Motivational interviewing increases physical activity for adults with low back pain: a systematic review and meta-analysis

Background

Low back pain (LBP) is the leading cause of disability globally and contributes substantially to healthcare costs and lost productivity. Physical activity (PA) is recommended for managing LBP, nevertheless, many individuals with LBP remain insufficiently physically active, and strategies to support behavior change are needed. Motivational interviewing (MI) may support behavior change by enhancing intrinsic motivation and self-efficacy.

Purpose

To synthesize evidence on the effects of MI interventions targeting PA behavior in adults with LBP.

Methods

Six databases (MEDLINE, Embase, CINAHL, Web of Science, CENTRAL, PsycINFO) and clinical trial registries were searched from inception to February 2026. Eligible trials evaluated MI-based interventions targeting PA in adults with acute, subacute, or chronic LBP. Random-effects meta-analyses were conducted to calculate standardized mean differences (SMD; Hedges’ g) and 95% confidence intervals (CI). The primary outcome was change in PA; secondary outcomes included pain and disability-related outcomes. Risk of bias was assessed using the Cochrane tool, and certainty of evidence was evaluated using GRADE.

Results

Motivational interviewing-based interventions were associated with a statistically significant increase in PA compared with control conditions (SMD: 0.57; 95% CI, 0.10-1.03; P = .02), representing a moderate effect. No statistically significant effects were observed for pain (SMD: 0.04; 95% CI, −0.27 to 0.36; P = .76) or disability (SMD: 0.08; 95% CI, −0.25 to 0.40; P = .60). Certainty of evidence was low for PA and very low for pain and disability outcomes.

Conclusions

Motivational interviewing interventions were associated with increased PA in adults with LBP but did not demonstrate significant effects on pain or disability. MI may serve as a client-centered support strategy within broader rehabilitation models. Further high-quality trials with fidelity assessment and longer follow-up are warranted.

Low back pain is one of the most common health problems worldwide, and staying physically active is an important part of managing it. However, many people struggle to stay active because of fear of pain, low confidence, or uncertainty about what is safe. This review examined whether structured, supportive conversations that help people build confidence and strengthen their own motivation can increase physical activity in people with low back pain. Across eight clinical trials, people who received this approach were more physically active than those receiving usual care or simple advice alone. While becoming more active did not consistently reduce pain or disability in these studies, physical activity remains an important part of long-term self-management. These findings suggest that motivation-focused support can help people take meaningful steps toward a more active lifestyle and may work best when combined with treatments that directly address pain and physical function.