Effects of exercise therapy in patients with acute low back pain: a systematic review of systematic reviews

Karlsson, Marc; Bergenheim, Anna; Larsson, Maria; Nordeman, Lena; Tulder, Maurits W. van; Bernhardsson, Susanne

doi:10.1186/s13643-020-01412-8

Cited by 40 publications

(31 citation statements)

References 94 publications

(448 reference statements)

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“…Physiotherapy was the most frequent treatment option although only a few international guidelines recommend physiotherapy for acute LBP 3 and the evidence for efficacy is low. 31 Compared to a large USA cohort, the proportion of physiotherapy use was threefold higher in our study. 26 Similarly, the proportion of physiotherapy use was twofold higher compared to a representative national survey among patients with LBP.…”

Section: Non-pharmacologic Therapiescontrasting

confidence: 64%

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Treatment Patterns in Patients with Diagnostic Imaging for Low Back Pain: A Retrospective Observational Study

Gangi¹,

Bagnoud²,

Pichierri³

et al. 2021

JPR

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Purpose: Low back pain (LBP) is one of the most frequent reasons for medical consultations. Literature suggests a large evidence-performance gap, especially regarding pain management. Therefore, the monitoring of treatment patterns is important to ensure high quality of treatment. This study aimed to describe treatment patterns specific to patients with diagnostic imaging of the spine for LBP. Patients and Methods:The study was retrospective observational and based on health claims data from 2015 to 2019 provided by a Swiss health insurance company covering around 12% of the population. Patients, ≥18 years of age, with diagnostic imaging of the spine were included and observed 12 months before and after imaging. Patients with back surgery or comorbidities associated with the use of pain medications were excluded. Results: In total, 60,822 patients (mean age: 53.5 y, 56.1% female) were included and 85% received at least one pain medication. Of these, non-steroidal anti-inflammatory drugs, paracetamol, or opioids were prescribed in 88.6%, 70.7%, and 40.3% of patients, respectively. Strong opioids were used in 17% of patients given opioids. Patients with combinations of diagnostic imaging methods had the highest odds of receiving pain medication prescriptions (1.81, 95% CI: 1.66, 1.96, P < 0.001). Prescribed defined daily doses corresponded to short-term therapies. Conclusion: Although the majority of patients received non-opioid short-term therapies, we found a substantial use of opioids, and in particular, a relative high usage of strong opioids. Our results highlighted the importance of both patient and healthcare provider awareness regarding the prudent treatment of LBP.

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Section: Non-pharmacologic Therapiescontrasting

confidence: 64%

“…In addition to patient characteristics, provider factors and local routines may influence prescribing behavior. 20,24,31,32 Thus, further studies are needed to identify patient groups at risk, and provider characteristics associated with increased and perhaps unnecessary opioid prescriptions in the Swiss healthcare setting.…”

mentioning

confidence: 99%

Treatment Patterns in Patients with Diagnostic Imaging for Low Back Pain: A Retrospective Observational Study

Gangi¹,

Bagnoud²,

Pichierri³

et al. 2021

JPR

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“…Opinions differ over the optimal exercise modalities used to treat LBP. The "active ingredient" of exercise programs is largely unknown, although various exercise options are available [2,60,61]. Considerably more research is required in order to allow for the development and promotion of a wider variety of low cost, but effective exercise programs [2,3].…”

Section: Which Type Of Exercise Training?mentioning

confidence: 99%

Effect of Home Exercise Training in Patients with Nonspecific Low-Back Pain: A Systematic Review and Meta-Analysis

Quentin

Bagheri

Ugbolue

et al. 2021

IJERPH

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Background: Exercise therapy is recommended to treat non-specific low back pain (LBP). Home-based exercises are promising way to mitigate the lack of availability of exercise centers. In this paper, we conducted a systemic review and meta-analysis on the effects of home-based exercise on pain and functional limitation in LBP. Method: PubMed, Cochrane, Embase and ScienceDirect were searched until April 20th, 2021. In order to be selected, studies needed to report the pain and functional limitation of patients before and after home-based exercise or after exercise both in a center and at-home. Random-effect meta-analyses and meta-regressions were conducted. Results: We included 33 studies and 9588 patients. We found that pain intensity decreased in the exclusive home exercise group (Effect size = −0.89. 95% CI −0.99 to −0.80) and in the group which conducted exercise both at-home and at another setting (−0.73. −0.86 to −0.59). Similarly, functional limitation also decreased in both groups (−0.75. −0.91 to −0.60, and −0.70, −0.92 to −0.48, respectively). Relaxation and postural exercise seemed to be ineffective in decreasing pain intensity, whereas trunk, pelvic or leg stretching decreased pain intensity. Yoga improved functional limitation. Supervised training was the most effective method to improve pain intensity. Insufficient data precluded robust conclusions around the duration and frequency of the sessions and program. Conclusion: Home-based exercise training improved pain intensity and functional limitation parameters in LBP.

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“…Recently a review of review of exercise therapies used in acute LBP was published and concluded that there is very low-to-moderate evidence that exercise therapy of any type results in any important difference in pain or disability in adult patients with acute LBP (26). Whether this is also the case in exercise types used and prescribed in chronic LBP has not, to the best of our knowledge, been investigated in a review of reviews.…”

Section: Introductionmentioning

confidence: 99%

Summarizing the Effects of Different Exercise Types in Chronic Low Back Pain – A Systematic Review of Systematic Reviews

Grooten¹,

Boström²,

Dedering³

et al. 2021

Preprint

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Background Recently, a review of reviews concluded that exercise therapy of any type makes no difference to the effect on pain or disability in adult patients with acute low back pain (LBP). Whether this is also the case for exercise therapy in chronic LBP is still unknown. Objectives To summarize and synthesize systematic reviews (SR) and meta-analyses (MA) investigating the effects on pain and disability of common exercise types used in chronic LBP. Methods We included systematic reviews from several databases in which ≥ 75% of the studies were RCTs on adults between 18 and 70 years of age suffering from chronic or recurrent LBP for a period of at least 12 weeks. These were grouped into nine exercise types: Aerobic training, Aquatic exercises, Motor control exercises (MCE), Resistance training, Pilates, Sling exercises, Traditional Chinese Exercises (TCE), Walking, and Yoga. The study quality was assessed with AMSTAR-2. For each type of exercise, a narrative analysis was performed, and the levels of evidence for the effects of exercise were assessed through GRADE. Results The wide search resulted in 2,345 studies, and out of the 246 full texts that were screened, 41 SR/MA were included. Of these, 10 SR/MA were of high quality, 15 of moderate, 14 of low, and two of critically low quality. We found low to moderate evidence of mainly short-term and small beneficial effects on pain and disability for MCE, Resistance training, Pilates, TCE, and Yoga compared to no intervention. Few reviews were found for Aerobic, Aquatic, Sling, and Walking exercises, but with promising results. Aquatic exercises seem to be more beneficial compared to land exercises (low level of evidence). Conclusions In line with previous studies but in a broader perspective, this systematic review of reviews showed that there is low to moderate evidence that exercises are effective for reducing pain and disability compared to no or minimal interventions, but that no exercise type is more effective than other conservative interventions (very low to moderate evidence). Systematic review registration number PROSPERO: https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=190409

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Effects of exercise therapy in patients with acute low back pain: a systematic review of systematic reviews

Cited by 40 publications

References 94 publications

Treatment Patterns in Patients with Diagnostic Imaging for Low Back Pain: A Retrospective Observational Study

Treatment Patterns in Patients with Diagnostic Imaging for Low Back Pain: A Retrospective Observational Study

Effect of Home Exercise Training in Patients with Nonspecific Low-Back Pain: A Systematic Review and Meta-Analysis

Summarizing the Effects of Different Exercise Types in Chronic Low Back Pain – A Systematic Review of Systematic Reviews

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