Chronic mechanical low back pain (CMLBP) remains a leading cause of disability among
agricultural workers in low-resource settings. Previous quasi-experimental and clusterrandomized studies suggest that structured back care education may reduce pain and disability; however, methodological limitations such as village-level randomization and short-term follow-up restrict causal interpretation. This paper presents the protocol for a multi-center, individually randomized controlled trial evaluating the effectiveness of structured back care education among farmers with CMLBP. The study aims to assess short-term and long-term outcomes including pain intensity, functional disability, recurrence rates, work productivity, and cost-effectiveness over 12 months. The proposed design addresses prior methodological limitations and provides a scalable framework for rural health interventions.
