Is the combination of exercise therapy and health education more effective than usual medical care in the prevention of non-specific back pain? A systematic review with meta-analysis

Abstract

Background Clinical practice guidelines emphasize the importance of the prevention and treatment of non-specific back pain through exercise therapy and health education. However, it has not yet been confirmed that the combination of exercise plus education is more effective than usual medical care. Objective The aim of this study was to determine if the combination of exercise plus education is more effective for the prevention of non-specific back pain than usual medical care. Materials and methods A systematic search in PubMed, Scopus, Web of Science and Medline was conducted with the terms Back Pain, Neck Pain, Musculoskeletal Pain, Exercise, Exercise Therapy, Health Education, Cognitive Behavioral Therapy, Primary Prevention, Secondary Prevention and Clinical Trial. The inclusion criteria were: articles published from 2016 to 2021, the intervention included exercise and education, and the sample consisted of non-specific back pain patients. Results A total of 4 randomized controlled trials were selected (average PEDro score 6.5 points). The meta-analysis showed statistically significant differences in the pain intensity, standardized mean differences was found to be −0.75 (95% CI = −1.41 to −0.08; p = 0.03); and in disability, standardized mean differences was found to be −0.24 (95% CI = −0.38 to −0.1; p = 0.001). Conclusions Interventions combining exercise and education seem to have a greater preventive effect on non-specific back pain than usual medical care. Key messages Exercise therapy and health education combination prevent better non-specific back pain than usual care. Combining exercise with educational interventions has a higher improvement on disability and kinesophobia than usual care.

Fascia Tissue Manipulations in Chronic Low Back Pain: A Pragmatic Comparative Randomized Clinical Trial of the 4xT Method® and Exercise Therapy

“…Within the scope of managing LBP, both the literature and clinical guidelines in the field of physical therapy propose a variety of interventions, spanning from manual techniques to exercise therapy and health education [16][17][18][19][20]. However, the treatment effects of the suggested interventions, encompassing both manual techniques and exercises, are reported to be low to moderate [60].…”

“…The literature and the clinical practice guidelines in the field of physical therapy addressing the management of LBP advocate for a range of interventions [16][17][18][19][20]. This includes a more individualized approach, commonly practiced, and recognized for its potential to be more effective for individuals with LBP [21].…”

Digital Therapeutics (DTx) Expand Multimodal Treatment Options for Chronic Low Back Pain: The Nexus of Precision Medicine, Patient Education, and Public Health

“…Preventive interventions can be more effective when using artificial intelligence-based technologies that can identify patients at risk for developing CLBP [180]. Since a combination of health education and physical exercises can be effective in preventing non-specific back pain [181], DTx delivering these modalities can yield both therapeutic and preventive effects. Mobile apps are recognized as means to improve health literacy and preventive behaviors [182][183][184].…”

Physiotherapeutic and non-conventional approaches in patients with chronic low-back pain: a level I Bayesian network meta-analysis

“…Furthermore, education and lifestyle modifications aim to provide patients with the tools to prevent future episodes of cLBP 18 – 21 . Different physiotherapeutic regimes have been developed and investigated in this setting 22 , 23 . In particular, different forms of exercise, manual therapy, physical agent modalities, and education, or a combination of these in a multidisciplinary approach have been efficiently applied in the setting of cLBP 24 , 25 .…”