Low back pain remains stubbornly difficult to treat, with available treatments generally producing only modest short-term improvements for people with chronic non-specific low back pain. 

An editorial in the October issue of Journal of Physiotherapy proposes that one way forward may be to rethink how we understand pain itself, using an emerging neuroscience framework called active inference. 

Put simply, the brain does not passively receive information from the body and produce pain in response. 

Instead, our experience is continually shaped by an interaction between incoming sensory information and our brain’s predictions about ourselves, our bodies and the world around us. 

For low back pain, those predictions may include a strongly held expectation that the back is damaged or vulnerable. 

Imaging findings, terms such as ‘slipped disc’ and messages about protecting the back can reinforce such expectations and potentially influence pain and behaviour. 

Active inference therefore offers a way of bringing biological, psychological and environmental influences on pain into a single explanatory framework, with potentially important implications for how physiotherapists communicate with and treat people with persistent low back pain. 

A World Physiotherapy-supported study asks what research is needed to advance physiotherapy as a profession globally. 

Seventy-four people with expert knowledge of physiotherapy research or the profession contributed across a structured conceptmapping process. 

They generated 374 suggestions, which were distilled to 64 distinct research priorities and ultimately organised into nine clusters, which are listed in the breakout box. 

Prevention and rehabilitation across the life span was rated the most important and feasible of the nine areas, its priorities including chronic conditions, prevention/self-management, health promotion and the long-term effects of physiotherapy. 

Technology and digital transformation also ranked highly, including research into AI, telehealth, wearable devices and virtual reality. 

Particularly striking among the individual priorities was the importance placed on demonstrating physiotherapy’s value within health systems. 

Health-economic evaluation of interventions supporting greater direct access to physiotherapists received the highest importance rating of all 64 priorities, while research into the cost-effectiveness of physiotherapy and the skills needed to meet future healthcare needs also ranked highly. 

Elsewhere in the October issue, an invited topical review examines persistent pelvic pain, a heterogeneous condition that is increasingly understood as much more than a problem arising from a single pelvic organ or structure. 

Contemporary models recognise interacting musculoskeletal, visceral, neurological, psychological and social contributors, with assessment complicated by overlapping conditions and often inconclusive imaging and laboratory investigations. 

The review considers current approaches to classification, assessment and treatment across women and men and highlights important gaps in knowledge. 

Associate Professor Tiffany Dwyer leads a contribution on recent highlights in pulmonary rehabilitation. 

Summarising research published from 2021 to 2026, it shows how far the field has moved beyond traditional centre-based programs for people with stable chronic obstructive pulmonary disease. 

Pulmonary rehabilitation is now supported for a much wider range of chronic respiratory diseases, including interstitial lung disease, pulmonary hypertension, bronchiectasis, lung cancer and asthma. 

Alternative approaches including telerehabilitation, home-based, communitybased and minimal-equipment programs can improve access and allow care to be better matched to patients and healthcare settings, provided they retain the essential components of high-quality pulmonary rehabilitation. 

Yet access remains a major problem, with fewer than five to 10 per cent of eligible people estimated to have access in high-income countries and even greater inequities elsewhere. 

Recent research also points to the importance of culturally adapted services, effective referral conversations and behaviour-change strategies to maintain benefits after rehabilitation. 

Meanwhile, growing evidence that pulmonary rehabilitation can reduce healthcare costs strengthens the case for improving referral, uptake and completion. 

This is all supplemented by appraisal items spanning online tai chi for knee osteoarthritis, prevention of falls after stroke and performance-based measurement of lower limb function. 

World Physiotherapy research priorities

• Prevention and rehabilitation across the life span
• Technology and digital transformation
• Equitable access and value-based care
• Contextually responsive care
• Generating and moving evidence into practice
• Health systems
• Practice competence and sustainability
• Education and professional development
• Professional identity 

>>>Clinical Associate Professor Mark Elkins APAM is the editor of Journal of Physiotherapy. Read the research at journalofphysiotherapy.com