ArticleBMJ open2026
Role of psychosocial factors in muscle performance and response to outpatient supervised exercise-based physical therapy in individuals with chronic low back pain: a prospective cohort analysis.
Article in BMJ open, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
objectiveThe purpose of this study is to evaluate the relationship between psychosocial factors, muscle performance and treatment response in individuals undergoing an exercise-based physical therapy (EBPT) programme for chronic low back pain (CLBP).
designA secondary analysis of a prospectively collected clinical registry involving participants with CLBP enrolled in an 8-10-week EBPT programme. Participants completed psychosocial questionnaires before starting EBPT for CLBP. Lumbar extensor muscle performance was assessed using an isokinetic dynamometer, which recorded absolute and age and sex adjusted torque. Differences in muscle performance (absolute and adjusted) were calculated and regressed against psychosocial factors and clinical outcomes.
resultsAbsolute and adjusted torque increased with treatment (33.33% and 82.84% respectively, p<0.01). On average, pain, disability and patient goal achievement improved with treatment (p<0.10). Improvements in muscle performance were associated with lower fear avoidance (ß=-0.29 to -0.31, p<0.04), whereas higher absolute baseline and final torque correlated positively with pain self-efficacy (ß=0.20, p=0.04; ß=0.27, p=0.02). No significant correlations were observed between changes in muscle performance and improvements in clinical outcomes, including pain, disability or functional status (all p>0.20).
conclusionIndividuals with CLBP demonstrated improved muscle performance and clinical outcomes after EBPT, though these improvements were independent of each other. Better absolute lumbar extensor muscle performance correlated with higher pain self-efficacy, and greater treatment response corresponded with lower fear-avoidance. These data suggest that pain coping strategies and addressing fear avoidance through educational and exposure-based interventions may be a target for modifying muscle performance in CLBP.
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