Physiotherapy Based on a Biobehavioral Approach with or Without Orthopedic Manual Physical Therapy in the Treatment of Nonspecific Chronic Low Back Pain: A Randomized Controlled Trial

Pain Med. 2019 Dec 1;20(12):2571-2587. doi: 10.1093/pm/pnz093.


Objective: To compare the effectiveness of a biobehavioral approach with and without orthopedic manual physical therapy on the intensity and frequency of pain in patients diagnosed with nonspecific chronic low back pain.

Methods: A single-blind randomized controlled trial. Fifty patients were randomly allocated into two groups: one group received biobehavioral therapy with orthopedic manual physical therapy, and the other group received only biobehavioral therapy. Both groups completed a total of eight sessions, with a frequency of two sessions per week. The somatosensory, physical, and psychological variables were recorded at baseline and during the first and third month after initiation of treatment.

Results: In both groups, the treatment was effective, presenting significant differences for all the variables in the time factor. There were no significant differences between groups in intensity or frequency of pain, with a large effect size (>0.80), but there were intragroup differences for both intervention groups at one- and three-month follow-up. There were also no significant differences between groups in the secondary variables during the same follow-up period.

Conclusions: The results of this study suggest that orthopedic manual physical therapy does not increase the effects of a treatment based on biobehavioral therapy in the short or medium term, but these results should be interpreted with caution.

Keywords: Biobehavioral Approach; Chronic Pain; Coping Skills; Nonspecific Chronic Low Back Pain; Physical Therapy.

Publication types

  • Randomized Controlled Trial

MeSH terms

  • Adult
  • Biobehavioral Sciences
  • Catastrophization
  • Chronic Pain / therapy*
  • Exercise Therapy / methods*
  • Female
  • Humans
  • Low Back Pain / therapy*
  • Male
  • Manipulation, Orthopedic / methods*
  • Middle Aged
  • Pain Measurement
  • Patient Education as Topic / methods*
  • Physical Therapy Modalities*
  • Self Efficacy
  • Single-Blind Method
  • Treatment Outcome