Exercise therapy for chronic low back pain

Hayden, Jill A.; Ellis, Jenna; Ogilvie, Rachel; Malmivaara, Antti; Tulder, Maurits W. van

doi:10.1002/14651858.cd009790.pub2

Cited by 157 publications

(127 citation statements)

References 538 publications

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“…Studies regarding symptom relief and functional improvement following an exercise program for CLBP have suggested exercise to be effective in reducing and preventing pain. [9,10,[22][23][24] Amorim et al [25] conducted a pilot randomized controlled trial evaluating the e cacy of the IMPACT app versus conventional lower back pain management in reducing pain and increasing functionality. They found the app to be more effective in function improvement, but equally effective in pain reduction than conventional treatment.…”

Section: Discussionmentioning

confidence: 99%

“…[8] Important studies have demonstrated that exercise reduces pain and improves function in patients with CLBP. [9][10][11] Clinical implementation of exercise programs as a treatment for CLBP is challenging due to the lack of outcome consistency. Many of the differences in outcomes are due to the wide variety of exercise programs available, the use of supervised programs versus non-supervised programs, the low patient adherence to exercise programs, and the inconsistent recommendations of intensity and duration of programs.…”

Section: Introductionmentioning

confidence: 99%

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“Limbr, A Novel Personalized Mobile Application For Discogenic Chronic Low Back Pain: A Prospective Pilot Study”

Vad

Madrazo-Ibarra

Estrin

et al. 2022

Preprint

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Background: Exercise has showed to reduce pain and improve function in patients with chronic lower back pain (CLBP), however, outcomes have been inconsistent. Limbr is a mobile application (app) developed to increase patient adherence to the exercise program, and enhance exercise’s technique for better results. Methods: Patients 18 to 65 years of age, with CLBP (more than 3 months) and evidence of lumbar disc pathology by magnetic resonance imaging (MRI) were enrolled. Patients’ symptomatology was prospectively evaluated at baseline and during 3 months of using the Limbr app with patient-reported outcome measures (PROMs) including: the Visual Analog Scale for pian (VAS), the Oswestry Disability Index (ODI), and the Your Activities of Daily Living (YADL) score. Patients’ compliance and satisfaction were evaluated at the end of the follow-up. Results: Seventy-five patients with CLBP were enrolled in the study. All patients had a significant improvement from baseline to final follow-up in all PROMs. Average VAS scores decreased from 5.17± 2.1 at baseline to 3.8±2.6 at final follow-up (P= 0.016), and ODI scores from 25.7±13.8 to 18.2±13.6 (P= 0.001). Patients showed a significant decrease in the number of pain medications taken during a week (P=0.001). Overall compliance with the app was greater than 52%, with almost 65% of the patients rating the overall experience as good or excellent. Conclusion: Limbr showed to be an effective tool in reducing low back pain symptomatology, as well as generating great compliance to an exercise program for patients with CLBP. Trial registration number: 2/2/2017 NCT03040310 (ClinicalTrials.gov)

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

“Limbr, A Novel Personalized Mobile Application For Discogenic Chronic Low Back Pain: A Prospective Pilot Study”

Vad

Madrazo-Ibarra

Estrin

et al. 2022

Preprint

View full text Add to dashboard Cite

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“…To interpret the clinical relevance of the meta-analyses results, we considered a 1.5-point difference in pain and a 1.0-point difference on a 10 point VAS in disability to be clinically important for the comparisons of exercise versus any comparator group . 6 We interpreted smaller differences in the effectiveness of exercise treatments compared to other conservative treatments as ‘probably meaningful’, when the 95% confidence interval was entirely on one side of the no effect line. This is relevant given similar inconveniences and adverse effects for comparison of treatments considered in this review (Qaseem 2017).…”

Section: Methodsmentioning

confidence: 99%

“…This will consolidate previous knowledge and will build a bridge to known effects such as the above mentioned classification systems 18 or classical exercise. 6…”

Section: Introductionmentioning

confidence: 99%

“…45 Still, current research reveals only relatively small and heterogeneous effects when combining exercise and cognitive-behavioural therapies. 19, 22, 25 This is likely to be attributed to inter-individual heterogeneities in the effects. 33 Stratified or even individualized/personalized therapies may be the potential key to increase the (group and individual) therapeutic effect.…”

Section: Introductionmentioning

confidence: 99%

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Individualized exercise in chronic non-specific low back pain: a systematic review with meta-analysis on the effects of exercise alone or in combination with psychological interventions on pain and disability

Fleckenstein

Floessel

Engel

et al. 2021

Preprint

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ObjectiveTo investigate the effects of individualised exercise interventions consisting with or without combined psychological intervention on pain intensity and disability in patients with chronic non-specific low back pain.DesignSystematic review with meta-analysis and meta-regression.Data sourcesFive databases (PubMed, Cochrane Central, EMBASE, Clarivate Web of Science, and Google Scholar) were searched up to 31 March 2021.Selection criteriaRandomised controlled trials were eligible if they included participants with chronic non-specific low back pain, compared at least one individualised/personalised/stratified exercise intervention with or without psychological treatment to any control / comparator group, and if they assessed at least pain intensity or disability as outcome measure.ResultsFifty-eight studies (n = 9099 patients, 44.3 years, 56% female) compared individualised to other types of exercise (n = 44; 62%), usual care (n = 16; 23%), advice to stay active, or true controls. The remaining studies had passive controls.At short-term follow-up, low-certainty evidence for pain intensity (SMD -0.33 [95%CI -0.47 to -0.18]) and very low-certainty evidence for disability (−0.16 [-0.30 to -0.02]) indicates effects of individualised exercise compared to other exercises. Very low-certainty evidence for pain intensity (−0.35; [-0.53 to - 0.17])) and low-certainty evidence for disability (−0.12; [-0.22 to -0.02]) indicates effects compared to passive controls.At long-term follow-up, moderate-certainty evidence for pain intensity (−0.14 [-0.23 to -0.06]) and disability (−0.23 [-0.33 to -0.12]) indicates effects compared to passive controls exercises.All findings stayed below the threshold for minimal clinically important difference (MCID). Certainty of evidence was downgraded mainly due to evidence of risk of bias, publication bias and inconsistency that could not be explained. Sensitivity analyses indicated that the effects on pain, but not on disability (always short-term and versus active treatments) were robust. Sub-group analysis of pain outcomes suggested that individualised exercise treatment is probably more effective in combination with psychological interventions (−0.32 [-0.51 to -0.14]), a clinically important differenceConclusionWe found very low to moderate-certainty evidence that individualised exercise is effective for treatment of chronic non-specific low back pain. Individualised exercise seems superior to other active treatments and sub-group analysis suggests that some forms of individualised exercise (especially motor-control based treatments) combined with behavioural therapy interventions enhances the treatment effect. Certainty of evidence was higher for long-term follow-up. In summary, individualised exercise can be recommended from a clinical point of view.

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Effect of Graded Sensorimotor Retraining on Pain Intensity in Patients With Chronic Low Back Pain

Bagg

Wand

Cashin

et al. 2022

JAMA

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IMPORTANCEThe effects of altered neural processing, defined as altering neural networks responsible for perceptions of pain and function, on chronic pain remains unclear.OBJECTIVE To estimate the effect of a graded sensorimotor retraining intervention (RESOLVE) on pain intensity in people with chronic low back pain. DESIGN, SETTING, AND PARTICIPANTSThis parallel, 2-group, randomized clinical trial recruited participants with chronic (>3 months) nonspecific low back pain from primary care and community settings. A total of 276 adults were randomized (in a 1:1 ratio) to the intervention or sham procedure and attention control groups delivered by clinicians at a medical research institute in Sydney, Australia. The first participant was randomized on December 10, 2015, and the last was randomized on July 25, 2019. Follow-up was completed on February 3, 2020.INTERVENTIONS Participants randomized to the intervention group (n = 138) were asked to participate in 12 weekly clinical sessions and home training designed to educate them about and assist them with movement and physical activity while experiencing lower back pain. Participants randomized to the control group (n = 138) were asked to participate in 12 weekly clinical sessions and home training that required similar time as the intervention but did not focus on education, movement, and physical activity. The control group included sham laser and shortwave diathermy applied to the back and sham noninvasive brain stimulation. MAIN OUTCOMES AND MEASURESThe primary outcome was pain intensity at 18 weeks, measured on an 11-point numerical rating scale (range, 0 [no pain] to 10 [worst pain imaginable]) for which the between-group minimum clinically important difference is 1.0 point. RESULTS Among 276 randomized patients (mean [SD] age, 46 [14.3] years; 138 [50%] women), 261 (95%) completed follow-up at 18 weeks. The mean pain intensity was 5.6 at baseline and 3.1 at 18 weeks in the intervention group and 5.8 at baseline and 4.0 at 18 weeks in the control group, with an estimated between-group mean difference at 18 weeks of −1.0 point ([95% CI, −1.5 to −0.4]; P = .001), favoring the intervention group. CONCLUSIONS AND RELEVANCEIn this randomized clinical trial conducted at a single center among patients with chronic low back pain, graded sensorimotor retraining, compared with a sham procedure and attention control, significantly improved pain intensity at 18 weeks. The improvements in pain intensity were small, and further research is needed to understand the generalizability of the findings.

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Exercise therapy for chronic low back pain

Cited by 157 publications

References 538 publications

“Limbr, A Novel Personalized Mobile Application For Discogenic Chronic Low Back Pain: A Prospective Pilot Study”

“Limbr, A Novel Personalized Mobile Application For Discogenic Chronic Low Back Pain: A Prospective Pilot Study”

Individualized exercise in chronic non-specific low back pain: a systematic review with meta-analysis on the effects of exercise alone or in combination with psychological interventions on pain and disability

Effect of Graded Sensorimotor Retraining on Pain Intensity in Patients With Chronic Low Back Pain

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