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Chronic Low-back PainSTOPS-BanglaNCT05880212

Implementation of the Specific Treatment Of Problems of the Spine Approach in Bangladesh

A study testing Usual physiotherapy care and Individualized (STOPS) physiotherapy in people with Chronic Low-back Pain, run by Mohammad Ali at 1 site in Bangladesh.

Recruiting

Looking for participants now. Contact the study team or a site below to ask about taking part.

Sites and contacts
Official record
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Trial summary

The goal of this implementation trial is to evaluate the clinical outcomes associated with usual physiotherapy care compared to individualized physiotherapy in accordance with the Specific Treatment of Problems of the Spine (STOPS) approach in patients with chronic low back pain (CLBP). Read more about this study

Who is it for?
Ages 18 to 65 years
Conditions the study is for
Chronic Low-back Pain
What is being tested?
Usual physiotherapy care and Individualized (STOPS) physiotherapy
Could I receive a placebo?
No, everyone receives an active treatment
How many people
154 participants
Where
1 siteBangladesh
Study dates
1 Aug 2023to 30 Jun 2026
Phase
Interventional
Are there results?
Not yet: the study is under way

Key requirements

Who can take part, as listed by the sponsor. Only the study team can confirm whether you are eligible, so take this list to your doctor.

  • Ages 18 to 65 years
  • All sexes
  • No healthy volunteers
  • Adult, Older adult

Who may be able to join

  • Physiotherapists:
  • Qualified physiotherapists and physiotherapy assistants in Bangladesh who are involved in low back pain management and working in either or both trial settings will provide the treatment in phases 1 and 3. To be eligible, physiotherapists and physiotherapy assistants must be willing to participate in all phases of the trial (Phases I, II, and III). They must have completed the organised STOPS training course led by the original Australian developers (Jon Ford and Andrew Hahne), where the assessment and treatment protocols will be taught in Phase II.
  • Patients:
  • A primary complaint of either:
  • low back pain, defined as pain between the inferior costal margin and the inferior gluteal fold with or without referral into the leg(s)
  • or
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  • referred leg pain, defined as predominately unilateral posterior leg pain extending below the knee, or anterior thigh pain, with or without back pain
  • Duration of the current episode of primary complaint lasting for greater than 3 months (chronic stage of the injury)
  • Aged between 18 and 65 (inclusive)
  • Fluency in English or Bengali sufficient to complete questionnaires and to enable understanding of the intervention
  • Agreeing to refrain from other interventions wherever possible for the 10-week treatment period of the trial, aside from consultations with medical practitioners, medication, and any exercises already being undertaken

Who cannot join

  • Physiotherapist:
  • Not willing to participate in the study for all 3 phases.
  • Patient:
  • Red flag pathologies such as active cancer under current treatment, risk of spinal fracture, signs of potential infection, and major systemic inflammatory disease.
  • Signs of cauda equina syndrome based on bladder or bowel disturbance and/or imaging
  • Current pregnancy, or childbirth within the last 6 months, as this could impair the ability to undertake exercises, and could also cause back and leg symptoms that are not related to the subgroups under investigation
Show all 12Show fewer
  • Spinal injections within the last 6 weeks, as we wish to study treatment effects independent of the effects of injections
  • Any history of lumbar spine surgery, as there is already considerable research evaluating the efficacy of post-surgical rehabilitation programs
  • A pain intensity score of less than 2/10 on the numerical pain rating scale due to low severity.
  • Minimal activity limitation, evidenced by a baseline ability to perform ALL of (walk, sit, and stand for one hour or more and no sleep disturbance at night), as we wish to exclude people with low severity.
  • Inability to walk safely, such as severe foot drop causing regular tripping, as the interventions in the trial include walking for most participants.
  • Planned absence of more than one week during the treatment period (such as holidays).

Trial locations and contacts

1 site in 1 country. Contact the study team or a site near you to ask about taking part.

Andrew Hahne, PhD contact

61394793392

A.Hahne@latrobe.edu.au

Bangladesh1 site, 1 recruiting
  • Uttara Adhunik Medical College Hospital

    Dhaka, Uttara, 1230

    Mohammad Ali, MPhil, 8801715043533, mohammad.ali@latrobe.edu.au

    Recruiting

Other trials in Bangladesh

About this study

Official title: Implementation of the Specific Treatment Of Problems of the Spine (STOPS) Approach in Bangladesh: A Prospective Sequential Comparison

The goal of this implementation trial is to evaluate the clinical outcomes associated with usual physiotherapy care compared to individualized physiotherapy in accordance with the Specific Treatment of Problems of the Spine (STOPS) approach in patients with chronic low back pain (CLBP). The main questions it aims to answer are:

  • Is the STOPS approach more effective than usual care physiotherapy among patients with CLBP?
  • Is STOPS physiotherapy cost-effective compared to usual physiotherapy care for patients with CLBP.
  • Does STOPS training improve the quality of care among Bangladeshi physiotherapists?
Read the detailed description

The goal of this implementation trial is to evaluate the clinical outcomes associated with usual physiotherapy care compared to individualized physiotherapy in accordance with the Specific Treatment of Problems of the Spine (STOPS) approach in patients with chronic low back pain (CLBP). The main questions it aims to answer are:

  • Is the STOPS approach more effective than usual care physiotherapy among patients with CLBP?
  • Is STOPS physiotherapy cost-effective compared to usual physiotherapy care for patients with CLBP.
  • Does STOPS training improve the quality of care among Bangladeshi physiotherapists?

In phase I, patients with CLBP will be treated with usual physiotherapy care. In phase II, Bangladeshi physiotherapists will be provided with a STOPS training program by the Australian developers of STOPS. In phase III, the trained Bangladeshi physiotherapists will treat patients using the STOPS approach.

Clinical patient outcomes will be evaluated in Phase 1 and Phase 3 (pre and post implementation).

Physiotherapists' self-confidence and implementation behaviour will be evaluated before and after STOPS training.

A qualitative study of physiotherapists' and patients' experiences will be conducted after the completion of the usual care (Phase I) and STOPS treatment programs (Phase III).

Being tested
Usual physiotherapy care, Individualized (STOPS) physiotherapy
Keywords
Chronic low back pain, Physiotherapy, Usual care, STOPS, Implementation trial, Bangladesh, Physiotherapist

What participants receive

What participants receive. In a randomised study each person is assigned to one group by chance.

  • Usual physiotherapy careOther

    In Phase 1, physiotherapists will provide treatment for participants with chronic low back pain in accordance with their current standard physiotherapy practice. Physiotherapists will be free to choose the treatment approach they wish to.

  • Individualized (STOPS) physiotherapyOther

    In Phase 3, participants will receive individualized physiotherapy in accordance with the Specific Treatment of Problems of the Spine (STOPS) approach modified for chronic low back pain. Treatment will be individualized on the basis of biopsychosocial assessment findings including dominant pain type (nociceptive, neuropathic or nociplastic), pathoanatomical subgroups (if any), and other barriers to recovery (eg. inflammation, depression, anxiety, stress, catastrophising, pain self-efficacy, and unhelpful motor control strategies). Available treatment strategies will include individualized education/advice, exercise, manual therapy, activity modification/facilitation, goal setting, motor control optimisation, cognitive-behavioural strategies, inflammation management, pain management strategies, sleep management, work management, and relaxation approaches.

Study groups in NCT05880212
Study groupRoleWhat they receive
Usual physiotherapy careActive comparatorOne physiotherapy assessment, 10 x 45-minute sessions of usual care physiotherapy (over a 10-week period), plus 1 x 45-minute followup session of usual care physiotherapy after 6 months.
Receives: Other: Usual physiotherapy care
Individualized (STOPS) physiotherapyExperimentalOne physiotherapy assessment, 10 x 45-minute sessions of individualised (STOPS) physiotherapy (weekly for 10 weeks), plus 1 x 45-minute followup session of individualised (STOPS) physiotherapy after 6 months.
Receives: Other: Individualized (STOPS) physiotherapy

What is being measured

The primary outcome is the main question the study is designed to answer.

  1. Activity limitation

    Oswestry Disability Questionnaire (ODI). Measured from 0-100% with lower scores meaning less disability.

    Measured: Primary endpoint will be 26 weeks post-enrolment.

  2. Back Pain Intensity

    0-10 numerical pain rating scale, average over the previous week. Lower scores indicate a better outcome.

    Measured: Primary endpoint will be 26 weeks post-enrolment.

  3. Leg Pain Intensity

    0-10 numerical pain rating scale, average over the previous week. Lower scores indicate a better outcome.

    Measured: Primary endpoint will be 26 weeks post-enrolment.

Secondary outcomes (22)
  1. Work hours missed

    Number of work/housework hours missed during the past 7 days (continuous scale from 0 to 50). Lower score indicated less hours missed (better outcome)

    Measured: 5, 10, and 26-weeks post enrolment

  2. Work productivity

    0-10 numerical rating scale of how much pain affected work productivity in the last 7 days. Score 0-10, with lower scores indicating less interference with work productivity.

    Measured: 5, 10, and 26-weeks post enrolment

  3. Short-Form Örebro Musculoskeletal Pain Screening Questionnaire (ÖMPSQ-SF)

    The total score ranges between 1 and 100, with higher scores indicating a worse outcome.

    Measured: 5, 10, and 26-weeks post enrolment

  4. Health-related quality of life (EQ-5D-5L)

    Utility scores will be calculated from the EuroQOL-5D-5L, with scores ranging from -0.148 to 0.949 (higher scores indicate better quality of life)

    Measured: 5, 10, and 26-weeks post enrolment

  5. Depression, Anxiety and Stress Scales - DASS-21

    The DASS-21 measures symptoms of stress, anxiety and depression, with a total composite score ranging from 0-63 with higher scores indicating more severe symptoms of distress.

    Measured: 5, 10, and 26-weeks post enrolment

  6. Pain Self Efficacy

    Pain Self Efficacy Questionnaire (PSEQ). A raw score is presented with a range from 0 - 60, where high scores indicate greater levels of confidence in dealing with pain (better outcome).

    Measured: 5, 10, and 26-weeks post enrolment

  7. Pain Catastrophizing

    Pain Catastrophizing Scale (PCS). The score ranges from 0 to 52. A higher score denotes more catastrophizing (worse outcome)

    Measured: 5, 10, and 26-weeks post enrolment

  8. Sleep quality

    Insomnia Severity Index (ISI-7). Score ranges from 0 to 28, with higher scores indicating worse sleep quality (worse outcome)

    Measured: 5, 10, and 26-weeks post enrolment

  9. Central Sensitisation symptoms

    Central Sensitisation Inventory (CSI-9). Score ranges from 0 to 36, with higher scores indicating more symptoms indicative of potential central sensitisation

    Measured: 5, 10, and 26-weeks post enrolment

  10. Inflammatory symptoms

    The 4-item clinical inflammation score will measure low back-related inflammatory symptoms. Scores range from 0 to 4, with higher scores indicating more inflammatory symptoms (worse outcome)

    Measured: 5, 10, and 26-weeks post enrolment

  11. Treatment Credibility

    Treatment credibility questionnaire. Scored 0-10. A higher score indicates greater confidence in the treatment (better outcome).

    Measured: 5, 10, and 26-weeks post enrolment

  12. Healthcare utilization

    A patient diary will be used to track healthcare service utilization, imaging, and medication. These are recorded descriptively.

    Measured: 5, 10, and 26-weeks post enrolment

  13. Participant adherence with treatment

    Participant adherence with treatment will be determined via a self-administered 0-10 rating scale, with higher scores indicating greater adherence with treatment (better outcome).

    Measured: 5, 10, and 26-weeks post enrolment

  14. Global rating of change

    Global change will be measured on a 7-point scale ranging from "very much worse" to "very much better". Scores range from 1-7, with a higher score indicating greater improvement.

    Measured: 5, 10, and 26-weeks post enrolment

  15. Satisfaction with treatment

    Participants will rate their satisfaction with physiotherapy treatment on a 5-point Likert scale, with ratings from "very satisfied" to "very dissatisfied".

    Measured: 5, 10, and 26-weeks post enrolment

  16. Adverse events

    Adverse effects events (harmful or unpleasant) will be recorded descriptively in the therapists clinical notes.

    Measured: 5, 10, and 26-weeks post enrolment

  17. Qualitative interviews

    Semi-structured interviews relating to the patient's experiences with the Usual care and STOPS physiotherapy will be conducted.

    Measured: 10 weeks post-enrolment

  18. Pain severity

    Brief Pain Inventory. Average of the four pain severity items, scores range from 0-10, lower scores indicate less pain severity.

    Measured: 5, 10, and 26-weeks post enrolment

  19. Pain interference

    Brief Pain Inventory. Average of the seven pain interference items, scores range from 0-10, lower scores indicate less pain interference.

    Measured: 5, 10, and 26-weeks post enrolment

  20. Back Pain Intensity

    0-10 numerical pain rating scale, average over the previous week. Lower scores indicate a better outcome.

    Measured: 5, 10 and 52-weeks post enrolment

  21. Leg Pain Intensity

    0-10 numerical pain rating scale, average over the previous week. Lower scores indicate a better outcome.

    Measured: 5, 10 and 52-weeks post enrolment

  22. Activity limitation

    Oswestry Disability Questionnaire (ODI). Measured from 0-100% with lower scores meaning less disability.

    Measured: 5, 10 and 52-weeks post enrolment

Timeline

From the start of the study to its completion; the mark is today. Estimated dates are the sponsor’s plan.

  1. First posted30 May 2023
  2. Study start1 Aug 2023
  3. Primary completion30 May 2026 (estimated)
  4. Study completion30 Jun 2026 (estimated)

Resources

More details

For doctors and researchers: how the study is designed, who runs it, and its registry IDs.

Study design
Study type
Interventional
Phase
Phase N/A
Primary purpose
Treatment
Allocation
Non-randomised
Intervention model
Sequential
Masking
Double blind
Who is masked
Participant, Outcomes assessor
Enrolment
154 participants (estimated)
IDs, dates and publications
ClinicalTrials.gov ID
NCT05880212
Sponsor's protocol ID
HEC22334
Acronym
STOPS-Bangla
Status last verified
Apr 2026
First submitted
4 May 2023
Last updated
4 May 2026
Results posted
No
Data monitoring committee
Yes
FDA-regulated drug
No
FDA-regulated device
No
Individual data sharing
Yes: De-identified participant data collected during the trial will be available upon specific request t the researchers.

Publications

  • Ali M, Ford JJ, Hossain A, Danazumi MS, Hahne AJ. 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. Contemp Clin Trials. 2025 Jul;154:107960. doi: 10.1016/j.cct.2025.107960. Epub 2025 May 21.

    PubMed 40409680

Questions about this trial

What is this clinical trial studying?

A study testing Usual physiotherapy care and Individualized (STOPS) physiotherapy in people with Chronic Low-back Pain, run by Mohammad Ali at 1 site in Bangladesh.

The full registered description is in the About this study section and the official record.

Who may be eligible to take part?

The sponsor lists 11 inclusion and 12 exclusion criteria. Eligibility is decided by the study team after screening, so read the full criteria and contact a listed site.

Is this clinical trial currently recruiting?

The record says: looking for participants now, as of the sponsor's last update on 4 May 2026. Status can change between updates, so confirm with the study contact before making plans.

Where is the study taking place?

The record lists 1 site in Bangladesh. Whether a site is taking part right now should be confirmed with that site. See every site.

What are the possible benefits and risks?

They depend on the study and the treatment, and no study can promise a benefit. The study team explains the known risks during informed consent, before anyone joins; the record itself does not list them.

Are results available for this study?

This study is still under way. Results are not available in the source record yet.

How can a doctor refer a patient or contact the research team?

Contact Mohammad Ali, MPhil ((88) 01715043533, mohammad.ali@latrobe.edu.au), or a site near the patient. AzTrials does not enrol participants or take referrals.

What does the primary outcome measure?

Activity limitation (time frame: Primary endpoint will be 26 weeks post-enrolment.). The study lists 3 primary outcomes in all. It is what the study was designed to measure, not a finding.

Where can I read the original study information?

On the ClinicalTrials.gov record for NCT05880212, which also lists 1 linked publication.

Does a listing mean the treatment is approved or proven to work?

No. A listing means the study is registered. It does not show that the treatment is safe, works, or is approved by a regulator.

How often is this information updated?

AzTrials copies changed records from ClinicalTrials.gov every night and reloads the whole registry every week. The sponsor last updated this record on 4 May 2026.

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