Research Repository

How does individualised physiotherapy work for people with low back pain? A Bayesian Network analysis using randomised controlled trial data.

Liew, Bernard XW and Ford, Jon J and Scutari, Marco and Hahne, Andrew J (2021) 'How does individualised physiotherapy work for people with low back pain? A Bayesian Network analysis using randomised controlled trial data.' PLoS One, 16 (10). e0258515-e0258515. ISSN 1932-6203

journal.pone.0258515.pdf - Published Version
Available under License Creative Commons Attribution.

Download (1MB) | Preview


Purpose Individualised physiotherapy is an effective treatment for low back pain. We sought to determine how this treatment works by using randomised controlled trial data to develop a Bayesian Network model. Methods 300 randomised controlled trial participants (153 male, 147 female, mean age 44.1) with low back pain (of duration 6–26 weeks) received either individualised physiotherapy or advice. Variables with potential to explain how individualised physiotherapy works were included in a multivariate Bayesian Network model. Modelling incorporated the intervention period (0–10 weeks after study commencement–“early” changes) and the follow-up period (10–52 weeks after study commencement–“late” changes). Sequences of variables in the Bayesian Network showed the most common direct and indirect recovery pathways followed by participants with low back pain receiving individualised physiotherapy versus advice. Results Individualised physiotherapy directly reduced early disability in people with low back pain. Individualised physiotherapy exerted indirect effects on pain intensity, recovery expectations, sleep, fear, anxiety, and depression via its ability to facilitate early improvement in disability. Early improvement in disability, led to an early reduction in depression both directly and via more complex pathways involving fear, recovery expectations, anxiety, and pain intensity. Individualised physiotherapy had its greatest influence on early change variables (during the intervention period). Conclusion Individualised physiotherapy for low back pain appears to work predominately by facilitating an early reduction in disability, which in turn leads to improvements in other biopsychosocial outcomes. The current study cannot rule out that unmeasured mechanisms (such as tissue healing or reduced inflammation) may mediate the relationship between individualised physiotherapy treatment and improvement in disability. Further data-driven analyses involving a broad range of plausible biopsychosocial variables are recommended to fully understand how treatments work for people with low back pain.

Item Type: Article
Uncontrolled Keywords: Humans; Low Back Pain; Bayes Theorem; Adult; Physical Therapy Modalities
Divisions: Faculty of Science and Health
Faculty of Science and Health > Sport, Rehabilitation and Exercise Sciences, School of
SWORD Depositor: Elements
Depositing User: Elements
Date Deposited: 10 Nov 2021 16:47
Last Modified: 18 Aug 2022 12:30

Actions (login required)

View Item View Item