{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T18:10:56Z","timestamp":1790014256874,"version":"4.0.1"},"reference-count":33,"publisher":"Public Library of Science (PLoS)","issue":"9","license":[{"start":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T00:00:00Z","timestamp":1789948800000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS One"],"abstract":"<jats:sec id=\"sec001\">\n                    <jats:title>Background<\/jats:title>\n                    <jats:p>Low back pain (LBP) is a leading cause of disability worldwide and disproportionately affects women, particularly after menopause. However, evidence on the prevalence and associated factors of LBP among postmenopausal women in low- and middle-income countries remains limited. This study aimed to estimate the past-year prevalence of LBP among postmenopausal women attending selected rehabilitation and physiotherapy facilities in Bangladesh, examine factors associated with LBP, and evaluate the internal classification performance of machine learning models.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec002\">\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>A clinic-based cross-sectional study was conducted among 566 postmenopausal women attending two specialized rehabilitation centers in Bangladesh. Sociodemographic, clinical, lifestyle, and socioeconomic data were collected using structured questionnaires. Multivariable logistic regression was used to estimate adjusted associations with LBP. Machine learning models (Logistic Regression, Support Vector Machine with radial basis function (SVM-RBF), Random Forest, Bernoulli Na\u00efve Bayes, and Extreme Gradient Boosting) were developed to classify LBP. Model development used nested cross-validation, and final discriminative performance was evaluated using a held-out test set. Model interpretability was assessed using SHapley Additive exPlanations.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec003\">\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>The prevalence of past-year LBP among the postmenopausal women was 46.6%. Multivariable analysis showed lower odds of LBP among women aged 51\u201357 years than those aged 43\u201350 years (AOR\u2009=\u20090.50, 95% CI: 0.31\u20130.81), and higher odds among housewives (AOR\u2009=\u20092.20, 95% CI: 1.33\u20133.64), women with hypertension (AOR\u2009=\u20091.60, 95% CI: 1.09\u20132.35), respiratory disease (AOR\u2009=\u20092.46, 95% CI: 1.28\u20134.71), and selected socioeconomic groups, while heart disease and BMI category were not clearly associated after adjustment. Among the evaluated machine learning models, the SVM-RBF classifier achieved the highest accuracy during nested cross-validation (0.772), while random forest achieved comparable accuracy (0.768) and the highest F1-score (0.744). On the held-out test set, SVM-RBF achieved the highest ROC-AUC (0.890), followed by random forest (0.885). SHAP analysis identified sunlight exposure, hypertension, and socioeconomic status as the most influential contributors to model classification.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec id=\"sec004\">\n                    <jats:title>Conclusions<\/jats:title>\n                    <jats:p>LBP is commonly reported among postmenopausal women seeking rehabilitation and physiotherapy care in Bangladesh and is associated with multiple social, occupational, and health-related factors. Machine learning models demonstrated relatively strong internal classification performance; however, external validation is required before broader clinical use can be considered. Longitudinal community- and clinic-based studies are needed to clarify temporal relationships and assess the generalizability of these findings.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1371\/journal.pone.0355864","type":"journal-article","created":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T17:43:56Z","timestamp":1790012636000},"page":"e0355864","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":0,"title":["Prevalence, associated factors, and machine learning classification of low back pain among postmenopausal women attending rehabilitation and physiotherapy facilities in Bangladesh"],"prefix":"10.1371","volume":"21","author":[{"given":"Md. Faruqul","family":"Islam","sequence":"first","affiliation":[{"name":"Jashore University of Science and Technology","place":["Jashore, Bangladesh"],"department":["Department of Nutrition and Food Technology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Md. Omar","family":"Faruque","sequence":"additional","affiliation":[{"name":"Jashore University of Science and Technology","place":["Jashore, Bangladesh"],"department":["Department of Nutrition and Food Technology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Md.","family":"Alauddin","sequence":"additional","affiliation":[{"name":"Jashore University of Science and Technology","place":["Jashore, Bangladesh"],"department":["Department of Nutrition and Food Technology"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0009-0004-8413-3042","authenticated-orcid":true,"given":"Md. Omar","family":"Faruk","sequence":"additional","affiliation":[{"name":"Saic College of Medical Science and Technology","place":["Dhaka, Bangladesh"],"department":["Department of Physiotherapy"]},{"name":"CHINTA Research Bangladesh","place":["Dhaka, Bangladesh"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zakia","family":"Rahman","sequence":"additional","affiliation":[{"name":"Dhaka College of Physiotherapy","place":["Dhaka, Bangladesh"],"department":["Department of Physiotherapy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Zahid Bin Sultan","family":"Nahid","sequence":"additional","affiliation":[{"name":"Dhaka College of Physiotherapy","place":["Dhaka, Bangladesh"],"department":["Department of Physiotherapy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ahsan Habib","family":"Bulbul","sequence":"additional","affiliation":[{"name":"Saic College of Medical Science and Technology","place":["Dhaka, Bangladesh"],"department":["Department of Physiotherapy"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Md Emran","family":"Hasan","sequence":"additional","affiliation":[{"name":"CHINTA Research Bangladesh","place":["Dhaka, Bangladesh"]},{"name":"School of Computer Science and Engineering, Nanjing University of Science and Technology","place":["Nanjing, China"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maysa Mohamed Rabea","family":"Abdelall","sequence":"additional","affiliation":[{"name":"College of Sport Sciences and Physical Activity, Princess Nourah bint Abdulrahman University","place":["Riyadh, Saudi Arabia"],"department":["Department of Physical Sport Sciences"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Firoj","family":"Al-Mamun","sequence":"additional","affiliation":[{"name":"CHINTA Research Bangladesh","place":["Dhaka, Bangladesh"]},{"name":"University of South Asia","place":["Dhaka, Bangladesh"],"department":["Department of Public Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1728-8966","authenticated-orcid":true,"given":"Mohammed A.","family":"Mamun","sequence":"additional","affiliation":[{"name":"CHINTA Research Bangladesh","place":["Dhaka, Bangladesh"]},{"name":"University of South Asia","place":["Dhaka, Bangladesh"],"department":["Department of Public Health"]}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2026,9,21]]},"reference":[{"issue":"1","key":"pone.0355864.ref001","doi-asserted-by":"crossref","first-page":"52","DOI":"10.1038\/s41572-018-0052-1","article-title":"Low back pain","volume":"4","author":"JWS Vlaeyen","year":"2018","journal-title":"Nature Reviews Disease Primers"},{"issue":"9814","key":"pone.0355864.ref002","doi-asserted-by":"crossref","first-page":"482","DOI":"10.1016\/S0140-6736(11)60610-7","article-title":"Non-specific low back pain","volume":"379","author":"F Balagu\u00e9","year":"2012","journal-title":"The Lancet"},{"issue":"10294","key":"pone.0355864.ref003","doi-asserted-by":"crossref","first-page":"78","DOI":"10.1016\/S0140-6736(21)00733-9","article-title":"Low back pain","volume":"398","author":"NN Knezevic","year":"2021","journal-title":"The Lancet"},{"issue":"1","key":"pone.0355864.ref004","doi-asserted-by":"crossref","first-page":"42","DOI":"10.1038\/s41413-023-00280-x","article-title":"Low back pain and osteoarthritis pain: a perspective of estrogen","volume":"11","author":"H Pang","year":"2023","journal-title":"Bone Res"},{"issue":"3","key":"pone.0355864.ref005","first-page":"203","article-title":"Low back pain in women before and after menopause","volume":"14","author":"M Kozinoga","year":"2015","journal-title":"Prz Menopauzalny"},{"issue":"2","key":"pone.0355864.ref006","doi-asserted-by":"crossref","first-page":"199","DOI":"10.21037\/qims.2016.04.06","article-title":"Increased low back pain prevalence in females than in males after menopause age: evidences based on synthetic literature review","volume":"6","author":"YXJ W\u00e1ng","year":"2016","journal-title":"Quant Imaging Med Surg"},{"key":"pone.0355864.ref007","first-page":"49","article-title":"Global, regional and national burden of low back pain 1990\u20132019: A systematic analysis of the Global Burden of Disease study 2019. 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district","volume":"8","author":"MA Gilani","year":"2022","journal-title":"Int J Res Orthop"},{"issue":"5","key":"pone.0355864.ref014","doi-asserted-by":"crossref","DOI":"10.1371\/journal.pone.0177370","article-title":"Low back pain in healthy postmenopausal women and the effect of physical activity: A secondary analysis in a randomized trial","volume":"12","author":"M Marini","year":"2017","journal-title":"PLoS One"},{"issue":"9","key":"pone.0355864.ref015","doi-asserted-by":"crossref","DOI":"10.1136\/bmjopen-2021-059192","article-title":"Low back pain in the Bangladeshi adult population: a cross-sectional national survey","volume":"12","author":"MS Momen Majumder","year":"2022","journal-title":"BMJ Open"},{"key":"pone.0355864.ref016","doi-asserted-by":"crossref","first-page":"273","DOI":"10.1080\/19338244.2024.2447270","article-title":"Assessment of prevalence and factors associated with perceived lower back pain among the bicycle rickshaw pullers in Dhaka","volume":"79","author":"MS Mahabub","year":"2024","journal-title":"Arch Environ Occup Health"},{"key":"pone.0355864.ref017","doi-asserted-by":"crossref","first-page":"905","DOI":"10.2147\/JPR.S133013","article-title":"Participation in physical activity and back pain among an elderly population in South Asia","volume":"10","author":"G Bishwajit","year":"2017","journal-title":"J Pain Res"},{"key":"pone.0355864.ref018","doi-asserted-by":"crossref","first-page":"1392074","DOI":"10.3389\/fpubh.2024.1392074","article-title":"Sociodemographic determinants of health inequities in low back pain: a narrative review","volume":"12","author":"J Mathieu","year":"2024","journal-title":"Front Public Health"},{"issue":"7","key":"pone.0355864.ref019","doi-asserted-by":"crossref","first-page":"3205","DOI":"10.3390\/app11073205","article-title":"Machine Learning in Chronic Pain Research: A Scoping Review","volume":"11","author":"MDK Jenssen","year":"2021","journal-title":"Applied Sciences"},{"key":"pone.0355864.ref020","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1007\/s11916-024-01264-0","article-title":"The Role and Applications of Artificial Intelligence in the Treatment of Chronic Pain","volume":"28","author":"TA Meier","year":"2024","journal-title":"Current Pain and Headache Reports"},{"key":"pone.0355864.ref021","doi-asserted-by":"crossref","first-page":"185","DOI":"10.4103\/0970-0218.116358","article-title":"Modified Kuppuswamy\u2019s Socioeconomic Scale: Social Researcher Should Include Updated Income Criteria","volume":"38","author":"M Bairwa","year":"2013","journal-title":"Indian J Community Med"},{"issue":"11","key":"pone.0355864.ref022","doi-asserted-by":"crossref","first-page":"2476","DOI":"10.1097\/j.pain.0000000000001944","article-title":"Low back pain and the social determinants of health: A systematic review and narrative synthesis","volume":"161","author":"EL Karran","year":"2020","journal-title":"Pain"},{"issue":"9","key":"pone.0355864.ref023","article-title":"Association between hypertension and the prevalence of low back pain and osteoarthritis in koreans: a cross-sectional study","volume":"10","author":"Y-H Bae","year":"2015","journal-title":"PLoS One"},{"issue":"11","key":"pone.0355864.ref024","doi-asserted-by":"crossref","first-page":"1322","DOI":"10.2522\/ptj.20080008","article-title":"Diabetes-related microvascular and macrovascular diseases in the physical therapy setting","volume":"88","author":"WT Cade","year":"2008","journal-title":"Phys Ther"},{"issue":"1","key":"pone.0355864.ref025","doi-asserted-by":"crossref","first-page":"833","DOI":"10.1186\/s12891-022-05793-w","article-title":"Correlation between intervertebral disc degeneration and bone mineral density difference: a retrospective study of postmenopausal women using an eight-level MRI-based disc degeneration grading system","volume":"23","author":"Patiman","year":"2022","journal-title":"BMC Musculoskelet Disord"},{"issue":"11","key":"pone.0355864.ref026","doi-asserted-by":"crossref","first-page":"2502","DOI":"10.1007\/s00586-019-06071-5","article-title":"Are respiratory disorders risk factors for troublesome low-back pain? A study of a general population cohort in Sweden","volume":"28","author":"E Rasmussen-Barr","year":"2019","journal-title":"Eur Spine J"},{"key":"pone.0355864.ref027","unstructured":"World Health Organization. Household air pollution. https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/household-air-pollution-and-health. 2024. Accessed 2025 July 4."},{"issue":"4","key":"pone.0355864.ref028","doi-asserted-by":"crossref","first-page":"878","DOI":"10.1007\/s00586-012-2560-0","article-title":"The impact of body mass index and central obesity on the spino-pelvic parameters: a correlation study","volume":"22","author":"S Romero-Vargas","year":"2013","journal-title":"Eur Spine J"},{"issue":"12","key":"pone.0355864.ref029","doi-asserted-by":"crossref","first-page":"3511","DOI":"10.1002\/art.38861","article-title":"Relationships between body mass index, fat mass, muscle mass, and musculoskeletal pain in community residents","volume":"66","author":"JJ Yoo","year":"2014","journal-title":"Arthritis Rheumatol"},{"issue":"1","key":"pone.0355864.ref030","doi-asserted-by":"crossref","first-page":"6738","DOI":"10.1038\/s41598-026-38059-9","article-title":"Machine learning models for predicting treatment outcomes in chronic non-specific back pain patients undergoing lumbar extension traction","volume":"16","author":"IM Moustafa","year":"2026","journal-title":"Sci Rep"},{"issue":"1","key":"pone.0355864.ref031","doi-asserted-by":"crossref","first-page":"63","DOI":"10.1080\/10669817.2024.2424619","article-title":"Use of machine learning to identify prognostic variables for outcomes in chronic low back pain treatment: a retrospective analysis","volume":"33","author":"C Cheema","year":"2025","journal-title":"J Man Manip Ther"},{"issue":"1","key":"pone.0355864.ref032","doi-asserted-by":"crossref","first-page":"92","DOI":"10.1186\/s12911-026-03384-6","article-title":"Machine learning-based prediction of disability in subacute low back pain: a primary care study on clinical and psychosocial determinants","volume":"26","author":"JA Ben\u00edtez-Andrades","year":"2026","journal-title":"BMC Med Inform Decis Mak"},{"issue":"11","key":"pone.0355864.ref033","first-page":"1230","article-title":"Machine Learning Approaches to Predict Chronic Lower Back Pain in People Aged over 50 Years","volume":"57","author":"JG Shim","year":"2021"}],"container-title":["PLOS One"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0355864","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,9,21]],"date-time":"2026-09-21T17:44:03Z","timestamp":1790012643000},"score":1,"resource":{"primary":{"URL":"https:\/\/dx.plos.org\/10.1371\/journal.pone.0355864"}},"subtitle":[],"editor":[{"given":"Sohel","family":"Ahmed","sequence":"first","affiliation":[{"name":"Bangladesh University of Engineering and Technology","place":["BANGLADESH"]}],"role":[{"vocabulary":"crossref","role":"editor"}]}],"short-title":[],"issued":{"date-parts":[[2026,9,21]]},"references-count":33,"journal-issue":{"issue":"9","published-online":{"date-parts":[[2026,9,21]]}},"URL":"https:\/\/doi.org\/10.1371\/journal.pone.0355864","relation":{},"ISSN":["1932-6203"],"issn-type":[{"value":"1932-6203","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,9,21]]}}}