The Determinants of Low Back Pain; A Systematic Review

Abstract

Low back pain is a highly prevalent and disabling musculoskeletal condition that imposes a substantial clinical, social, and economic burden worldwide. This systematic review aimed to synthesize current evidence on the prevalence, determinants, and outcomes of low back pain, with particular emphasis on behavioral, occupational, and contextual influences. Following PRISMA 2020 guidelines, relevant peer-reviewed studies were systematically identified, screened, and analyzed using predefined eligibility criteria, and findings were synthesized narratively and through structured evidence mapping. The reviewed literature indicates that low back pain affects diverse populations, with higher prevalence among older adults, women, and individuals exposed to physically demanding or ergonomically unfavorable work environments. Behavioral and psychosocial factors, including maladaptive pain beliefs, emotional distress, and reduced self-efficacy, alongside lifestyle factors such as obesity, physical inactivity, and poor sleep quality, were consistently associated with increased risk, pain chronicity, and functional limitation. Occupational exposures and adverse sociodemographic contexts further amplified disability, reduced quality of life, and increased healthcare utilization. Overall, the findings highlight the multifactorial and interdependent nature of low back pain, underscoring the need for integrated, biopsychosocial approaches to prevention, assessment, and management to reduce long-term disability and improve patient outcomes.