Evidence map›Paper›PMID 42154226›Full record

ArticleEuropean spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society2026

A meta-model of low back pain to examine collective expert knowledge of treatment effects and their mechanisms.

Jacek Cholewicki, Paul W Hodges, John M Popovich, Payam Aminpour, Steven A Gray, Angela S Lee, Alan Breen, Simon Brumagne, Jaap H van Dieën, Linda R Van Dillen and 22 more

Abstract read
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In one paragraph

Article in European spine journal : official publication of the European Spine Society, the European Spinal Deformity Society, and the European Section of the Cervical Spine Research Society, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Review
4 · The record

Corrections and comments

5 · Who and what money

Authors and funding

32 authors.

Jacek CholewickiCenter for Neuromusculoskeletal Clinical Research, College of Osteopathic Medicine, Michigan State University, MI, East Lansing, USA. cholewic@msu.edu.
Paul W HodgesCentre for Innovation in Pain and Health Research (CIPHeR) and School of Health and Rehabilitation Sciences, University of Queensland, QLD, Brisbane, Australia.
John M PopovichCenter for Neuromusculoskeletal Clinical Research, College of Osteopathic Medicine, Michigan State University, MI, East Lansing, USA.
Payam AminpourLife Sciences Group, Thermo Fisher Scientific (United States), CA, Carlsbad, USA.
Steven A GrayDepartment of Community Sustainability, Michigan State University, MI, East Lansing, USA.
Angela S LeeCenter for Neuromusculoskeletal Clinical Research, College of Osteopathic Medicine, Michigan State University, MI, East Lansing, USA.
Alan BreenFaculty of Science and Technology, Bournemouth University, Poole, UK.
Simon BrumagneDepartment of Rehabilitation Sciences, KU Leuven, Leuven, Belgium.
Jaap H van DieënDepartment of Human Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Netherlands.
Linda R Van DillenProgram in Physical Therapy and Department of Orthopaedic Surgery, Washington University School of Medicine in St. Louis, MO, St. Louis, USA.
Thomas E DreisingerTherapy Advisors, AZ, Tucson, USA.
Manuela L FerreiraThe George Institute for Global Health, NSW, Sydney, Australia.
Steven Z GeorgeDepartment of Orthopaedic Surgery and Population Health Sciences and Duke Clinical Research Institute, Duke University, NC, Durham, USA.
Christine M GoertzDepartment of Orthopaedic Surgery and Duke Clinical Research Institute, Duke University School of Medicine, NC, Durham, United States of America.
Jan HartvigsenCenter for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
Julie A HidesSchool of Allied Health, Sport and Social Work, Griffith University, QLD, Brisbane, Australia.
Damian HoyGlobal Alliance for Musculoskeletal Health (GMUSC), The University of Sydney, NSW, Sydney, Australia.
Gregory N KawchukDepartment of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, AB, Edmonton, Canada.
Bart W KoesDepartment of General Practice, Erasmus MC, Rotterdam, Netherlands.
Ralph KotheClinic for Spinal Surgery, Schön Klinik Hamburg Eilbek, Hamburg, Germany.
Helene M LangevinThe Osher Center for Integrative Health, University of Vermont, VT, Burlington, USA.
Diane LeeDiane Lee & Associates, BC, South Surrey, Canada.
Jeffrey C LotzDepartment of Orthopaedic Surgery, University of California, San Francisco, CA, San Francisco, USA.
G Lorimer MoseleyCollege of Health, Adelaide University, SA, Adelaide, Australia.
Heidi PratherPhysical Medicine and Rehabilitation Weill Cornell Medicine, Hospital for Special Surgery, NY, New York, USA.
N Peter ReevesSumaq Life LLC, MI, Lansing, USA.
Shirley SahrmannProgram in Physical Therapy, Washington University School of Medicine in St. Louis, MO, St. Louis, USA.
Rob J SmeetsDepartment of Rehabilitation Medicine, School for Public Health and Primary Care, Maastricht University, Maastricht, Netherlands.
Laura S StoneDepartment of Anesthesiology, School of Medicine, University of Minnesota, MN, Minneapolis, USA.
Johan W S VlaeyenResearch Group Health Psychology, KU Leuven, Leuven, Belgium.
Jeffrey C WangDepartment of Orthopaedics and Neurosurgery, Keck School of Medicine, University of Southern California, CA, Los Angeles, USA.
Sherri WeiserOccupational and Industrial Orthopedics Center, New York University Langone Medical Center, NY, New York, USA.

Funding

National Health and Medical Research Council 1091302
6 · The paper itself

Abstract

purposeLow back pain (LBP) is a complex, multifactorial condition with numerous contributors across biopsychosocial domains. To advance understanding of this complexity, we synthesized diverse expert knowledge on treatment effectiveness and underlying mechanisms using a systems-based, collaborative modeling approach.

methodsTwenty-nine experts from diverse disciplines created individual fuzzy cognitive maps (FCMs) to represent their understanding of factors affecting pain, disability, and quality of life (QoL), along with treatment mechanisms. These maps were aggregated into a meta-model comprising 142 Components and 1,161 weighted Connections. Centrality was used to quantify the relative contribution of each domain within the meta-model. Simulations with the meta-model based on expert knowledge (1) estimated the relative effectiveness of treatments on pain, disability, and QoL and (2) identified key Mediators and mediating Domains based on their relative contribution to mediating treatment effects.

resultsPsychological, biomechanical, and social/contextual Domains were central to expert conceptualizations of LBP. Simulation indicated cognitive behavioral therapy was considered the most effective among all interventions. Most interventions were mediated by Components across multiple Domains, with psychological factors frequently serving as mediators. The structure of the conceptual meta-model reflected both the multifactorial complexity of LBP and the diversity of expert perspectives regarding factors that influence treatment effectiveness.

conclusionThe developed meta-model provides a novel, systems-based representation of expert knowledge about LBP, enabling quantitative exploration of treatment effects and underlying mechanisms. This conceptual framework also offers a foundation for advancing research on multi-modal, personalized care.

Indexed as

Low Back PainHumansQuality of LifeTreatment OutcomeBiopsychosocial modelLow back painSystems modelingTreatment effectivenessTreatment mechanisms

Identifiers

PMID42154226
PMCPMC13372931

What OpenQuestion holds

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Registered trials

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.