Effectiveness of Biopsychosocial Model-Based Care versus Routine Physical Therapy on Clinical, Sensorimotor, and Psychosocial Outcomes in Patients with Chronic Low Back Pain: A Randomized Clinical Trial

Abstract

Background Chronic low back pain (CLBP) is a leading cause of disability around the world and needs a treatment plan that should include the treatment of the physical, psychological and social aspects of the condition. Routine physical therapy (RPT) primarily targets physical impairments, with comparatively limited emphasis on the psychosocial and cognitive dimensions of recovery. The proposed study examines the efficacy of biopsychosocial (BPS) based treatment on pain intensity as the primary outcome, alongside secondary clinical, sensorimotor, and psychological outcomes. Methodology This study is a single-centered, assessor-blinded, randomized clinical trial conducted at the Physiotherapy Department, National Hospital, Lahore, Pakistan, involving 80 patients. Randomization was performed using an online randomizer, with 1:1 allocation into two groups of 40 patients each. Sealed opaque numbered envelopes were used to ensure concealment. The BPS group received joint/neural mobilization, muscle performance training, pain neuroscience education, and group-based functional activities, while the RPT group received supervised exercises (stretching, motor control, strengthening) with patient education, both for 30 minutes, 3 sessions/week for 4 weeks, plus 10 minutes of heating pad and TENS. Pain intensity was measured by the short form Macgill pain questionnaire (SF-MPQ-2), Functional Disability by Oswestry disability index (ODI), Lumbar Core Muscle Control by pressure biofeedback unit (PBU), Pain Self-Efficacy by pain self-efficacy questionnaire (PSEQ), Perceived Social Support by multidimensional scale of perceived social support (MSPSS), and Health Related Quality of Life (SF-36) at baseline, at the fourth week, and at eight weeks. Results At 8 weeks, the BPS care group showed significantly greater improvement than the RPT group across clinical (pain intensity: mean difference [MD] = −10.51; functional disability: MD = −7.08), sensorimotor (lumbar core muscle control: MD = 1.92 mmHg), and psychosocial (pain self-efficacy: MD = 9.05; perceived social support: MD = 16.22; health-related quality of life: MD = 7.07) outcomes (all p<0.001), with Group × Time interaction effect sizes (η2) ranging from 0.13 to 0.53. Conclusion The BPS-care approach resulted in greater improvements than the RPT-care among patients with CLBP in relation to pain relief, functional impairments, lumbar core muscle control, pain self-efficacy, social support perception, and health-related quality of life. Trial Registration This trial was registered at ClinicalTrials.org using the number NCT07280806 on December 10, 2025.