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However, the role of task-specific pain-related fear and lifting kinematics in the development of low back pain (LBP) remains unclear. This study aimed to develop and evaluate a supervised machine learning model to predict one-year LBP incidence and to identify the most important predictors. Baseline data from 156 healthy participants included pain-related fear, demographic, health, and lifestyle factors as well as lumbar spine range of motion (ROM) and whole-body lifting strategy during 15-kg lifting. LBP incidence was assessed using biweekly follow-up questionnaires. We trained and evaluated an Explainable Boosting Machine to predict one-year LBP incidence from baseline variables. The final model achieved an accuracy of 0.815 and an ROC AUC of 0.839 for out-of-sample predictions. The most important predictors were higher BMI, lower sleep quality, greater lifting-specific pain-related fear, and reduced lumbar spine ROM. This predictive performance suggests that a machine learning approach may help identify individuals at higher risk of developing LBP according to the applied criteria. These findings emphasize the role of lifting-specific pain-related fear and lifting kinematics in the development of LBP and highlight multifactorial contributors to LBP incidence.<\/jats:p>","DOI":"10.1038\/s41598-026-62770-2","type":"journal-article","created":{"date-parts":[[2026,7,21]],"date-time":"2026-07-21T11:24:23Z","timestamp":1784633063000},"update-policy":"https:\/\/doi.org\/10.1007\/springer_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Exploring the role of pain-related fear and lifting biomechanics in predicting low back pain incidence using supervised machine learning"],"prefix":"10.1038","volume":"16","author":[{"given":"Christian","family":"Bangerter","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliver","family":"Faude","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Monika","family":"D\u00f6rig","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Michael L.","family":"Meier","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carol-Claudius","family":"Hasler","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Stefan","family":"Schmid","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"297","published-online":{"date-parts":[[2026,7,21]]},"reference":[{"key":"62770_CR1","doi-asserted-by":"publisher","first-page":"482","DOI":"10.1016\/S0140-6736(11)60610-7","volume":"379","author":"F Balagu\u00e9","year":"2012","unstructured":"Balagu\u00e9, F., Mannion, A. 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