Research indicates that individuals suffering from chronic lower back pain may experience significant improvements through a change in mindset, potentially reducing the need for physiotherapy. A study published on January 9, 2026, in the journal JAMA Network Open, highlights the effectiveness of a self-management approach, known as the Enhanced Transtheoretical Model Intervention (ETMI), in enhancing patient outcomes.
The trial involved over 1,600 patients suffering from chronic lower back pain. Traditional clinical guidelines suggest that treatment should include reassurance about self-management capabilities. However, this advice is frequently overlooked in practice. The research demonstrates that a focus on altering patients’ beliefs regarding their condition and promoting physical activity can be as effective, if not more so, than conventional physiotherapy methods.
ETMI emphasizes changing unhelpful beliefs about back pain and encourages participants to engage in leisure-time physical activities of their choosing. This approach differs from standard physiotherapy, which typically combines exercise therapy, education, and various adjunct therapies like acupuncture.
The study monitored the physical activity levels of patients—categorized as none, one to two times a week, or more than three times a week—alongside their number of physiotherapy appointments and ETMI participation. Participants were also asked to track changes in their functional abilities, pain levels, and beliefs about physical activity throughout the treatment period. Functionality was rated on a scale from 0 to 100, with higher scores indicating better overall function. Pain intensity was measured on a scale from 0 to 10.
Of the study’s participants, 83 percent received ‘usual care,’ while 259 patients were treated with ETMI. Those in the ETMI group, which included brisk walking sessions, required fewer treatment sessions and showed greater enhancements in functionality and reduced fear-avoidance beliefs regarding physical activity compared to those receiving standard care.
The findings suggest that ETMI outperformed traditional care in alleviating activity limitations caused by chronic back pain. This was especially true for patients diagnosed with depression and/or anxiety. Despite these improvements, researchers observed no significant differences in pain levels across groups, indicating that the intervention primarily targeted patients’ beliefs and activity patterns rather than directly addressing pain symptoms.
The researchers concluded that transitioning from a clinician-managed model focused on specific diagnoses and treatments to one that prioritizes patient self-management may be challenging. However, embracing such a model could lead to more sustainable care for musculoskeletal conditions.
This study underscores the importance of empowering patients to take control of their health through mindset changes and active participation in their recovery process. As chronic lower back pain affects millions worldwide, these findings may offer a new perspective on managing this debilitating condition without relying solely on traditional physiotherapy.
