A meta-model of low back pain to examine collective expert knowledge of treatment effects and their mechanisms
Year: 2026
Type: article
Abstract: PURPOSE: Low 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. METHODS: Twenty-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. RESULTS: Psychological, 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. CONCLUSION: The 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.
Source: European Spine Journal
Authors: 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, Thomas E Dreisinger, Manuela L Ferreira, Steven Z George, Christine M Goertz, Jan Hartvigsen, Julie A Hides, Damian Hoy, Gregory N Kawchuk, Bart W Koes, Ralph Kothe, Helene M Langevin, Diane Lee, Jeffrey C Lotz, G. Lorimer Moseley, Heidi Prather, N. Peter Reeves, Shirley Sahrmann, Rob J Smeets, Laura S Stone, Johan W.S Vlaeyen, Jeffrey C Wang, Sherri Weiser
Institutions: Michigan State University, The University of Queensland, Thermo Fisher Scientific (United States), Bournemouth University, KU Leuven, Vrije Universiteit Amsterdam, Washington University in St. Louis, The George Institute for Global Health, Duke University, University of Southern Denmark, Griffith University, Mater Health Services, The University of Sydney, University of Alberta, Erasmus MC, Schön Klinik Hamburg Eilbek, University of Vermont, University of California, San Francisco, Adelaide University, The University of Adelaide, Hospital for Special Surgery, Weill Cornell Medicine, Maastricht University, University of Minnesota, University of Southern California, NYU Langone Health, New York University
Language: English
Subfield: Pharmacology
Field: Medicine
Domain: Health Sciences
Open Access status: hybrid
Estimated APC paid: $2,790
Awards: Asthenes: From acute aversive sensations to chronic bodily symptoms., Spinal Control during Functional Activities to Improve Low Back Pain Outcomes, Musculoskeletal pain and disability: improving outcomes through conservative interventions, Understanding persistent pain and innovating, testing and implementing new solutions., Less pain in the back: how new approaches can improve care for low back pain , G5520316217, From understanding the mechanisms to implementing conservative management of musculoskeletal conditions
OpenAlex ID: W7161635957