Non-Specific Chronic Low Back Pain, Lifestyle Interventions, Systematic Review, Exercise Therapies, Biopsychosocial Model, Rehabilitation.

Background: Non-specific chronic low back pain (NSCLBP) is a prevalent musculoskeletal condition affecting adults all over the world. It often leads to disability, reduced quality of life, and high health care costs. In the absence of a specific pathological cause, lifestyle factors such as physical inactivity, poor posture, stress, and unhealthy habits have been identified as key contributors. Lifestyle interventions targeting these factors are increasingly recognized as effective, non-invasive approaches to managing NSCLBP and improving overall well-being. Aim of study: The aim of this study is to synthesize the best available evidence from Randomized Controlled Trials (RCTs) on the effectiveness of lifestyle and related non- pharmacological interventions for improving pain, disability and functional outcomes in adults with Non-Specific Chronic Low Back Pain. Methods: A systematic online search was conducted on PUBMED, Cochrane, PEDro, PsychInfo, Science Direct and Google Scholar. All steps of the process followed the recommendation of the PRISMA guidelines. The review included RCTs that evaluated lifestyle interventions such as exercise (e.g. core stabilization, strength training, Tai Chi), complementary and alternative medicine e.g. acupuncture, cupping therapy and biopsychosocial/behavioural approaches, manual therapy and technological based interventions for adults with NSCLBP. Methodological quality of included studies was appraised using the JADAD scale. Results: A total of 27 RCTs met the inclusion criteria. The majority (88.89%) were of high methodological quality. Exercise-based interventions (51.85%) of studies including core stabilization and high intensity training consistently demonstrated significant improvements in pain and disability. Complementary/alternative medicine (33.33%) of studies such as acupuncture and osteopathic manipulation showed promising results for pain relief. Technology based and biopsychosocial interventions were also effective with the latter particularly successful in addressing fear-avoidance behaviours. However, a significant geographical skew was noted with 70.37% of the evidence originating from high income countries. Conclusion: A diverse range of lifestyle and non-pharmacological interventions are effective for managing NSCLBP, with exercise serving as a corner stone of care. Biopsychosocial and Technological based approaches represent promising, modern strategies. To optimize patient outcomes, a personalized, multimodal management plan is recommended. Future research should address the identified evidence gap in low and middle-income countries and focus on longer term outcomes. Registration: A review protocol was developed and registered with the PROSPERO database, with the ID: 1123743