Advice and education provide small short-term improvements in pain and disability in people with non-specific spinal pain: a systematic review

Jones, Caitlin; Shaheed, Christina Abdel; Ferreira, Giovanni E; Kharel, Priti; Lin, Chung‐Wei Christine; Maher, Chris G

doi:10.1016/j.jphys.2021.08.014

Cited by 22 publications

(25 citation statements)

References 46 publications

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“…The effect sizes were generally small, but above the cut-off value for clinical relevance ( Table 2 ) [ 54 , 55 ]. These results are generally consistent with those from studies conducted in other cultural settings [ 56 , 57 ]. In fact, the small size of the effect on disability triggered by education is in line with most medical treatments for LBP [ 6 , 7 , 58 ]…”

Section: Discussionsupporting

confidence: 91%

The Efficacy and Effectiveness of Education for Preventing and Treating Non-Specific Low Back Pain in the Hispanic Cultural Setting: A Systematic Review

Kovacs

Burgos-Alonso

Martín-Nogueras

et al. 2022

IJERPH

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A systematic review was conducted to assess the efficacy and effectiveness of education programs to prevent and treat low back pain (LBP) in the Hispanic cultural setting. Electronic and manual searches identified 1148 unique references. Nine randomized clinical trials (RCTs) were included in this review. Methodological quality assessment and data extraction followed the recommendations from the Cochrane Back Pain Review Group. Education programs which were assessed focused on active management (3 studies), postural hygiene (7), exercise (4) and pain neurophysiology (1). Comparators were no intervention, usual care, exercise, other types of education, and different combinations of these procedures. Five RCTs had a low risk of bias. Results show that: (a) education programs in the school setting can transmit potentially useful knowledge for LBP prevention and (b) education programs for patients with LBP improve the outcomes of usual care, especially in terms of disability. Education on pain neurophysiology improves the results of education on exercise, and education on active management is more effective than “sham” education and education on postural hygiene. Future studies should assess the comparative or summatory effects of education on exercise, education on pain neurophysiology and education on active management, as well as explore their efficiency.

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Section: Discussionsupporting

confidence: 91%

The Efficacy and Effectiveness of Education for Preventing and Treating Non-Specific Low Back Pain in the Hispanic Cultural Setting: A Systematic Review

Kovacs

Burgos-Alonso

Martín-Nogueras

et al. 2022

IJERPH

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“…A third explanation might be the relatively high proportion of patients with a low risk of developing persistent LBP in this study. For this group, earlier research has shown that providing advice as a single intervention is likely to reassure the patient with LBP but does not result in different management of pain and disability in the short term [ 54 , 59 ]. In addition, for this group, a stratified approach is beneficial from an economic perspective rather than in terms of clinical outcomes, as many of these patients recover completely within 2 to 3 weeks but nevertheless receive unnecessary treatment [ 57 , 60 , 61 ].…”

Section: Discussionmentioning

confidence: 99%

The 3-Month Effectiveness of a Stratified Blended Physiotherapy Intervention in Patients With Nonspecific Low Back Pain: Cluster Randomized Controlled Trial

Koppenaal¹,

Pisters²,

Kloek³

et al. 2022

J Med Internet Res

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Background Patient education, home-based exercise therapy, and advice on returning to normal activities are established physiotherapeutic treatment options for patients with nonspecific low back pain (LBP). However, the effectiveness of physiotherapy interventions on health-related outcomes largely depends on patient self-management and adherence to exercise and physical activity recommendations. e-Exercise LBP is a recently developed stratified blended care intervention comprising a smartphone app integrated with face-to-face physiotherapy treatment. Following the promising effects of web-based applications on patients’ self-management skills and adherence to exercise and physical activity recommendations, it is hypothesized that e-Exercise LBP will improve patients’ physical functioning. Objective This study aims to investigate the short-term (3 months) effectiveness of stratified blended physiotherapy (e-Exercise LBP) on physical functioning in comparison with face-to-face physiotherapy in patients with nonspecific LBP. Methods The study design was a multicenter cluster randomized controlled trial with intention-to-treat analysis. Patients with nonspecific LBP aged ≥18 years were asked to participate in the study. The patients were treated with either stratified blended physiotherapy or face-to-face physiotherapy. Both interventions were conducted according to the Dutch physiotherapy guidelines for nonspecific LBP. Blended physiotherapy was stratified according to the patients’ risk of developing persistent LBP using the Keele STarT Back Screening Tool. The primary outcome was physical functioning (Oswestry Disability Index, range 0-100). Secondary outcomes included pain intensity, fear-avoidance beliefs, and self-reported adherence. Measurements were taken at baseline and at the 3-month follow-up. Results Both the stratified blended physiotherapy group (104/208, 50%) and the face-to-face physiotherapy group (104/208, 50%) had improved clinically relevant and statistically significant physical functioning; however, there was no statistically significant or clinically relevant between-group difference (mean difference −1.96, 95% CI −4.47 to 0.55). For the secondary outcomes, stratified blended physiotherapy showed statistically significant between-group differences in fear-avoidance beliefs and self-reported adherence. In patients with a high risk of developing persistent LBP (13/208, 6.3%), stratified blended physiotherapy showed statistically significant between-group differences in physical functioning (mean difference −16.39, 95% CI −27.98 to −4.79) and several secondary outcomes. Conclusions The stratified blended physiotherapy intervention e-Exercise LBP is not more effective than face-to-face physiotherapy in patients with nonspecific LBP in improving physical functioning in the short term. For both stratified blended physiotherapy and face-to-face physiotherapy, within-group improvements were clinically relevant. To be able to decide whether e-Exercise LBP should be implemented in daily physiotherapy practice, future research should focus on the long-term cost-effectiveness and determine which patients benefit most from stratified blended physiotherapy. Trial Registration ISRCTN Registry 94074203; https://doi.org/10.1186/ISRCTN94074203 International Registered Report Identifier (IRRID) RR2-https://doi.org/10.1186/s12891-020-3174-z

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“…Our findings were consistent with a recent review, which found a short-term effect of advice or education on pain and disability for nonspecific spinal pain (ie, neck and back pain). 27 Our results were more imprecise due to fewer included trials (wider CIs). Our review had a more specific research question and narrowed the eligibility criteria to focus on acute and subacute LBP, individual patient education (vs all types of patient education), and a core outcome set for LBP.…”

mentioning

confidence: 75%

“…There was strong evidence of the effectiveness of an intensive individual patient education program (at least 2.5 hours) on return to work at the short and long term compared to no intervention for acute and/or subacute LBP. 11 Since 2008, 4 other systematic reviews published on this topic have focused on different outcomes and/or populations: Traeger et al 49 focused on reassurance as an outcome; Ainpradub et al 1 focused on the treatment of multiple stages of LBP; Zahari et al 57 focused on an older population with LBP; and Jones et al 27 focused on mixed population (neck/back pain) as well as on pain, disability, and adverse events as outcomes. As new trials on individual patient education for patients with acute and/or subacute LBP have been published since the 2008 Cochrane review, an updated synthesis was warranted.…”

mentioning

confidence: 99%

Individual Patient Education for Managing Acute and/or Subacute Low Back Pain: Little Additional Benefit for Pain and Function Compared to Placebo. A Systematic Review With Meta-analysis of Randomized Controlled Trials

Piano¹,

Ritorto²,

Vigna³

et al. 2022

Journal of Orthopaedic & Sports Physical Therapy

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Randomizedcontrolled trials (RCTs) evaluating individual education for patients with acute and/or subacute LBP.U DATA SYNTHESIS: Random-effects meta-analysis for clinically homogeneous RCTs. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation approach.U RESULTS: We included 13 RCTs. There was moderate certainty evidence that individual patient education was more effective than placebo education for pain at medium term (mean difference [MD], −0.79; 95% confidence interval [CI]: -1.52, -0.07) and physical function at short term (standardized mean difference [SMD], −0.25; 95% CI: −0.47, −0.02) and medium term (SMD, −0.26; 95% CI: −0.48, −0.04), but with no clinically relevant effects. There was low-to-moderate certainty evidence that individual patient education was superior to noneducational interventions on short-term quality of life (MD, −12.00; 95% CI: −20.05, −3.95) and medium-term sick leave (odds ratio = 0.32; 95% CI: 0.11, 0.88). We found no clinically relevant betweengroup effects for any other comparison (low-to-high certainty of evidence) at any follow-up.U CONCLUSION: One or 2 hours of individual patient education probably makes little to no difference in pain and functional outcomes compared with placebo for patients with acute and/or subacute LBP. Considering its effects on other outcomes (eg, reassurance) and patients' desire for information about their condition, it is reasonable to retain patient education as part of a first-line approach when managing acute and subacute LBP.

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Advice and education provide small short-term improvements in pain and disability in people with non-specific spinal pain: a systematic review

Cited by 22 publications

References 46 publications

The Efficacy and Effectiveness of Education for Preventing and Treating Non-Specific Low Back Pain in the Hispanic Cultural Setting: A Systematic Review

The Efficacy and Effectiveness of Education for Preventing and Treating Non-Specific Low Back Pain in the Hispanic Cultural Setting: A Systematic Review

The 3-Month Effectiveness of a Stratified Blended Physiotherapy Intervention in Patients With Nonspecific Low Back Pain: Cluster Randomized Controlled Trial

Individual Patient Education for Managing Acute and/or Subacute Low Back Pain: Little Additional Benefit for Pain and Function Compared to Placebo. A Systematic Review With Meta-analysis of Randomized Controlled Trials

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