Cappelletti Sonia [Università degli Studi di Firenze, Firenze, Italia]
Di Bari Mauro [Università degli Studi di Firenze, Firenze, Italia]
Borghi Sara [Università degli Studi di Firenze, Firenze, Italia]
Low Back Pain (LBP) is the most common and important clinical, social
and economic problem of all musculoskeletal disorders. Several factors, including
biological, psychological, social, genetic, may contribute to the persistence of pain and
disability of LBP. NICE guidelines promote the use of conservative treatment that
incorporates pain self-management, therapeutic exercise, manual therapy.
Psychologically Informed Physical Therapy (PIPT) represents a multimodal
rehabilitation approach to treating pain that incorporates behavioral strategies from the
mental health realm into the physical therapist’s practice. The aim of this study is to
investigate the effectiveness of behavioral PIPT approaches in patients with
musculoskeletal LBP.
A systematic review was conducted in PubMed, Embase, Cochrane Library,
CINAHL, Scopus, PEDro, PsycInfo and Web of Science. RCTs that met the eligibility
criteria of the present research were included. The studies were assessed by blinded
reviewers using standardized tables. The assessment of the methodological quality of the
studies was carried out using the Risk of Bias 2.0 tool.
11 RCTs that met the inclusion/exclusion criteria were included. 8 studies had a
high risk of bias, 3 studies had a moderate risk of bias. The sample size of the included
studies varies from 30 participants to 248. Only one RCT investigates subacute LBP, the
remaining trials include only patients with chronic LBP. The results showed that
behavioral PIPT approaches, associated or not with other interventions, are effective
compared to active or passive control groups in the outcome of fear-avoidance, anxiety
and depression and in the quality of life both post-intervention and to follow-up.
The results of this systematic review suggest that there is limited and
inconsistent evidence on the effectiveness of behavioral PIPT interventions in patients
with LBP. Further research will be necessary to produce clinical trials with
greater methodological quality and standardization of procedures.
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