Meta-Analysis: Exercise Therapy for Nonspecific Low Back Pain

Abstract

Background: Exercise therapy is widely used as an intervention in low back pain.Objective: To evaluate the effectiveness of exercise therapy in adult nonspecific acute, subacute, and chronic low back pain versus no treatment and other conservative treatments.Data Sources: MEDLINE, EMBASE, PsychInfo, CINAHL, and Cochrane Library databases to October 2004; citation searches and bibliographic reviews of previous systematic reviews.Study Selection: Randomized, controlled trials evaluating exercise therapy for adult nonspecific low back pain and measuring pain, function, return to work or absenteeism, and global improvement outcomes.Data Extraction: Two reviewers independently selected studies and extracted data on study characteristics, quality, and outcomes at short-, intermediate-, and long-term follow-up.Data Synthesis: 61 randomized, controlled trials (6390 participants) met inclusion criteria: acute (11 trials), subacute (6 trials), and chronic (43 trials) low back pain (1 trial was unclear). Evidence suggests that exercise therapy is effective in chronic back pain relative to comparisons at all follow-up periods. Pooled mean improvement (of 100 points) was 7.3 points (95% CI, 3.7 to 10.9 points) for pain and 2.5 points (CI, 1.0 to 3.9 points) for function at earliest follow-up. In studies investigating patients (people seeking care for back pain), mean improvement was 13.3 points (CI, 5.5 to 21.1 points) for pain and 6.9 points (CI, 2.2 to 11.7 points) for function, compared with studies where some participants had been recruited from a general population (for example, with advertisements). Some evidence suggests effectiveness of a graded-activity exercise program in subacute low back pain in occupational settings, although the evidence for other types of exercise therapy in other populations is inconsistent. In acute low back pain, exercise therapy and other programs were equally effective (pain, 0.03 point [CI, ؊1.3 to 1.4 points]).Limitations: Limitations of the literature, including low-quality studies with heterogeneous outcome measures inconsistent and poor reporting, and possibility of publication bias.Conclusions: Exercise therapy seems to be slightly effective at decreasing pain and improving function in adults with chronic low back pain, particularly in health care populations. In subacute low back pain populations, some evidence suggests that a gradedactivity program improves absenteeism outcomes, although evidence for other types of exercise is unclear. In acute low back pain populations, exercise therapy is as effective as either no treatment or other conservative treatments. Ann Intern Med. 2005;142:765-775. www.annals.org For author affiliations, see end of text.L ow back pain is one of the leading causes of disability.Exercise therapy is a management strategy that is widely used in low back pain. It encompasses a heterogeneous group of interventions ranging from general physical fitness or aerobic exercise to muscle-strengthening and various types of flexibility and stretching exercises.In 20...

Workers with a chronic disease and work disability

“…For individuals with chronic low-back pain, exercise therapy appears to be somewhat effective at improving function. In adults with subacute low back pain there is some evidence that a graded activity programme improves absenteeism outcomes [29]. For workers with prolonged fatigue complaints, it was found that physical training improved physiological parameters and had a positive effect on fatigue complaints [30].…”

Rest versus exercise as treatment for patients with low back pain and Modic changes. a randomized controlled clinical trial

“…However, a meta-analysis of exercise therapy trials in patients with chronic LBP has shown that despite statistically significant improvements, the effect size of exercise (mean treatment effect) was small for pain (7 points out of 100) and disability (3 points out of 100) compared with no treatment or other conservative treatments [2]. …”

Lumbar Degenerative Disc Disease: Clinical Presentation and Treatment Approaches

“…Exercise therapy (ET) remains one of the conservative mainstays of treatment for chronic lumbar spine pain, and may be tailored to include aerobic exercise, muscle strengthening, and stretching exercises [49]. Significant variation in regimen, intensity, and frequency of prescribed programs presents challenges to assessing efficacy among patients [50].…”

“…One meta-analysis of the current literature exploring the role of ET in patients with varying duration of symptoms found a graded exercise program implemented within the occupational setting demonstrated some effectiveness in subacute LBP. Among those suffering chronic pain symptoms, small, but statistically significant improvements were observed among patients, with regard to pain reduction and functional improvement [49]. The optimal approach to exercise therapy in chronic low back pain sufferers appears to be those regimens involving an individually-designed exercise program emphasizing stretching and muscle strengthening, administered in a supervised fashion, with high frequency and close adherence.…”