Background
low back pain, back pain, pain, Low back pain, prolonged trunk flexion, disability
Low back pain remains the most common musculoskeletal and burdensome condition. It has been the leading cause of disability internationally, accounting for 63.7 million years lived with disability across all age groups since 1990 [As the number of people with low back pain is increasing likely due to global ageing and population growth [Occupational biomechanical factors, such as heavy physical work, heavy manual lifting and prolonged trunk flexion mainly due to farming [Despite the burden of low back pain in rural Nigeria, rehabilitation services are lacking even at the rural primary health care centres [As contemporary understanding suggests that biophysical and psychosocial factors, as well as peripheral and central processing mechanisms, play an important role in CLBP [Patient education, a common intervention strategy for the prevention and management of low back pain, is typically used to modify the beliefs and behaviors of patients to improve their health outcomes [Compelling evidence suggests that exercise therapy is moderately effective for CLBP [In light of the growing burden of CLBP and the non-availability of rehabilitation services in rural Nigeria, there is a pressing need to determine safe, effective and affordable guideline-endorsed interventions to help rural dwellers suffering from this disabling condition. Delivering low-cost evidence-based interventions to communities with limited or no access to health care would help to prevent harmful treatments. Our previous pilot study [The primary objective of this study was to determine the effectiveness of PE plus MCE compared with either therapy alone on pain intensity and disability level among rural community-dwelling adults with CLBP. Secondary objectives were to compare the effectiveness of these interventions on quality of life (QoL), perceived recovery, fear-avoidance beliefs, pain catastrophising, back pain consequences belief and pain medication use. We hypothesised that participants receiving PE plus MCE would demonstrate greater improvements in pain intensity and disability level compared with those receiving either therapy alone.