Vol 14, Issue 1, No 8, July 2026

A New Subgrouping of Psychological and Disability Factors in Young Adults of Nonspecific Chronic Low Back Pain: Cluster Analysis Study

Rahmat Adnan1,4, Muhammad Naufal Qayyim Khairulnizam1, Muhammad Nadzhan Ruzaini1, Siti Nurul Ezzah Che Man1, Hamad Haziq Ismail1, Dzulhafiz Zikrie Dzulkapli, Nuramnani Suffiya Rohim@Rahim, Muhammad Nur Syahid Mohd Pozi, Nurariqah Nazihah Alham, Nurul Ain Syazwani Zulkarnain @ Ismail, Norshahizah Halidi, Norasrudin Sulaiman1 , Mazuin Mohd Razalli2,3,  Shariman Ismadi Ismail1,4

1 Faculty of Sports Science and Recreation Universiti Teknologi MARA Shah Alam Malaysia

2Department of Radiology, Hospital Al-Sultan Abdullah, Universiti Teknologi Mara Puncak Alam Malaysia

3Faculty of Medicine, Universiti Teknologi MARA, Sungai Buloh Campus, Selangor Malaysia

4Sports Technology, Faculty of Sports Science and Recreation Universiti Teknologi MARA Shah Alam Malaysia

DOI: http://doi.org/10.47836.14.1.08

ABSTRACT

This study aimed to identify homogeneous subgroups among young adults with chronic low back pain (CLBP) based on psychological measures encompassing fear avoidance beliefs, pain coping strategies, fear of movement and disability-related LBP measures. A cross-sectional study design was conducted, involving 74 young adults with CLBP and a control group (CG), who completed a questionnaire of self-reported assessments, including the Fear-Avoidance Beliefs Questionnaire (FABQ), Pain Coping Inventory (PCI), Tampa Scale for Kinesiophobia (TSK), and Roland-Morris Disability Questionnaire (RMDQ). Cluster analysis showed three distinct CLBP subgroups alongside one healthy group reference clustered. The first cluster, designated as Control Group (CG) (n=19, 25.8%) comprised healthy individuals with no LBP history and lowest score across all measures. The second cluster, labelled the “Acceptance Subgroup (AS)” (n= 23, 30.9%), consisted of CLBP individuals who demonstrated significantly lower score on the FABQ, PCI, TSK and RMDQ, reflecting relatively adaptive psychological and functional profiles. The third cluster, designated Moderate subgroup (MS)” (n=20, 26.7%), was characterized by mild fear of avoidance beliefs, moderate reliance on pain coping strategies and moderate disability. Cluster 4 was labelled as the “Severe subgroup (SG)” (n=12, 16.6%), and individuals of this subgroup severely suffered from fear avoidance belief, pain coping, fear of movement, and were disabled by their LBP. These findings highlight the heterogeneity present within CLBP subgroups. Therefore, assessment of psychological and disability at intake of the programme is essential for effective treatment program for CLBP. 

Keywords: NSCLBP, psychological factors, fear-avoidance, kinesiophobia, disability, subgrouping, pain coping