{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T23:49:16Z","timestamp":1773272956774,"version":"3.50.1"},"reference-count":106,"publisher":"MDPI AG","issue":"3","license":[{"start":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T00:00:00Z","timestamp":1773187200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>This study aimed to assess the relative impact of the Osijek multidisciplinary biopsychosocial program for chronic low back pain (CLBP) compared with standard multimodal care with respect to pain intensity, disability, health-related quality of life, anxiety, depression, stress, and sleep quality using standardized self-assessment questionnaires and a smartwatch. A total of 128 patients treated at the Department of Pain Management, University Hospital Osijek, were randomly allocated to two groups. The multidisciplinary biopsychosocial group participated in a structured four-week program combining education, exercise, and individualized multidisciplinary care, while the multimodal group received conventional conservative treatment including pharmacotherapy and selected physical therapy modalities. The four-week intervention included standardized self-report questionnaires, a sociodemographic data form, and a Fitbit Charge 3 smartwatch for objective monitoring of sleep and physical activity. A significant reduction in pain intensity was observed across numerical scales and most questionnaire measures (Wilcoxon test, p &lt; 0.01), except for the subscale assessing difficulties in performing daily activities due to sleep deprivation. Participants who underwent the multidisciplinary biopsychosocial treatment exhibited significant improvements (p &lt; 0.03) in pain intensity, disability, health-related quality of life, stress, anxiety, and sleep quality compared with those receiving multimodal treatment. In both groups, a weak negative correlation was found between sleep quality and daily step count (Spearman\u2019s rho = \u22120.234, p = 0.04). A multidisciplinary biopsychosocial program was associated with greater improvements in health-related quality of life, psychological well-being, and sleep quality in patients with chronic low back pain compared with a multimodal conservative approach. Increased daily physical activity was linked to improvements in anxiety and sleep. Although this study was designed as a randomized controlled trial, certain baseline differences between groups should be considered when interpreting the findings.<\/jats:p>","DOI":"10.3390\/ijerph23030350","type":"journal-article","created":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T09:00:37Z","timestamp":1773219637000},"page":"350","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Impact of the Osijek Multidisciplinary Biopsychosocial Program on Chronic Low Back Pain: A Prospective Randomized Controlled Study"],"prefix":"10.3390","volume":"23","author":[{"given":"Dijana","family":"Hnate\u0161en","sequence":"first","affiliation":[{"name":"Department of Pain Management, University Hospital Osijek, 31000 Osijek, Croatia"},{"name":"Nursing Institute \u201cProfessor Radivoje Radi\u0107\u201d, Faculty of Dental Medicine and Health Osijek, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ivan","family":"Rado\u0161","sequence":"additional","affiliation":[{"name":"Department of Pain Management, University Hospital Osijek, 31000 Osijek, Croatia"},{"name":"Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Iva","family":"Dimitrijevi\u0107","sequence":"additional","affiliation":[{"name":"Department of Pain Management, University Hospital Osijek, 31000 Osijek, Croatia"},{"name":"Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Dino","family":"Budrovac","sequence":"additional","affiliation":[{"name":"Department of Pain Management, University Hospital Osijek, 31000 Osijek, Croatia"},{"name":"Faculty of Medicine, Josip Juraj Strossmayer University of Osijek, 31000 Osijek, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Vanja","family":"Matkovi\u0107","sequence":"additional","affiliation":[{"name":"Department of Pain Management, University Hospital Osijek, 31000 Osijek, Croatia"},{"name":"Department of Physiotherapy, College of Applied Sciences \u201cLavoslav Ru\u017ei\u010dka\u201d, 32000 Vukovar, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-4829-1543","authenticated-orcid":false,"given":"Ivana","family":"Gusar","sequence":"additional","affiliation":[{"name":"Department of Health Studies, University of Zadar, 23000 Zadar, Croatia"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2026,3,11]]},"reference":[{"key":"ref_1","unstructured":"Institutes of Health (US) Committee on Advancing Pain Research, Care, and Education (2011). Relieving Pain in America: A Blueprint for Transforming Prevention, Care, Education, and Research, The National Academies Press (US)."},{"key":"ref_2","doi-asserted-by":"crossref","unstructured":"International Pain Summit of the International Association for the Study of Pain (2011). Declaration of Montr\u00e9al: Declaration that access to pain management is a fundamental human right. J. Pain Palliat. Care Pharmacother., 25, 29\u201331.","DOI":"10.3109\/15360288.2010.547560"},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"61","DOI":"10.2105\/AJPH.2018.304743","article-title":"Access to pain management as a human right","volume":"109","author":"Brennan","year":"2019","journal-title":"Am. J. Public. Health"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"205","DOI":"10.1213\/01.ane.0000268145.52345.55","article-title":"Pain management: A fundamental human right","volume":"105","author":"Brennan","year":"2007","journal-title":"Anesth. Analg."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"287","DOI":"10.1016\/j.ejpain.2005.06.009","article-title":"Survey of chronic pain in Europe: Prevalence, impact on daily life, and treatment","volume":"10","author":"Breivik","year":"2006","journal-title":"Eur. J. Pain"},{"key":"ref_6","unstructured":"GBD 2021 Low Back Pain Collaborators (2023). Global, regional, and national burden of low back pain, 1990\u20132020, its attributable risk factors, and projections to 2050: A systematic analysis of the Global Burden of Disease Study 2021. Lancet Rheumatol., 5, e316\u2013329."},{"key":"ref_7","unstructured":"WHO (2025, November 15). Basic Documents. Available online: https:\/\/apps.who.int\/gb\/bd\/pdf\/bd48\/basic-documents-48th-edition-en.pdf."},{"key":"ref_8","doi-asserted-by":"crossref","first-page":"1976","DOI":"10.1097\/j.pain.0000000000001939","article-title":"The Revised IASP definition of pain: Concepts, challenges, and compromises","volume":"161","author":"Raja","year":"2020","journal-title":"Pain"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Toye, F., Seers, K., Hannink, E., and Barker, K. (2017). A mega-ethnography of eleven qualitative evidence syntheses exploring the experience of living with chronic non-malignant pain. BMC Med. Res. Methodol., 17.","DOI":"10.1186\/s12874-017-0392-7"},{"key":"ref_10","unstructured":"Bond, M., Breivik, H., Jensen, T.S., Scholten, W., Soyannwo, O., and Treede, R.-D. (2006). Pain associated with neurological disorders. Neurological Disorders: Public Health Challenges, World Health Organization."},{"key":"ref_11","doi-asserted-by":"crossref","unstructured":"Goldberg, D., and Summer, M. (2011). Pain as a Global Public Health Priority. BMC Public. Health, 11.","DOI":"10.1186\/1471-2458-11-770"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"514","DOI":"10.7326\/M16-2367","article-title":"Noninvasive treatments for acute, subacute, and chronic low back pain: A clinical practice guideline from the American College of Physicians","volume":"166","author":"Qaseem","year":"2017","journal-title":"Ann. Intern. Med."},{"key":"ref_13","first-page":"10","article-title":"Low back pain and sciatica: Summary of NICE guidance","volume":"356","author":"Bernstein","year":"2017","journal-title":"BMJ"},{"key":"ref_14","first-page":"2","article-title":"Chronic Non-cancer Pain Management and Addiction: A Review","volume":"12","author":"Genova","year":"2020","journal-title":"Cureus"},{"key":"ref_15","unstructured":"EFIC (2025, November 15). What Is the Biopsychosocial Model of Pain?. Available online: https:\/\/europeanpainfederation.eu\/what-is-the-bio-psycho-social-model-of-pain\/."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1080\/24740527.2017.1325715","article-title":"Predicting treatment outcomes of pain patients attending tertiary multidisciplinary pain treatment centers: A pain trajectory approach","volume":"1","author":"Ware","year":"2017","journal-title":"Can. J. Pain"},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"124","DOI":"10.1080\/21642850.2021.2022487","article-title":"Determinants of quality of life in individuals with chronic low back pain: A systematic review","volume":"10","author":"Rajkumar","year":"2022","journal-title":"Health Psychol. Behav. Med."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"593","DOI":"10.1016\/0021-9681(87)90019-1","article-title":"Utility approach to measuring health-related quality of life","volume":"40","author":"Torrance","year":"1987","journal-title":"J. Chronic Dis."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"541","DOI":"10.1007\/s00508-019-01542-7","article-title":"Association between low back pain and various everyday performances: Activities of daily living, ability to work and sexual function","volume":"131","author":"Grabovac","year":"2019","journal-title":"Wien. Klin. Wochenschr."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"275","DOI":"10.1007\/s11136-019-02302-w","article-title":"The longitudinal relationships between pain severity and disability versus health-related quality of life and costs among chronic low back pain patients","volume":"29","author":"Mutubuki","year":"2020","journal-title":"Qual. Life Res."},{"key":"ref_21","first-page":"396","article-title":"Managing low back pain in primary care","volume":"46","author":"Kamal","year":"2020","journal-title":"Curr. Health Sci. J."},{"key":"ref_22","unstructured":"IASP (2025, November 15). IASP Terminology Background. Available online: https:\/\/www.iasp-pain.org\/resources\/terminology\/."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"312","DOI":"10.1097\/ALN.0000000000004444","article-title":"Multidisciplinary Pain Management: A Tale of Two Outcomes","volume":"138","author":"Butler","year":"2023","journal-title":"Anesthesiology"},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1016\/j.sjpain.2013.06.003","article-title":"Effectiveness of multidisciplinary rehabilitation treatment for patients with chronic pain in a primary health care unit","volume":"4","author":"Stein","year":"2013","journal-title":"Scand. J. Pain"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1016\/j.berh.2009.12.001","article-title":"Prevention and management of chronic back pain","volume":"24","author":"Weiner","year":"2010","journal-title":"Best. Pract. Res. Clin. Rheumatol."},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"e026874","DOI":"10.1136\/bmjopen-2018-026874","article-title":"Results of a feasibility randomised clinical trial on pain education for low back pain in Nepal: The Pain Education in Nepal-Low Back Pain (PEN-LBP) feasibility trial","volume":"9","author":"Sharma","year":"2019","journal-title":"BMJ Open"},{"key":"ref_27","first-page":"CD000963","article-title":"Multidisciplinary biopsychosocial rehabilitation for chronic low back pain","volume":"2","author":"Kamper","year":"2014","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"70","DOI":"10.1080\/24740527.2019.1582296","article-title":"Evaluation of an interdisciplinary chronic pain program and predictors of readiness for change","volume":"3","author":"Katz","year":"2019","journal-title":"Can. J. Pain"},{"key":"ref_29","doi-asserted-by":"crossref","unstructured":"Clark, T., Wakim, J.C., and Noe, C. (2016). Getting \u201cunstuck\u201d: A multi-site evaluation of the efficacy of an interdisciplinary pain intervention program for chronic low back pain. Healthcare, 4.","DOI":"10.3390\/healthcare4020033"},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"h444","DOI":"10.1136\/bmj.h444","article-title":"Multidisciplinary biopsychosocial rehabilitation for chronic low back pain: Cochrane systematic review and meta-analysis","volume":"350","author":"Kamper","year":"2015","journal-title":"BMJ"},{"key":"ref_31","unstructured":"British Pain Society (2025, November 15). Guidelines for PMP. Available online: https:\/\/www.britishpainsociety.org\/static\/uploads\/resources\/files\/Guidelines_for_PMP_01082019_xc33xiN.pdf."},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/24740527.2022.2156330","article-title":"Examining the roles of depression, pain catastrophizing, and self-efficacy in quality of life changes following chronic pain treatment","volume":"7","author":"Montag","year":"2023","journal-title":"Can. J. Pain"},{"key":"ref_33","unstructured":"Institute for Quality and Efficiency in Health Care (IQWiG) (2025, November 17). Low Back Pain: Multimodal Pain Management and Cognitive Behavioral Therapy, Available online: https:\/\/www.ncbi.nlm.nih.gov\/books\/NBK538548\/."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"17","DOI":"10.1093\/bja\/aen103","article-title":"Assessment of pain","volume":"101","author":"Breivik","year":"2008","journal-title":"Br. J. Anaesth."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"217","DOI":"10.1002\/hec.4730020305","article-title":"The RAND 36-Item Health Survey 1.0","volume":"2","author":"Hays","year":"1993","journal-title":"Health Econ."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"473","DOI":"10.1097\/00005650-199206000-00002","article-title":"The MOS 36-item short-form health survey (SF-36). I. Conceptual framework and item selection","volume":"30","author":"Ware","year":"1992","journal-title":"Med. Care"},{"key":"ref_37","unstructured":"Buttanshaw, C. (1999). Tipping the Balance Towards Primary Healthcare Network. Proceedings of the 10th Anniversary Conference of the Tipping the Balance Towards Primary Healthcare Network, The Nordic School of Public Health."},{"key":"ref_38","unstructured":"The Brithish Pain Society (2019). Outcome Measures, The Faculty of Pain Medicine of the Royal College of Anesthetists."},{"key":"ref_39","first-page":"95","article-title":"Psychometric Evaluation and Establisching Norms of Croatian SF-36 Survey: Framework for Subjective Health Research","volume":"47","year":"2006","journal-title":"Croat. Med. J."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"193","DOI":"10.1016\/0165-1781(89)90047-4","article-title":"The Pittsburgh Sleep Quality Index: A new instrument for psychiatric practice and research","volume":"28","author":"Buysse","year":"1989","journal-title":"Psychiatry Res."},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1080\/15402002.2012.720315","article-title":"Confirmatory factor analysis of the Pittsburgh Sleep Quality Index in rheumatoid arthritis patients","volume":"12","author":"Nicassio","year":"2014","journal-title":"Behav. Sleep. Med."},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"2940","DOI":"10.1097\/00007632-200011150-00017","article-title":"The Oswestry Disability Index","volume":"25","author":"Fairbank","year":"2000","journal-title":"Spine"},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"2814","DOI":"10.1007\/s00586-018-5757-z","article-title":"Validation of the Croatian version of the Oswestry Disability Index","volume":"27","author":"Domazet","year":"2018","journal-title":"Eur. Spine J."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"3115","DOI":"10.1097\/00007632-200012150-00006","article-title":"The Roland-Morris Disability Questionnaire and the Oswestry Disability Questionnaire","volume":"25","author":"Roland","year":"2000","journal-title":"Spine"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"111","DOI":"10.2522\/ptj.20110076","article-title":"Reliability and construct validity of self-report questionnaires for patients with pelvic girdle pain","volume":"92","author":"Grotle","year":"2012","journal-title":"Phys. Ther."},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"E237","DOI":"10.1097\/BRS.0b013e31827e948b","article-title":"Validation and cross-cultural adaptation of the Polish version of the Oswestry Disability Index","volume":"38","author":"Miekisiak","year":"2013","journal-title":"Spine"},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"8","DOI":"10.1093\/ptj\/82.1.8","article-title":"A comparison of five low back disability questionnaires: Reliability and responsiveness","volume":"8","author":"Davidson","year":"2002","journal-title":"Phys. Ther."},{"key":"ref_48","doi-asserted-by":"crossref","unstructured":"Lovibond, S.H., and Lovibond, P.F. (1995). Manual for the Depression Anxiety Stress Scales, Psychology Foundation. [2nd ed.].","DOI":"10.1037\/t01004-000"},{"key":"ref_49","unstructured":"Ivezi\u0107, E., Jak\u0161i\u0107, N., Joki\u0107-Begi\u0107, N., and Sur\u00e1nyi, Z. (2012). Validation of the Croatian adaptation of the Depression, Anxiety, Stress Scales\u201321 (DASS-21) in a clinical sample. Conference Paper Presented at 18th Psychology Days in Zadar, Zadar, Croatia, 24\u201326 May 2012, University of Zadar."},{"key":"ref_50","doi-asserted-by":"crossref","first-page":"176","DOI":"10.1037\/1040-3590.10.2.176","article-title":"Psychometric properties of the 42-item and 21-item versions of the Depression Anxiety Stress Scales in clinical groups and a community sample","volume":"10","author":"Antony","year":"1998","journal-title":"Psychol. Assess."},{"key":"ref_51","doi-asserted-by":"crossref","first-page":"61","DOI":"10.1023\/A:1011095624717","article-title":"Confirmatory factor analysis of the depression-Anxiety-Stress Scales in depressed and anxious patients","volume":"23","author":"Clara","year":"2001","journal-title":"J. Psychopathol. Behav. Assess."},{"key":"ref_52","doi-asserted-by":"crossref","first-page":"111","DOI":"10.1348\/014466503321903544","article-title":"The Depression Anxiety Stress Scales (DASS): Normative data and latent structure in a large non-clinical sample","volume":"42","author":"Crawford","year":"2003","journal-title":"Br. J. Clin. Psychol."},{"key":"ref_53","doi-asserted-by":"crossref","first-page":"102850","DOI":"10.1016\/j.msard.2021.102850","article-title":"Psychometric properties of the Croatian version of the depression, anxiety, and stress scale-21 and multiple sclerosis impact scale-29 in multiple sclerosis patients","volume":"50","year":"2021","journal-title":"Mult. Scler. Relat. Disord."},{"key":"ref_54","doi-asserted-by":"crossref","first-page":"e329","DOI":"10.2196\/jmir.7809","article-title":"Evaluating Patient Empowerment in Association With eHealth Technology: Scoping Review","volume":"19","author":"Risling","year":"2017","journal-title":"J. Med. Internet Res."},{"key":"ref_55","doi-asserted-by":"crossref","first-page":"265","DOI":"10.1016\/j.jbspin.2017.12.007","article-title":"e-Health, social media, and rheumatology: Can they get along?","volume":"85","author":"Berenbaum","year":"2018","journal-title":"Joint Bone Spine"},{"key":"ref_56","doi-asserted-by":"crossref","first-page":"31","DOI":"10.12968\/bjon.2016.25.1.31","article-title":"Living With Inflammatory Arthritis","volume":"25","author":"Palmer","year":"2016","journal-title":"Br. J. Nurs."},{"key":"ref_57","doi-asserted-by":"crossref","first-page":"e161","DOI":"10.2196\/jmir.2171","article-title":"Increasing physical activity with mobile devices: A meta-analysis","volume":"14","author":"Fanning","year":"2012","journal-title":"J. Med. Internet Res."},{"key":"ref_58","unstructured":"Statista (2025, November 14). Fitbit\u2014Number of Active Users 2012\u20132022. Available online: https:\/\/www.statista.com\/statistics\/472600\/fitbit-active-users\/."},{"key":"ref_59","unstructured":"Fitbit (2025, November 14). User Manual Version 2.3. Available online: https:\/\/staticcs.fitbit.com\/content\/assets\/help\/manuals\/manual_versa_en_US.pdf."},{"key":"ref_60","doi-asserted-by":"crossref","first-page":"e081123","DOI":"10.1136\/bmj-2024-081123","article-title":"CONSORT 2025 Statement: updated guideline for reporting randomised trials","volume":"388","author":"Hopewell","year":"2025","journal-title":"BMJ"},{"key":"ref_61","doi-asserted-by":"crossref","first-page":"1190","DOI":"10.1080\/09638288.2018.1424950","article-title":"The impact of age and gender on the ICF-based assessment of chronic low back pain","volume":"41","author":"Fehrmann","year":"2019","journal-title":"Disabil. Rehabil."},{"key":"ref_62","doi-asserted-by":"crossref","first-page":"1","DOI":"10.1590\/S0034-8910.2015049005874","article-title":"Prevalence of chronic low back pain: Systematic review","volume":"49","author":"Meucci","year":"2015","journal-title":"Rev. Saude Publica"},{"key":"ref_63","unstructured":"Croatian Central Bureau of Statistics (2025, November 12). 2021 Census. Available online: https:\/\/popis2021.hr\/."},{"key":"ref_64","doi-asserted-by":"crossref","first-page":"321","DOI":"10.2147\/PPA.S232577","article-title":"Non-Adherence to Pharmacotherapy: A Prospective Multicentre Study About Its Incidence and Its Causes Perceived by Chronic Pain Patients","volume":"14","author":"Sampaio","year":"2020","journal-title":"Patient Prefer. Adherence"},{"key":"ref_65","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1111\/aas.12697","article-title":"Prevalence and determinants of medication non-adherence in chronic pain patients: A systematic review","volume":"60","author":"Timmerman","year":"2016","journal-title":"Acta Anaesthesiol. Scand."},{"key":"ref_66","doi-asserted-by":"crossref","first-page":"1582","DOI":"10.1093\/pm\/pnac056","article-title":"Acupuncture Therapy as an Evidence-Based Nonpharmacologic Strategy for Comprehensive Acute Pain Care: The Academic Consortium Pain Task Force White Paper Update","volume":"23","author":"Nielsen","year":"2022","journal-title":"Pain Med."},{"key":"ref_67","doi-asserted-by":"crossref","first-page":"968","DOI":"10.1016\/j.berh.2017.05.001","article-title":"Clinical guidelines for low back pain: A critical review of consensus and inconsistencies across three major guidelines","volume":"30","author":"Cook","year":"2016","journal-title":"Best. Pract. Res. Clin. Rheumatol."},{"key":"ref_68","doi-asserted-by":"crossref","first-page":"215","DOI":"10.1097\/PHM.0000000000001053","article-title":"The Effectiveness of Group-Based Physiotherapy-Led Behavioral Psychological Interventions on Adults With Chronic Low Back Pain: A Systematic Review and Meta-Analysis","volume":"98","author":"Zhang","year":"2019","journal-title":"Am. J. Phys. Med. Rehabil."},{"key":"ref_69","doi-asserted-by":"crossref","first-page":"622","DOI":"10.1080\/09638288.2017.1410730","article-title":"The effectiveness of walking versus exercise on pain and function in chronic low back pain: A systematic review and meta-analysis of randomized trials","volume":"41","author":"Vanti","year":"2019","journal-title":"Disabil. Rehabil."},{"key":"ref_70","doi-asserted-by":"crossref","first-page":"252","DOI":"10.1111\/papr.13185","article-title":"Chronic low back pain comorbidity count and its impact on exacerbating opioid and non-opioid prescribing behavior","volume":"23","author":"Povieng","year":"2023","journal-title":"Pain Pract."},{"key":"ref_71","unstructured":"WHO (2025, November 10). Obesity and Overweight. Available online: https:\/\/www.who.int\/news-room\/fact-sheets\/detail\/obesity-and-overweight."},{"key":"ref_72","doi-asserted-by":"crossref","unstructured":"Tappia, P.S., Ramjiawan, B., and Dhalla, N.S. (2020). Association between obesity and poor sleep: A review of epidemiological evidence. Pathophysiology of Obesity-Induced Health Complications, Springer. Advances in Biochemistry in Health and Disease.","DOI":"10.1007\/978-3-030-35358-2"},{"key":"ref_73","doi-asserted-by":"crossref","unstructured":"Kristi\u010devi\u0107, T., \u0160tefan, L., and Spori\u0161, G. (2018). The Associations between Sleep Duration and Sleep Quality with Body-Mass Index in a Large Sample of Young Adults. Int. J. Environ. Res. Public. Health, 15.","DOI":"10.3390\/ijerph15040758"},{"key":"ref_74","doi-asserted-by":"crossref","first-page":"359.e1","DOI":"10.1016\/j.jpain.2016.11.004","article-title":"The Transition of Acute Postoperative Pain to Chronic Pain: An Integrative Overview of Research on Mechanisms","volume":"18","author":"Chapman","year":"2017","journal-title":"J. Pain"},{"key":"ref_75","doi-asserted-by":"crossref","first-page":"121","DOI":"10.1016\/S0304-3959(99)00145-1","article-title":"From the gate to the neuromatrix","volume":"6","author":"Melzack","year":"1999","journal-title":"Pain"},{"key":"ref_76","doi-asserted-by":"crossref","unstructured":"Wilkie, R., Tajar, A., and McBeth, J. (2013). The onset of widespread musculoskeletal pain is associated with a decrease in healthy ageing in older people: A population-based prospective study. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0059858"},{"key":"ref_77","doi-asserted-by":"crossref","first-page":"281","DOI":"10.2340\/16501977-2544","article-title":"Return to work after interdisciplinary pain rehabilitation: One-and two-year follow-up study based on the Swedish Quality Registry for pain rehabilitation","volume":"51","author":"Persson","year":"2019","journal-title":"J. Rehabil. Med."},{"key":"ref_78","doi-asserted-by":"crossref","first-page":"327","DOI":"10.5935\/2595-0118.20210060","article-title":"Evaluation of a multidisciplinary team in chronic pain treatment: Interventional and prospective study","volume":"4","author":"Maemura","year":"2021","journal-title":"BrJP"},{"key":"ref_79","doi-asserted-by":"crossref","first-page":"1318","DOI":"10.1002\/ejp.1398","article-title":"Health-related quality of life change in patients treated at a multidisciplinary pain clinic","volume":"23","author":"Vartiainen","year":"2019","journal-title":"Eur. J. Pain"},{"key":"ref_80","doi-asserted-by":"crossref","first-page":"81","DOI":"10.1007\/s11916-019-0817-6","article-title":"Patients with Chronic Musculoskeletal Pain of 3\u20136-Month Duration Already Have Low Levels of Health-Related Quality of Life and Physical Activity","volume":"23","author":"Majlesi","year":"2019","journal-title":"Curr. Pain Headache Rep."},{"key":"ref_81","doi-asserted-by":"crossref","unstructured":"Hnate\u0161en, D., Pavi\u0107, R., Rado\u0161, I., Dimitrijevi\u0107, I., Budrovac, D., \u010cebohin, M., and Gusar, I. (2022). Quality of Life and Mental Distress in Patients with Chronic Low Back Pain: A Cross-Sectional Study. Int. J. Environ. Res. Public. Health, 19.","DOI":"10.3390\/ijerph191710657"},{"key":"ref_82","first-page":"157","article-title":"Quality of life in patients with rheumatoid arthritis\u2014A preliminary study","volume":"58","author":"Martinec","year":"2019","journal-title":"Acta Clin. Croat."},{"key":"ref_83","doi-asserted-by":"crossref","first-page":"133","DOI":"10.1177\/2374373518786013","article-title":"Impact of Chronic Pain on Patients\u2019 Quality of Life: A Comparative Mixed-Methods Study","volume":"6","author":"Hadi","year":"2019","journal-title":"J. Patient Exp."},{"key":"ref_84","doi-asserted-by":"crossref","first-page":"413","DOI":"10.1016\/j.nmd.2020.02.017","article-title":"Chronic pain is common in mitochondrial disease","volume":"30","author":"Fuge","year":"2020","journal-title":"Neuromuscul. Disord."},{"key":"ref_85","doi-asserted-by":"crossref","first-page":"012183","DOI":"10.1088\/1755-1315\/125\/1\/012183","article-title":"The correlation of pain intensity and quality of life in chronic LBP patients in Adam Malik general hospital","volume":"125","author":"Nasution","year":"2018","journal-title":"IOP Conf. Ser. Earth Environ. Sci."},{"key":"ref_86","doi-asserted-by":"crossref","first-page":"211","DOI":"10.1111\/papr.12846","article-title":"Domains of Chronic Low Back Pain and Assessing Treatment Effectiveness: A Clinical Perspective","volume":"20","author":"Tagliaferri","year":"2020","journal-title":"Pain Pract."},{"key":"ref_87","first-page":"553","article-title":"Catastrophizing, Anxiety, and Depression in Patients with Chronic Non-Malignant Pain","volume":"30","author":"Dimitrijevic","year":"2021","journal-title":"Drus. Istraz."},{"key":"ref_88","doi-asserted-by":"crossref","first-page":"363","DOI":"10.3109\/09638288.2014.923522","article-title":"Chronic pain affects the whole person\u2014A phenomenological study","volume":"37","author":"Ojala","year":"2015","journal-title":"Disabil. Rehabil."},{"key":"ref_89","doi-asserted-by":"crossref","first-page":"100208","DOI":"10.1016\/j.mcpsp.2021.100208","article-title":"Relationship between sleep quality and pain intensity in patients with chronic low back pain","volume":"4","author":"Bintang","year":"2021","journal-title":"Med. Cl\u00ednica Pr\u00e1ctica"},{"key":"ref_90","doi-asserted-by":"crossref","first-page":"283","DOI":"10.1136\/jech-2019-212734","article-title":"Influence of sleep problems and co-occurring musculoskeletal pain on long-Term prognosis of chronic low back pain: The HUNT Study","volume":"74","author":"Skarpsno","year":"2020","journal-title":"J. Epidemiol. Community Health"},{"key":"ref_91","doi-asserted-by":"crossref","first-page":"10233","DOI":"10.3390\/ijerph181910233","article-title":"Pain, Sleep, and Health-Related Quality of Life after Multidisciplinary Intervention for Chronic Pain","volume":"18","author":"Sveinsdottir","year":"2021","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"ref_92","first-page":"1000388","article-title":"Effectiveness of a Multidisciplinary Chronic Pain Management Program in a Local Pain Center","volume":"10","author":"Barker","year":"2021","journal-title":"J. Pain Reli."},{"key":"ref_93","first-page":"94","article-title":"Predictors of disability in patients with chronic low back pain","volume":"19","author":"Sirbu","year":"2023","journal-title":"Arch. Med. Sci."},{"key":"ref_94","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1037\/0003-066X.55.1.89","article-title":"Adaptive mental mechanisms: Their role in a positive psychology","volume":"55","author":"Vaillant","year":"2000","journal-title":"Am. Psychol."},{"key":"ref_95","doi-asserted-by":"crossref","first-page":"6","DOI":"10.7453\/gahmj.2014.042","article-title":"Acupuncture: Past, Present, and Future","volume":"3","author":"Jishun","year":"2014","journal-title":"Glob. Adv. Health Med."},{"key":"ref_96","doi-asserted-by":"crossref","first-page":"15968","DOI":"10.3390\/ijerph192315968","article-title":"Influence of the Cognitive and Emotional Status of Patients with Chronic Pain on Treatment Success (Reduction in Pain Intensity and Adherence to Pharmacotherapy): A Prospective Study","volume":"19","author":"Budrovac","year":"2022","journal-title":"Int. J. Environ. Res. Public Health"},{"key":"ref_97","doi-asserted-by":"crossref","first-page":"192","DOI":"10.1007\/s00586-006-1072-1","article-title":"European guidelines for the management of chronic nonspecific low back pain","volume":"15","author":"Airaksinen","year":"2006","journal-title":"Eur. Spine J."},{"key":"ref_98","first-page":"328196","article-title":"Acupuncture for low back pain: An overview of systematic reviews","volume":"2015","author":"Liu","year":"2015","journal-title":"Evid. Based Complement. Alternat Med."},{"key":"ref_99","doi-asserted-by":"crossref","unstructured":"Tang, N.K.Y., and Sanborn, A.N. (2014). Better quality sleep promotes daytime physical activity in patients with chronic pain? A multilevel analysis of the within-person relationship. PLoS ONE, 9.","DOI":"10.1371\/journal.pone.0092158"},{"key":"ref_100","first-page":"2475","article-title":"Prevalence of sleep disturbance in chronic pain","volume":"18","author":"Karaman","year":"2014","journal-title":"Eur. Rev. Med. Pharmacol. Sci."},{"key":"ref_101","doi-asserted-by":"crossref","unstructured":"Vasudevan, S., Smerz, K., and Grunert, B.K. (2015). Cognitive Behavioral Coping Strategies. Multidisciplinary Management of Chronic Pain, Springer.","DOI":"10.1007\/978-3-319-20322-5_4"},{"key":"ref_102","doi-asserted-by":"crossref","unstructured":"Gellman, M. (2019). Quality of Life Technologies. Encyclopedia of Behavioral Medicine, Springer.","DOI":"10.1007\/978-1-4614-6439-6_1660-2"},{"key":"ref_103","doi-asserted-by":"crossref","unstructured":"Wac, K., and Wulfovich, S. (2022). Technologies for Quantifying Sleep: Improved Quality of Life or Overwhelming Gadgets?. Quantifying Quality of Life, Springer. Health Informatics.","DOI":"10.1007\/978-3-030-94212-0_26"},{"key":"ref_104","doi-asserted-by":"crossref","first-page":"46","DOI":"10.56936\/18290825-2023.17.1-46","article-title":"The use of wearable technology in a comprehensive chronic pain management programme","volume":"17","author":"Widmann","year":"2023","journal-title":"New Armen. Med. J."},{"key":"ref_105","doi-asserted-by":"crossref","first-page":"89","DOI":"10.1159\/000515576","article-title":"Wearable Devices: Current Status and Opportunities in Pain Assessment and Management","volume":"5","author":"Leroux","year":"2021","journal-title":"Digit. Biomark."},{"key":"ref_106","doi-asserted-by":"crossref","first-page":"444","DOI":"10.1016\/j.bbi.2023.08.008","article-title":"Wearable technologies for health research: Opportunities, limitations, and practical and conceptual considerations","volume":"113","author":"Roos","year":"2023","journal-title":"Brain Behav. Immun."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/23\/3\/350\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,3,11]],"date-time":"2026-03-11T09:05:32Z","timestamp":1773219932000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/23\/3\/350"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,3,11]]},"references-count":106,"journal-issue":{"issue":"3","published-online":{"date-parts":[[2026,3]]}},"alternative-id":["ijerph23030350"],"URL":"https:\/\/doi.org\/10.3390\/ijerph23030350","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,3,11]]}}}