A critical review of the biopsychosocial model of low back pain care: time for a new approach?

Purpose Low back pain (LBP) is the leading cause of disability worldwide. Clinical research advocates using the biopsychosocial model (BPS) to manage LBP, however there is still no clear consensus regarding the meaning of this model in physiotherapy and how best to apply it. The aim of this study was to investigate how physiotherapy LBP literature enacts the BPS model. Material and methods We conducted a critical review using discourse analysis of 66 articles retrieved from the PubMed and Web of Science databases. Results Analysis suggest that many texts conflated the BPS with the biomedical model [Discourse 1: Conflating the BPS with the biomedical model]. Psychological aspects were almost exclusively conceptualised as cognitive and behavioural [Discourse 2: Cognition, behaviour, yellow flags and rapport]. Social context was rarely mentioned [Discourse 3: Brief and occasional social underpinnings]; and other broader aspects of care such as culture and power dynamics received little attention within the texts [Discourse 4: Expanded aspects of care]. Conclusion Results imply that multiple important factors such as interpersonal or institutional power relations, cultural considerations, ethical, and social aspects of health may not be incorporated into physiotherapy research and practice when working with people with LBP.

Automated summary

This study found that there is confusion and limited understanding of the biopsychosocial model in physiotherapy literature on low back pain (LBP). Psychological aspects are often limited to cognitive and behavioral aspects, while social context and broader aspects of care receive little attention.