287: Which biopsychosocial factors best explain ICF domains in chronic non-specific low back pain?

Topic: Clinical Science
Subtopic: Pain category (ICD-11), Chronic primary musculoskeletal pain, Physiotherapy

Background and Aims: Chronic non-specific low back pain (CNLBP) is the leading cause of years-lived with disability worldwide. As CNLBP reflects interacting biopsychosocial factors, pain and disability scores may not fully capture its impact across International Classification of Functioning, Disability and Health (ICF) domains. ICF-informed analyses can highlight modifiable targets and support personalised rehabilitation planning. We examined the associations between clinical, sociodemographic, and psychosocial factors and overall disability, as well as ICF-linked activity/participation and body function domains, in adults with CNLBP. We hypothesised that there would be stronger psychosocial and sociodemographic links with activity/participation, and stronger clinical links with body functions.

Methods: Cross-sectional study conducted in a clinical setting in Brasília/Brazil, from 2023 to 2025. Adults aged 18–59 years with CNLBP were recruited via social media and community calls (n:112). Participants completed the Roland–Morris Disability Questionnaire (RMDQ), Numerical Rating Scale for pain, EQ-5D-3L for utility, Low Back Activity Confidence Scale (LoBACS), Fear-Avoidance Beliefs Questionnaire (FABQ) and STarT Back Screening Tool. RMDQ items were linked by expert consensus to ICF domains to create subscores for activity/participation and body functions. Three multiple linear regression models (stepwise; assumptions checked) were used to examine the predictors of the RMDQ total score and 2 subscores.

Results: Model 1 (RMDQ-total) explained 58.1% of the variance. Higher fear-avoidance beliefs (B:0.107), older age (B:0.101) and greater pain intensity (B:0.559) were associated with greater disability. Higher utility (B:−9.954) and low-risk prognosis (B:−3.406) were associated with lower disability. Model 2 (activity/participation) explained 56.0% of variance. Age (B:0.120) and fear-avoidance (B:0.078) were associated with increased limitations, while self-efficacy (B:−0.095) and low-risk prognosis (B:−2.798) were associated with reduced limitations. Model 3 (body functions) explained 27.8% of the variance. Pain (B:0.308) and fear-avoidance (B:0.030) were associated with increased impairments, while higher utility was associated with reduced impairments (B:−2.848).

Conclusions: Distinct, domain-specific patterns emerged across the ICF domains. Psychosocial factors such as fear-avoidance and self-efficacy were important for activity and participation, while pain intensity was most strongly associated with impairments in bodily functions. A better health-related quality of life and a low prognostic risk were protective factors. These findings support the implementation of routine biopsychosocial screening and ICF-informed goal setting to prioritise modifiable psychosocial barriers and customise rehabilitation programmes for adults with CNLBP.

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Presenting Author: Aline Martins de Toledo
Submitting Author: Aline Martins de Toledo

Senior Author: Rodrigo Luiz Carregaro

IASP 2026 Global Year theme of Neuropathic Pain: No

• Marina Cardoso de Melo Silva: MS - Universidade de Brasília (UnB)
• Maria Augusta de Araújo Mota: MS - Universidade de Brasília (UnB)
• Fernanda Pasinato: PhD - Universidade de Brasília (UnB)
• Silvana Schwerz Funghetto: PhD - Universidade de Brasília (UnB)
• Kennea Martins Almeida Ayupe: PhD - Universidade Federal do Espírito Santo (UFES)
• Rodrigo Luiz Carregaro: PhD - Universidade de Brasília (UnB)