Background

Low back pain (LBP) is pain occurring between the lower ribs and the buttocks. It can be acute, sub-acute, or chronic, and it affects people across all age groups. LBP often restricts movement, lowers quality of life, and impacts mental well-being, work capacity, and social participation. The condition may be specific, when linked to a known disease or spinal problem, or non-specific, when no clear structural cause is identified, the latter accounting for about 90% of cases. Rehabilitation is essential in every stage of LBP, as it helps individuals understand their pain, maintain or restore activity, and adopt strategies that promote recovery. Given its prevalence and link to reduced productivity, LBP is a major public health challenge with significant economic consequences. (World Health Organization, 2023.)

The interventions include cognitive behavioral therapy (CBT), mindfulness-based stress reduction (MBSR), and cognitive functional therapy (CFT). This mini-review examines the evidence from randomized controlled trials (RCTs) that evaluated the effectiveness of psychophysical physiotherapy methods in adults with chronic low back pain.

Chronic low back pain (CLBP) is one of the most prevalent musculoskeletal conditions worldwide and a leading cause of disability across populations. It imposes a significant burden on health care systems and society due to its chronic nature, reduced work ability, and high treatment costs. Rehabilitation is challenging as conventional physiotherapy often provides only partial relief and relapse rates remain high. (Cherkin et al., 2016; O’Keeffe et al., 2020.)

Given these challenges, psychophysical physiotherapy methods such as cognitive behavioral therapy (CBT), mindfulness-based stress reduction (MBSR) and cognitive functional therapy (CFT) have gained increasing attention. These approaches integrate physical rehabilitation with psychological strategies, targeting both the body and mind to improve outcomes.

This article is part of a series produced within the course Professional in Physiotherapy, which is included in the physiotherapy degree programme. The article was created as part of the evidence-based physiotherapy section of the course. In small groups, students practice elements of a systematic literature review, including systematic information retrieval, critical appraisal using the PEDro Scale tool, and writing up the results in the form of a scientific article.

Aim

This mini-review aimed to explore how different psychological and behavioral approaches can improve pain, function, and well-being among adults with chronic low back pain, and to identify key factors influencing their effectiveness.

Methods

We used the Pubmed database. We restricted the results by selecting studies that were published in the last ten years, fully available in free text, and are randomized controlled trials (RCT). We wanted to find studies that investigated the effects of psychophysical physiotherapy on chronic low back pain in adults. We wanted to research more closely the effects of cognitive behavioral therapy. So, the Keywords included “cognitive behavioral therapy” and “chronic low back pain.” With these keywords and criteria, 42 studies were found on PudMed. And we selected four research of them that met our eligibility criteria. Studies were excluded if they were not randomized controlled trials (RCT), if participants had a condition other than chronic low back pain, or if cognitive behavioral therapy (CBT) was not used as an intervention.

The selected studies were evaluated using the PEDro scale. Physiotherapy Evidence Database (PEDro) scale was developed to support evidence-based physiotherapy. The PEDro scale assesses the metodological quality of a study based on questions related to risk of bias and the overall quality of the article and helps PEDro users select a high-quality article before reading it. The PEDro scale is a valid and reliable tool for assessing the quality of studies. (Physiotherapy Evidence Database, n.d.)

Results

Recent evidence highlights the effectiveness of psychological and behavioral interventions for adults with chronic low back pain (CLBP), particularly those targeting maladaptive thoughts, behaviors, and emotional regulation related to pain. Across studies, cognitive behavioral therapy (CBT), mindfulness-based stress reduction (MBSR), and Cognitive Functional Therapy (CFT) have shown consistent benefits for pain, disability, and psychological functioning.

Several randomized controlled trials have demonstrated that brief and intensive psychological interventions can both yield meaningful improvements. Darnall et al. (2021) showed that even a single-session pain management intervention (“Empowered Relief”) produced comparable reductions in pain catastrophizing to an eight-session CBT program and superior outcomes to health education. Although CBT provided slightly greater benefits for physical function, the finding that a single, brief intervention can achieve clinically significant outcomes suggests scalability and accessibility advantages.

Similarly, Cherkin et al. (2016) found that both MBSR and CBT were superior to usual care in improving functional limitations and reducing pain bothersomeness, with effects sustained for up to one year. This supports the notion that both mindfulness- and cognition-focused therapies can produce durable benefits, reinforcing their role as effective non-pharmacological approaches to chronic pain management. Chen et al. (2023), in a secondary analysis of the same trial, further revealed that baseline psychological characteristics such as higher self-efficacy and mindfulness traits moderated treatment outcomes, suggesting that tailoring interventions to patient profiles could optimize effectiveness.

Extending beyond cognitive and mindfulness-based interventions, O’Keeffe et al. (2020) demonstrated that Cognitive Functional Therapy (CFT) which integrates behavioral, cognitive, and movement retraining components led to greater short-term improvements in disability, pain, and psychological outcomes than standard exercise and education programs. These advantages were sustained over time, although differences narrowed at one year, reflecting the potential for behavioral engagement and individualization as key mediators of long-term success.

When synthesizing these findings, a clear pattern emerges: psychological and behaviorally oriented interventions produce meaningful, lasting improvements in CLBP, with varying intensity and delivery formats yielding comparable benefits. Interventions that address maladaptive cognition (CBT, CFT), promote mindfulness (MBSR), or enhance self-efficacy (Empowered Relief) appear most effective in reducing pain-related distress and improving function. Methodologically, all studies demonstrated good to high quality (PEDro 7–8/10), with consistent strengths including randomization, retention rates over 80%, and validated outcome measures. Common limitations included limited participant blinding and potential selection bias due to incomplete allocation concealment.

Overall, the evidence suggests that multifaceted psychological approaches whether brief or extended can significantly improve outcomes in chronic low back pain, particularly when they enhance patients’ self-management, coping, and functional engagement. The choice of intervention may thus be guided by accessibility, patient preferences, and psychological profile rather than the superiority of one specific method.

Conclusion

Evidence from recent RCTs supports the effectiveness of psychophysical physiotherapy approaches particularly CBT, MBSR, and CFT for adults with chronic low back pain. These methods address both physical and psychological aspects of pain, and they offer more comprehensive care compared to usual medical management. While CBT and MBSR are effective group-based interventions, CFT highlights the role of individualized therapy. Importantly, patient characteristics such as self-efficacy and mindfulness levels may influence treatment outcomes. Future research should investigate the long-term durability of these treatments, explore their effectiveness across different age groups and clinical subgroups, and further clarify which patients benefit most from each intervention.

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Authors:

Josefiina Angerman, physiotherapy student, Savonia University of Applied Sciences

Vilma Räsänen, physiotherapy student, Savonia University of Applied Sciences

Sara Siivonen, physiotherapy student, Savonia University of Applied Sciences

Jenni Vuorio, physiotherapy student, Savonia University of Applied Sciences

Marja Äijö PT, PhD, Principal lecturer of Gerontology and Rehabilitation, Savonia University of Applied Sciences

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