Mapping guideline‐informed care for chronic non‐specific low back pain with the biopsychosocial approach: A rapid review

Abstract

Background Current evidence favors a multidisciplinary biopsychosocial approach to the management of chronic non‐specific low back pain (CLBP). However, it is unclear whether such an approach is facilitated by current clinical guidelines. This rapid review set out to examine the extent to which clinical guideline recommendations for managing CLBP address domains of the biopsychosocial approach. Methods MEDLINE, EMBASE, CINAHL, and the gray literature were searched for any clinical guidelines targeting the management of CLBP, published within the last 6 years. Title/abstract and full‐text screening were undertaken by two reviewers using the accelerated approach. Data extraction and critical appraisal were completed by two reviewers, independently. Extracted data were synthesized in narrative form. Results Fifteen guidelines met the review inclusion criteria. One‐half of the guidelines were considered to be of medium quality. All guidelines provided management recommendations addressing the biological domain of the biopsychosocial approach; 13 (87%) guidelines reported recommendations addressing the psychological domain, and 8 (53%) guidelines presented recommendations addressing the social domain. Only 53% (8/15) of guidelines reported recommendations addressing all three domains of the biopsychosocial approach. Guideline recommendations both across and within the biopsychosocial domains were varied and inconsistent. Conclusions The CLBP clinical guidelines included in this review provided detailed guidance on the biological domain, yet limited attention and detail were afforded to the psychological and social domains. Several recommendations are presented on how to improve the quality of future CLBP guidelines, and to help foster the provision of a biopsychosocial approach to CLBP management.

A Review of Clinical Practice Guidelines for Physiotherapy Management of Patients with Non-Specific Low Back Pain

“…This finding aligns with a recent rapid review on informed care for chronic NSLBP utilizing a biopsychosocial approach, which found that only 53% (8 out of 15) of the guidelines addressed all three domains of the biopsychosocial approach. 34 In future CPGs for the management of patients with NSLBP, it is anticipated that greater emphasis should be placed on psychological and social aspects alongside biological factors to enhance the biopsychosocial approach. This assertion is supported by a recent metaanalysis, which concluded that biopsychosocial interventions yielded superior outcomes compared to solely engaging in active physiotherapy management for patients with chronic NSLBP.…”

Fear-Avoidance Beliefs Associated with Non-Specific Chronic Low Back Pain in College Athletes

“… 9 The chronicity of non-specific LBP has been suggested to be due in part to psychosocial factors. 10 , 11 Previous studies have shown that fear-avoidance beliefs and kinesiophobia, as assessed by the physical activity subscale of the Fear-Avoidance Beliefs Questionnaire (FABQ-PA) and the Tampa Scale for Kinesiophobia (TSK)-11 scores, are significantly associated with presence of CLBP. 12 , 13 Although several investigations have shown an association CLBP and psychosocial factors in workers, 12 , 13 few similar studies have been conducted in athletes.…”

A Scoping Review of Interventions Targeting the Mental Health of Australian Veterans

“…Engel [ 15 ] theorised the biopsychosocial model and described how the interconnection between biological, psychological, and social factors influenced mental health. The biopsychosocial model comprises three domains—the biological domain (e.g., age, biomechanics, comorbidity, gender, genetics, metabolic factors, neurochemistry, pathophysiology, and physical), the psychological domain (e.g., addictions, attitudes/beliefs, cognitive factors, developmental issues, expectations, literacy/health literacy, mental illness, past experiences, personality, preferences, psychological stress, readiness to change, self-efficacy, and self-esteem), and the social domain (e.g., economic factors, employment/occupation, environment/geography, ethnicity/culture/race, family/social support and relationships, health provider/system factors, housing, and language proficiency) [ 16 ].…”