Implementing individualised physiotherapy using the Specific Treatment of Problems of the Spine (STOPS) approach for chronic low back pain in Bangladesh: Protocol for a prospective sequential comparison clinical trial

Background: Chronic low back pain (CLBP) is a major global health issue, with a particularly high burden in low- and middle-income countries (LMICs) due partly to inadequate evidence-based management. The Specific Treatment of Problems of the Spine (STOPS) approach offers individualised, biopsychosocial-based physiotherapy shown to be effective in Australia. This trial aims to evaluate the implementation, effectiveness, and cost-effectiveness of the STOPS approach to individualised physiotherapy compared to usual physiotherapy care in Bangladesh. Methods: A three-phase prospective sequential comparison trial will be conducted with eligible participants aged 18–65 years presenting for physiotherapy with CLBP at two centres in Bangladesh. Phase 1 will evaluate the usual physiotherapy care, and Phase 3 will evaluate individualised physiotherapy according to the STOPS approach. Phase 2 involves training physiotherapists and assistants in STOPS. Patients in Phases 1 & 3 will undergo 10 sessions of physiotherapy over 10 weeks, with an 11th booster session at 6 months. Primary outcomes are activity limitation (Oswestry Disability Index) and pain intensity (Numerical Rating Scales for back and leg pain) at 5, 10, 26 and 52 weeks. Secondary outcomes include global effect, patient satisfaction, work interference, psychosocial risk factors, quality of life, mental health, sleep, catastrophizing and self-efficacy. Qualitative interviews will explore patient and therapist experiences. Results: Quantitative and qualitative data will be analysed to assess implementation feasibility, cost-effectiveness, and treatment outcomes. Conclusion: Individualised physiotherapy using the STOPS approach could improve treatment outcomes for CLBP in Bangladesh.