Effectiveness of self‐management of low back pain: Systematic review with meta‐analysis

Oliveira, Vinícius Cunha; Ferreira, Paulo H.; Maher, Christopher G.; Pinto, Rafael Zambelli; Refshauge, Kathryn M.; Ferreira, Manuela L

doi:10.1002/acr.21737

Cited by 126 publications

(108 citation statements)

References 40 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Although no significant effect on pain was reported by Du et al, 195 Oliveira et al 196 found evidence to support a small, statistically significant effect at short-and longer-term follow-up. The impact of the interventions on disability was more consistently positive across the two reviews, with two of the three RCTs included in Du et al's review finding significant, small benefits (Du et al calls these 'moderate') in the medium term (6 months), 195 and Oliveira et al 196 reporting small, significant effects in the short and longer term.…”

Section: Explicit Self-managementmentioning

confidence: 84%

“…The impact of the interventions on disability was more consistently positive across the two reviews, with two of the three RCTs included in Du et al's review finding significant, small benefits (Du et al calls these 'moderate') in the medium term (6 months), 195 and Oliveira et al 196 reporting small, significant effects in the short and longer term.…”

Section: Explicit Self-managementmentioning

confidence: 94%

“…[195][196][197][198][199][200][201][202][203][204][205][206][207][208] These reviews reported on a total of 255 RCTs, of which 114 were included in more than one review. Reviews were published between 1995 and 2012 and included RCTs published from 1977 to 2010.…”

Section: Systematic Reviews Identifiedmentioning

confidence: 99%

“…These rigorous criteria led to the inclusion of just three RCTs on LBP, one of which focused on pregnancy-related LBP 3 weeks after delivery. Oliveira et al, 196 on the other hand, included 13 RCTs; just one RCT was common to both reviews. These two reviews included a diversity of self-management support components in various combinations, including fear-avoidance techniques; education; behavioural rehearsal; discussion sessions; and audiovisual resources.…”

Section: Explicit Self-managementmentioning

confidence: 99%

“…The two reviews identified which focused explicitly on self-management 195,196 were both assessed as high quality (scoring ≥ 31). The seven multicomponent rehabilitation reviews varied in their quality, with three defined as lower quality 197,198,201 and four classed as being of a higher quality.…”

Section: Quality Assessment and Weightingmentioning

confidence: 99%

See 4 more Smart Citations

A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – Practical systematic RevIew of Self-Management Support for long-term conditions

Taylor

Pinnock

Epiphaniou

et al. 2014

Health Services and Delivery Research

344

451

View full text Add to dashboard Cite

BackgroundDespite robust evidence concerning self-management for some long-term conditions (LTCs), others lack research explicitly on self-management and, consequently, some patient groups may be overlooked.AimTo undertake a rapid, systematic overview of the evidence on self-management support for LTCs to inform health-care commissioners and providers about what works, for whom, and in what contexts.MethodsSelf-management is ‘the tasks . . . individuals must undertake to live with one or more chronic conditions . . . [including] . . . having the confidence to deal with medical management, role management and emotional management of their conditions’. We convened an expert workshop and identified characteristics of LTCs potentially of relevance to self-management and 14 diverse exemplar LTCs (stroke, asthma, type 2 diabetes mellitus, depression, chronic obstructive pulmonary disease, chronic kidney disease, dementia, epilepsy, hypertension, inflammatory arthropathies, irritable bowel syndrome, low back pain, progressive neurological disorders and type 1 diabetes mellitus). For each LTC we conducted systematic overviews of systematic reviews of randomised controlled trials (RCTs) of self-management support interventions (‘quantitative meta-reviews’); and systematic overviews of systematic reviews of qualitative studies of patients’ experiences relating to self-management (‘qualitative meta-reviews’). We also conducted an original systematic review of implementation studies of self-management support in the LTCs. We synthesised all our data considering the different characteristics of LTCs. In parallel, we developed a taxonomy of the potential components of self-management support.ResultsWe included 30 qualitative systematic reviews (including 515 unique studies), 102 quantitative systematic reviews (including 969 RCTs), and 61 studies in the implementation systematic review. Effective self-management support interventions are multifaceted, should be tailored to the individual, their culture and beliefs, a specific LTC and position on the disease trajectory, and underpinned by a collaborative/communicative relationship between the patient and health-care professional (HCP) within the context of a health-care organisation that actively promotes self-management. Self-management support is a complex intervention and although many components were described and trialled in the studies no single component stood out as more important than any other. Core components include (1) provision of education about the LTC, recognising the importance of understanding patients’ pre-existing knowledge and beliefs about their LTC; (2) psychological strategies to support adjustment to life with a LTC; (3) strategies specifically to support adherence to treatments; (4) practical support tailored to the specific LTC, including support around activities of daily living for disabling conditions, action plans in conditions subject to marked exacerbations, intensive disease-specific training to enable self-management of specific clinical tasks; and (5) social support as appropriate. Implementation requires a whole-systems approach which intervenes at the level of the patient, the HCP and the organisation. The health-care organisation is responsible for providing the means (both training and time/material resources) to enable HCPs to implement, and patients to benefit from, self-management support, regularly evaluating self-management processes and clinical outcomes. More widely there is a societal need to address public understanding of LTCs. The lack of public story for many conditions impacted on patient help-seeking behaviour and public perceptions of need.ConclusionsSupporting self-management is inseparable from the high-quality care for LTCs. Commissioners and health-care providers should promote a culture of actively supporting self-management as a normal, expected, monitored and rewarded aspect of care. Further research is needed to understand how health service managers and staff can achieve this culture change in their health-care organisations.Study registrationThis study is registered as PROSPERO CRD42012002898.FundingThe National Institute for Health Research Health Services and Delivery Research programme.

show abstract

Section: Explicit Self-managementmentioning

confidence: 84%

Section: Explicit Self-managementmentioning

confidence: 94%

Section: Systematic Reviews Identifiedmentioning

confidence: 99%

Section: Explicit Self-managementmentioning

confidence: 99%

Section: Quality Assessment and Weightingmentioning

confidence: 99%

See 3 more Smart Citations

A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – Practical systematic RevIew of Self-Management Support for long-term conditions

Taylor

Pinnock

Epiphaniou

et al. 2014

Health Services and Delivery Research

344

451

View full text Add to dashboard Cite

show abstract

Influence of self-management and self-management support on chronic low back pain patients in primary care

Kawi¹

2014

Journal of the American Association of Nurse Practitioners

View full text Add to dashboard Cite

Purpose This study utilized a nonexperimental, cross‐sectional, descriptive design to examine self‐management (SM), self‐management support (SMS), and other pain‐related variables in chronic low back pain (CLBP), and described participants’ perceptions of their SM, SMS, and functional ablement. Data sources Data were collected from 120 participants in four primary care clinics using survey measures. Conclusions SMS was found to significantly influence SM and mental health. Overall health significantly influenced functional ablement and pain intensity. Participants described using medications, exercising, and making lifestyle changes as most common SM strategies. Prescribing medications, giving encouragement, and providing information were main participant‐perceived SMS activities. Depression and anxiety were key responses to perceptions on functional ablement. Implications for practice Study findings increase our understanding of the SM, SMS, and functional ablement of CLBP patients with relevance to application in practice. There is a great need to develop evidence‐based SM and SMS programs specific to CLBP patients’ needs. Nurses and nurse practitioners play major roles in leading this initiative. Study findings also reinforce the importance of psychologists and physical therapists’ collaboration in the complex care of CLBP. Longitudinal and experimental studies are recommended to evaluate SM and SMS programs that include physical therapy and psychological care components.

show abstract

Brief action planning targeting prognostic factors for an adult with persistent low back pain without radiculopathy: A case report

Connell

Verville

Cancelliere

et al. 2020

Clinical Case Reports

View full text Add to dashboard Cite

show abstract

Effectiveness of self‐management of low back pain: Systematic review with meta‐analysis

Abstract: There is moderate-quality evidence that self-management has small effects on pain and disability in people with LBP. These results challenge the endorsement of self-management in treatment guidelines.

Cited by 126 publications

References 40 publications

A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – Practical systematic RevIew of Self-Management Support for long-term conditions

A rapid synthesis of the evidence on interventions supporting self-management for people with long-term conditions: PRISMS – Practical systematic RevIew of Self-Management Support for long-term conditions

Influence of self-management and self-management support on chronic low back pain patients in primary care

Brief action planning targeting prognostic factors for an adult with persistent low back pain without radiculopathy: A case report

Contact Info

Product

Resources

About