Comparing the effectiveness of group-based exercise to other non-pharmacological interventions for chronic low back pain: A systematic review

Abstract

Background Low back pain (LBP) is the leading cause of disability worldwide with a substantial financial burden on individuals and health care systems. To address this, clinical practice guidelines often recommend non-pharmacological, non-invasive management approaches. One management approach that has been recommended and widely implemented for chronic LBP is group-based exercise programs, however, their clinical value compared with other non-pharmacological interventions has not been investigated systematically. Objective To compare the effectiveness of group-based exercise with other non-pharmacological interventions in people with chronic LBP. Methods Four electronic databases were searched by two independent reviewers. Only randomized controlled trials that compared group-based exercise with other non-pharmacological interventions for chronic LBP were eligible. Study quality was assessed using the Cochrane Handbook for systematic reviews of Interventions by two independent reviewers. Results Eleven studies were eligible. We identified strong evidence of no difference between group exercise and other non-pharmacologic interventions for disability level and pain scores 3-month post-intervention in people with chronic LBP. We could not find any strong or moderate evidence for or against the use of group-based exercise in the rehabilitation of people with chronic LBP for other time-points and health measurement outcomes. We found no statistically significant differences in disability and quality of life and pain between the group and individual non-pharmacological interventions that included exercise. Conclusion With this equivocal finding, group-based exercise may be a preferred choice given potential advantages in other domains not reviewed here such as motivation and cost. Further research in this area is needed to evaluate this possibility.

Effect of the association of continuous shortwave diathermy and Pilates-based exercises on pain, depression, and anxiety in chronic non-specific low back pain: a randomized clinical trial

“…Finally, our study corroborates the systematic review conducted by Lemieux et al ( 40 ), which found no statistically significant differences in disability, quality of life, and pain between exercise and other non-pharmacological interventions in patients with CNLBP. Therefore, to date, exercise programs are sufficient to control this dysfunction.…”

Psychotropic substitutions: Out of the frying pan and into the fire

“…Rather than perpetuating a recurring trend of substituting psychotropics, we should work to reduce the overall use of psychotropic medications by implementing safer non‐pharmacologic approaches. In the case of chronic pain, there is good evidence for exercise and psychoeducational interventions, though it is limited in patients living with dementia 22 . In the case of BPSD, systematic reviews of non‐pharmacologic interventions such as caregiver and health care worker training in person‐centered care and dementia communication skills show significant reductions in behavioral symptoms, with effect sizes that are small but greater than for antipsychotics 23,24 …”

“…In the case of chronic pain, there is good evidence for exercise and psychoeducational interventions, though it is limited in patients living with dementia. 22 In the case of BPSD, systematic reviews of non-pharmacologic interventions such as caregiver and health care worker training in personcentered care and dementia communication skills show significant reductions in behavioral symptoms, with effect sizes that are small but greater than for antipsychotics. 23,24 Ultimately, prescribers trying to manage complex symptoms and relieve distress among older adults living with dementia are working in an area devoid of good evidence where there are constantly trade-offs.…”

Dealing with Chronic Pain: Tips to Teach Undergraduate Health Sciences Students

“…49 When educating patients is a goal, research indicates that the most effective health promotional programmes for adults are social and educational group activities rather than individual health-focused interventions. 50,51 Educational group actions can help improve aspects such as differences in coping strategies illness perceptions, self-efficacy, fearavoidant beliefs, locus of control, and pain attitudes in different populations. However, when these actions are carried out, ethnic and cultural patient characteristics should be considered because these affect the pain beliefs, cognitions, and behaviours in those with chronic pain.…”