Background Acute low back pain is associated with pain and disability, but symptoms are often self-healing. The effectiveness of exercise therapy for acute low back pain remains uncertain with conflicting evidence from systematic reviews. The aim of this systematic review of systematic reviews was to assess the overall certainty of evidence for the effects of exercise therapy, compared with other interventions, on pain, disability, recurrence, and adverse effects in adult patients with acute low back pain. Methods PubMed, the Cochrane library, CINAHL, PEDro, Open Grey, Web of Science, and PROSPERO were searched for systematic reviews of randomized controlled trials. Methodological quality was assessed independently by two authors using AMSTAR. Meta-analyses were performed if possible, using data from the original studies. Data for pain, disability, recurrence, and adverse effects were analyzed. Certainty of evidence was assessed using GRADE. Results The searches retrieved 2602 records, of which 134 publications were selected for full-text screening. Twenty-four reviews were included, in which 21 randomized controlled trials (n = 2685) presented data for an acute population, related to 69 comparisons. Overlap was high, 76%, with a corrected covered area of 0.14. Methodological quality varied from low to high. Exercise therapy was categorized into general exercise therapy, stabilization exercise, and McKenzie therapy. No important difference in pain or disability was evident when exercise therapy was compared with sham ultrasound, nor for the comparators usual care, spinal manipulative therapy, advice to stay active, and educational booklet. Neither McKenzie therapy nor stabilization exercise yielded any important difference in effects compared with other types of exercise therapy. Certainty of evidence varied from very low to moderate. Conclusions The findings suggest very low to moderate certainty of evidence that exercise therapy may result in little or no important difference in pain or disability, compared with other interventions, in adult patients with acute low back pain. A limitation of this systematic review is that some included reviews were of low quality. When implementing findings of this systematic review in clinical practice, patients’ preferences and the clinician’s expertise also should be considered, to determine if and when exercise therapy should be the intervention of choice. Systematic review registration PROSPERO: CRD46146, available at: https://www.crd.york.ac.uk/PROSPERO/display_record.php?RecordID=46146.

Objective To determine the effectiveness of a person-centred intervention, including advice on physical activity, for improving pain intensity, physical activity, and other health-related outcomes in persons with chronic widespread pain, when delivered with digital eHealth support compared with standard telephone follow-up. Design Randomized controlled trial. Subjects Individuals with chronic widespread pain ( n = 139), aged 20–65 years, who had previously participated in a pain educational programme at primary healthcare units, were contacted during the period 2018–19 and randomized to an intervention group ( n = 69) or an active control group ( n = 70). Methods Together with a physiotherapist, participants in both groups developed person-centred health plans for physical activity. The intervention group was supported via a digital platform for 6 months. The active control group received support via one follow-up phone call. Primary outcome was pain intensity. Secondary outcomes were physical activity and other health-related outcomes. Results No significant differences were found between the groups after 6 months, except for a significant decrease in global fatigue in the active control group compared with the intervention group. Conclusion Future development of interventions supporting persons with chronic pain to maintain regular exercise is warranted. LAY ABSTRACT Despite documented positive effects of physical activity in treating persons with chronic widespread pain, it is challenging for many individuals with chronic widespread pain to independently continue to be physically active over time. This study measured the effects of a person-centred health plan to promote physical activity, delivered using eHealth support compared with standard follow-up by telephone, in persons with chronic widespread pain. Participants with chronic widespread pain ( n = 139) were randomized into 2 groups: an intervention group, in which participants created an individual health plan together with a physiotherapist and were provided with digital eHealth support for 6 months; and an active control group, who also created an individual health plan together with a physiotherapist, and received one follow-up support phone call. The results showed no significant difference between the groups regarding change in the primary outcome, pain intensity. The active control group showed a significant decrease in global fatigue compared with the intervention group. Future development of interventions supporting persons with chronic pain to maintain regular exercise is warranted.

Stress-related mental disorders contribute to work disabilities globally and are a common cause for sick leave. Nature-based rehabilitation (NBR) is a multi-disciplinary approach offered to this patient group on a limited scale. Qualitative studies provide insight into patients’ experiences of NBR, and there is a need to synthesize and assess the certainty of evidence for patient-experienced benefits. The aim was to identify, appraise, and synthesize studies reporting experiences and perceived benefits of participation in multidisciplinary, group-based NBR of adult patients with long-standing stress-related mental disorders. PubMed, Embase, CINAHL, AMED, APA PsycInfo, and the Cochrane Library were searched from inception to December 2020. Reference lists of relevant publications were searched. After title and abstract screening, full-text articles were retrieved and assessed for inclusion. The methodological quality of the included studies was assessed, and certainty of evidence was appraised according to CERQual. The search yielded 362 unique records; 19 full-text publications were assessed for eligibility, and 5 studies were included in the synthesis. The studies were considered relevant regarding context, population, and intervention, and quality was generally assessed as moderate to high. Extracted texts were inductively coded and organized into 16 descriptive themes and 4 broad, analytical themes: Instilling calm and joy; Needs being met; Gaining new insights; and Personal growth. Experiences and perceived benefits of participating in NBR and spending time in a nature environment were described as positive for recovery. Nine of the descriptive themes were based on explicit results from at least four of the five studies. Confidence in the evidence of the qualitative findings ranged from moderate to low. Moderate-to-low certainty evidence from the included studies suggests that patients with long-standing stress-related mental disorders experience positive health effects from participating in NBR.