1. 2025;28;397-416The Past, Present, and Future of the Biopsychosocial Approach to Nonspecific Chronic Low Back Pain in Research and Clinical Practice Based on a Bibliometric Analysis
   Bibliometric Analysis
   Aybuke Fanuscu, PT, Iris Meuwissen, PT, and Mira Meeus, PT, PhD.

BACKGROUND: Chronic low back pain (CLBP) is the leading cause of years lived with disability worldwide. Recent studies show increasing evidence for the implication of a multimodal treatment approach for CLBP, including education, exercise therapy, and physical activity. 

OBJECTIVE: This study aimed to analyze the trends in the biopsychosocial approach to CLBP through bibliometric analysis and to explore the main topics and provide recommendations for researchers and clinicians.

STUDY DESIGN: In this bibliometric analysis, a 2-phase literature screening was performed to generate clusters and thus explore the main topics of the years 2012-2023.

METHODS: Literature was derived from Web of Science for the years 2012-2023. Two researchers independently conducted double-blind title and abstract screening in accordance with PRISMA guidelines. VOSViewer and CiteSpace software were used to analyze authors, countries, institutions, journals, keywords, and references. The clusters of co-cited references generated by the CiteSpace software were analyzed, and the largest clusters related to the biopsychosocial approach were narratively reviewed in detail.

RESULTS: A total of 2,070 studies were included in the analysis. The most influential country, institution, and author were the United States of America, the University of Sydney, and Leonardo Oliveira Pena Costa, respectively. BMC Musculoskeletal Disorders was the journal with the greatest number of publications. Exercise therapy, cognitive-functional therapy, pain neuroscience education, manual therapy, mobile applications, and psychologically informed physical therapy stood out in the reference analysis.

LIMITATIONS: This study has several limitations, such as the restriction to studies indexed in the WOS database. Only English-language studies were included, and to maintain focus, we chose to discuss only those relevant to the biopsychosocial approach within the top 10 clusters.

CONCLUSIONS: This bibliometric analysis highlighted the evolving trends and main contributors in this field. The study mapped the complex knowledge network in the field, highlighting various interventions as focal points of scientific interest, particularly exercise therapy, cognitive-functional therapy, pain neuroscience education, manual therapy, mobile application, and psychologically informed physical therapy. Standardization in research methodologies and more high-quality studies are needed to solidify the efficacy of these interventions and inform clinical practice more effectively.

KEY WORDS: low back pain, biopsychosocial, exercise, education, telerehabilitation, manual therapy