Biopsychosocial predictors of functional recovery in chronic low back pain following physiotherapy: A survival analysis study.

Abstract

Background Functional recovery following physiotherapy in individuals with chronic low back pain varies considerably and may be influenced by biological, psychological, behavioral, and social characteristics. Few studies have examined the timing of functional recovery using survival analysis in routine physiotherapy practice. Methods This prospective observational cohort study included 250 adults with chronic nonspecific low back pain receiving individualized physiotherapy over a median of eight sessions during four weeks. Baseline biopsychosocial characteristics were assessed using the Numeric Pain Rating Scale, Oswestry Disability Index (ODI), Tampa Scale for Kinesiophobia, Pain Catastrophizing Scale, Hospital Anxiety and Depression Scale, Pain Self-Efficacy Questionnaire, and Pittsburgh Sleep Quality Index. Functional recovery was defined as a clinically important improvement of at least 10 points on the ODI. Kaplan-Meier survival analysis and Cox proportional hazards regression were used to examine factors associated with time to recovery. Results During follow-up, 176 participants (70.4%) achieved functional recovery, with a median recovery time of 14 weeks. In univariable analyses, greater pain intensity, disability, fear of movement, pain catastrophizing, anxiety, depression, poor sleep quality, and lower pain self-efficacy were associated with delayed recovery. After multivariable adjustment, greater baseline disability, fear of movement, pain catastrophizing, poor sleep quality, and lower pain self-efficacy remained independently associated with longer time to functional recovery. Conclusions Baseline functional, psychological, and sleep-related characteristics were independently associated with recovery timing in individuals with chronic low back pain receiving physiotherapy. Comprehensive biopsychosocial assessment may improve prognostic evaluation, support individualized monitoring and goal setting, and inform development of externally validated prognostic models.