Physical therapist–led interventions based on the biopsychosocial model provide improvement in disability and pain for spinal disorders: A systematic review and meta‐analysis

Abstract

ObjectiveTo summarize the effects of physical therapist–led interventions based on the biopsychosocial (BPS) model in spinal disorders compared to interventions with no BPS model through a systematic review and meta‐analysis of randomized‐controlled trials.TypeSystematic review and meta‐analysis.Literature SurveyWe searched the Web of Science, CENTRAL, MEDLINE, PsycINFO, CINAHL, and PEDro up to October 27, 2022.MethodologyPain intensity and disability were primary outcomes and psychological factors were secondary outcomes in spinal disorders. The included intervention was physical therapist–led interventions based on the BPS model. The control group received no physiotherapy intervention for BPS. Pooled effects were analyzed as standardized mean differences (SMDs) and 95% confidence intervals (CIs), and the random‐effects model was used for the meta‐analysis. The subgroup analysis was divided into low back pain group and neck pain group. Another subgroup analysis was conducted only of the groups that had received training of the BPS model.SynthesisFifty‐seven studies with 5471 participants met the inclusion criteria. For pain intensity, there was a statistically significant effect for the BPS model led by physical therapists in the short, medium, and long terms. The SMDs with 95% CIs were −0.44 (−0.62, −0.27), −0.24 (−0.37, −0.12), and −0.17 (−0.28, −0.06), respectively. Outcomes were clinically significant, except in the long term. For disability, there was a statistically significant effect in the short, medium, and long terms. The SMDs with 95% CIs were −0.48 (−0.69, −0.27), −0.44 (−0.64, −0.25), and −0.37 (−0.58, −0.15), respectively. All periods were clinically significant. The quality of the evidence was low for all of the main outcomes for all of the terms.ConclusionPhysical therapist–led interventions based on the BPS model effectively improve pain intensity and disability in patients with spinal disorders based on low‐quality evidence.

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“…Therefore, it is relevant to determine cost-effective therapeutic strategies that can improve the clinical condition of patients. In this sense, therapeutic strategies directed by physical therapists based on the biopsychosocial (BPS) model have been shown to effectively improve symptoms in people with spinal disorders ( Miki et al, 2023 ).…”

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How people with persistent pain experience in-person physiotherapy blended with biopsychosocial digital health - A qualitative study on participants' experiences with Back2Action

“…People with persistent, non-specific spinal pain who also have psychosocial risk factors associated with the development or maintenance of persistent pain, are often treated by physiotherapists ( Synnott et al, 2015 ). The use of a biopsychosocial model, an approach within healthcare that acknowledges health and illness result from complex interactions between biological, psychological, and social factors ( Engel, 1977 ), is advocated in the physiotherapy pain management of these people ( Hartvigsen et al, 2022 ; Ho et al, 2022 ; Miki et al, 2023 ). However, physiotherapists indicated that they do not always have the necessary skills and confidence to successfully address and treat the psychological problems seen in spinal pain ( Synnott et al, 2015 ; Holopainen et al, 2020 ).…”