Chronic low back pain (CLBP) is the second most common complaint in Brazilian elderly and the 4th most disabling musculoskeletal disorder in the world, affecting different areas of the lives of people with this condition. The International Classification of Functioning, Disability and Health (ICF) guides an approach that integrates in the care model the domains of structure and function, activities/participation, personal and environmental aspects. Therefore, an approach following the biopsychosocial model (BPS) becomes more adequate when compared to the biomedical model, based on the ICF recommendations.

To analyze the transition from the biomedical to the BPS model in exercise interventions for older adults with CLBP.

A search was conducted in June 2022, without date restriction, in 3 databases (PubMed/MEDLINE, PEDro and Scielo) using the descriptors "chronic low back pain", "elderly", "exercise", "disability" and synonyms. The articles were selected in two stages. First, there was selection by means of titles and abstracts based on the objective. The studies were read in the second phase and selected using the eligibility criteria: clinical trials, elderly with CLBP, and exercise. Each item of the measurement instruments was analyzed according to the first level of the CIEZA flowchart (CIEZA et al., 2019), which considers the ICF domains in its composition. Transition to the BPS model was considered if the measurement instruments of the studies had items that assessed body structure and functions with at least one more of the ICF domains described in level 1 of the flowchart. And the biomedical approach when the instrument represented only body structure and functions. The search and selection of the studies were developed by two independent reviewers (D,V), as well as the extraction and analysis of the data (descriptive).

515 studies were identified, 15 included, with publication year ranging from 2000 to 2020. The primary outcomes of the studies included: pain (intensity, catastrophizing, and perception), kinesiophobia, disability, quality of life, self-efficacy, self-care, physical activity and fear. The secondary ones were fall efficacy, sleep, general health, mobility. Thirty-one instruments were extracted, 23 (74.19%) evaluated concepts linked to the structure and function domain, 18 (58.06%) personal factors, 11 (35.48%) activity and participation, and 4 (12.9%) environmental factors. The distribution of the items of the instruments evaluated according to the CIEZA flowchart indicated that 100% of the studies were making the transition to the BPS model.

There is a transition from the biomedical model to the BPS model in all the studies including elderly people with CLBP. However, there is a predominance of the evaluation of the body structure and function domain, compared to the other ICF domains, in the measurement instruments.

Although there has been a transition to the BPS model, we suggest using more tools that involve activity and participation domains, environmental factors, and personal factors as outcome measures for exercise studies conducted with older adults with CLBP.