Explainable Machine Learning Applied to Bioelectrical Impedance for Low Back Pain: Classification and Pain-Score Prediction.

(1) Background: Low back pain (LBP) is the most prevalent cause of disability worldwide, yet current assessment relies mainly on subjective questionnaires, underscoring the need for objective and interpretable biomarkers. Bioelectrical impedance parameter (BIP), quantified by resistance (R), impedance magnitude (Z), and phase angle (PA), reflects tissue hydration and cellular integrity and may provide physiological correlates of pain; (2) Methods: This cross-sectional study used lumbar BIP and demographic characteristics from 83 participants (38 with lumbar BIP and 45 normal controls). We applied Extreme Gradient Boosting (XGBoost), a regularized tree-based machine learning (ML) algorithm, with stratified five-fold cross-validation. Model interpretability was ensured using SHapley Additive exPlanations (SHAP), which provide global importance rankings and local feature attributions. Outcomes included classification of LBP versus healthy status and regression-based prediction of pain scales: the Visual Analog Scale (VAS), Oswestry Disability Index (ODI), and Roland-Morris Disability Questionnaire (RMDQ); (3) Results: The classifier achieved high discrimination (ROC-AUC = 0.996 ± 0.009, sensitivity = 0.950 ± 0.068, specificity = 0.977 ± 0.049). Pain prediction showed best performance for VAS (R