-distress and fear avoidance, were significant positive predictors of persistent LBP, although the certainty of evidence was low to very low. For physical predictors, only individual studies identified reduced flexion and extension velocity and acceleration as potential predictors of persistent LBP, but this was also based on very low certainty of evidence. Given the limited research on physical factors associated with persistent or recurrent LBP, further investigation is needed. Additionally, high-quality studies are essential to strengthen the overall certainty of evidence for both psychological and physical predictors.

References: 1. Burke CA, Fillipo R, George SZ, Kapos FP, Kosinski AS, Ford E, et al. Transition from acute to chronic low back pain in a community-based cohort. J Pain. 2025;26:104704.
2. Collaborators GLBP. Global, regional, and national burden of low back pain, 1990-2020, its attributable risk factors, and projections to 2050: a systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol. 2023;5(6):e316-e29.
3. Nieminen LK, Pyysalo LM, Kankaanpää MJ. Prognostic factors for pain chronicity in low back pain: a systematic review. Pain Rep. 2021;6(1):e919.
4. Devecchi V, Rushton AB, Gallina A, Heneghan NR, Falla D. Are neuromuscular adaptations present in people with recurrent spinal pain during a period of remission? a systematic review. PLoS One. 2021;16(4):e0249220.
5. Fatoye F, Gebrye T, Ryan CG, Useh U, Mbada C. Global and regional estimates of clinical and economic burden of low back pain in high-income countries: a systematic review and meta-analysis. Front Public Health. 2023;11:1098100.

Presenting Author: Kanya Wongwitwichote
Submitting Author: Kanya Wongwitwichote

Senior Author: Deborah Falla

IASP 2026 Global Year theme of Neuropathic Pain: No

• Cho Wai Geoffrey Yu - University of Birmingham
• Valter Devecchi - University of Birmingham
• Michael Mansfield - University of Birmingham