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This quasi-randomized trial compared Pain Neuroscience Education emphasizing physical activity (PNE-PA) with traditional biomechanical treatments (BM) in older women with CLBP over 12 weeks. Community-dwelling women aged 65\u201390 years with CLBP were assigned to either group based on recruitment timing, using a double-blinded design. PNE-PA aimed to reduce pain-related fear by educating patients about pain neuroscience and encouraging physical activity. Outcomes included physical function, pain intensity, self-reported disability and psychological factors. Analyses used intention-to-treat and bootstrap resampling methods. Between-group differences were assessed using mean differences, 95% confidence intervals (CI), and Cohen\u2019s d. The PNE-PA group (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200924) showed significantly greater improvements than the BM group (\n                    <jats:italic>n<\/jats:italic>\n                    \u2009=\u200918) in Chair Stand Test (95% CI: 1.53\u00a0to\u00a07.76, d\u2009=\u20090.88), step count (95% CI: 475.97\u00a0to\u00a02550.42, d\u2009=\u20090.87), pain catastrophizing (95% CI: -10.64 to\u00a0-1.95, d = -0.87), and fear-avoidance beliefs (95% CI: -7.40 to\u00a0-0.14, d = -0.65). These findings suggest that Pain Neuroscience Education emphasizing physical activity was associated with better physical and psychological outcomes among older women with chronic low back pain.\n                  <\/jats:p>","DOI":"10.1038\/s41598-025-23951-7","type":"journal-article","created":{"date-parts":[[2025,11,7]],"date-time":"2025-11-07T12:29:25Z","timestamp":1762518565000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":5,"title":["Pain neuroscience education with physical activity improves physical and psychological outcomes in older women with chronic low back pain"],"prefix":"10.1038","volume":"15","author":[{"given":"Teppei","family":"Abiko","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Shin","family":"Murata","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hiroaki","family":"Iwase","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Koji","family":"Nonaka","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kunihiko","family":"Anami","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yuki","family":"Kikuchi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Katsuyuki","family":"Madoba","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kayoko","family":"Shiraiwa","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2025,11,7]]},"reference":[{"key":"23951_CR1","unstructured":"United Nations Department of Economic and Social Affairs. 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