Effectiveness of the Psychologically Informed Physical Therapy in Individuals With Low Back Pain: a Systematic Review With Meta-analysis

Autori

Borghi Sara [Department of Biomedical and Neuromotor Sciences (DIBINEM), Alma Mater Studiorum – University of Bologna, Bologna, Italy] [Department of Physical Medicine and Rehabilitation, Azienda USL Bologna, Ospedale di Bentivoglio, Bologna, Italy]

Cappelletti Sonia [Private Practice, Bergamo, Italy ]

Di Bari Mauro [Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy] [Department of Medicine and Geriatrics, Unit of Geriatrics, Azienda Ospedaliero-Universitaria Careggi, Florence, Italy ]

Paci Matteo [Department of Experimental and Clinical Medicine, University of Florence, Florence, Italy] [Department of Allied Health Professions, Azienda USL Toscana Centro, Florence, Italy]

Background and aims

The most recent National Institute for Health and Care Excellence (NICE) guidelines on LBP recommend conservative approaches, promoting self-management of pain, exercise and manual therapy, rather than pharmacological and invasive interventions. Among other conservative interventions, in recent years a new approach to LBP physiotherapy, called Psychologically Informed Physical Therapy (PIPT), has received wide research interest. The aim of this Systematic Review with Meta-analysis is to explore the effects of the behavioral and non-behavioral Psychologically Informed Physical Therapy (PIPT) approaches separately in patients with Low Back Pain (LBP).

Methods

A systematic review of the literature was conducted following the Preferred Reporting Items for Systematic Review and Meta-Analyses (PRISMA) statement. We searched PubMed, Embase, Cochrane Library, CINAHL, Scopus, PEDro, PsycInfo and Web of Science databases from inception to April 30th, 2024. Studies were included if they were randomized controlled trial (RCT) involving patients with LBP aged ≥ 18 years in which a PIPT-based intervention, behavioral or non-behavioral, was applied. Records were managed using the RAYYAN QCRI online software by two independent reviewers (SB and SC); a third blind reviewer (MDB) was involved in case of disagreements. We assessed risk of bias using the revised Cochrane risk-of-bias tool. Random effects meta-analysis was conducted separately for behavioral and non-behavioral PIPT approaches, pooling the individual estimates as standardized mean difference (SMD) with 95% confidence interval (CI).

Results

Twenty-two trials were included, 11 for each approach, of which two had low, 7 moderate and 13 high risk of bias. Meta-analyses were conducted only for pain and disability outcomes in the post-intervention: both approaches significantly improved pain; the non-behavioral PIPT significantly reduced disability and the behavioral PIPT showed results in the direction of improvement. Significant improvements in kinesiophobia and pain catastrophizing were found in the non-behavioral PIPT approaches; no differences were found for the other outcomes.

Conclusion

This systematic review suggests the effectiveness of PIPT, both behavioral and non-behavioral, for pain and disability in patients with LBP. Compared to other studies available in literature, in this study the PIPT was analyzed through a comprehensive view, rather than individual techniques. The results emerging from the present systematic review suggest the importance of integrating mental health strategies into physical therapy practice, which should be enriched with both theoretical and practical aspects that underlie PIPT. It suggests the importance of incorporating this approach into physical therapy practice integrating strategies from the mental health realm.

REFERENCES

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