Physical Activity Interventions for Increasing Objectively Measured Physical Activity Levels in Patients With Chronic Musculoskeletal Pain: A Systematic Review

Oliveira, Crystian B.; Franco, Márcia R.; Maher, Christopher G.; Lin, Chung‐Wei Christine; Morelhão, Priscila K.; Araújo, Amanda Costa; Filho, Rúben F. Negrão; Pinto, Rafael Zambelli

doi:10.1002/acr.22919

Cited by 42 publications

(38 citation statements)

References 44 publications

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“…The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to evaluate the overall quality of evidence and the strength of recommendation (35). The quality of evidence was downgraded for each of the following 5 factors encountered: limitations in the design and implementation [>25% of the trial, weighted by their sample size, scored <7 on the PEDro scale (36)], indirectness of evidence (trial design and objective not concordant), unexplained heterogeneity (I 2 > 50%), imprecision of results [comparisons with less than 400 participants were deemed "low quality evidence" (36,37)], and high probability of publication bias [assessed using Egger's funnel plot (38)]. We did not assess publication bias when a meta-analysis was not possible or if less than 10 studies were included in the meta-analysis (38,39).…”

Section: Methodological Qualitymentioning

confidence: 99%

Is Vitamin D Supplementation Effective for Low Back Pain? A Systematic Review and Meta-Analysis

Zadro

2018

Pain Phys

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Background: Low back pain (LBP) is the leading cause of years lived with disability worldwide. Current intervention strategies are failing to reduce the enormous global burden of LBP and are prompting researchers to investigate alternative management strategies, such as vitamin D supplementation. Vitamin D supplementation appears to down regulate pro-inflammatory cytokines which lead to pain and up regulate anti-inflammatory cytokines that reduce inflammation. These mechanisms might explain the increasing interest in the use of vitamin D supplementation for LBP. Objectives: To determine whether vitamin D supplementation improves pain more than a control intervention for individuals with LBP. Study Design: This study was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement. Methods: We performed searches in numerous electronic databases combining key words relating to “vitamin D” and “LBP” until March 2017. Studies were included if they investigated vitamin D supplementation in participants with LBP, provided there was a comparison intervention. There was no restriction on the type of LBP, the intervention parameters investigated, or the type of clinical trial (e.g., randomized, non-randomized). Two reviewers independently performed the selection of studies, extracted data, rated the methodological quality of the included studies, and evaluated the overall quality of the evidence using the Grading of Recommendations Assessment, Delevopment, and Evaulation (GRADE) approach. Results: After screening 3,534 articles, 8 clinical trials were included in this systematic review. There is very low quality evidence (based on the GRADE approach) that vitamin D supplementation is not more effective than any intervention (including placebo, no intervention, and other conservative/ pharmacological interventions) (continuous pain measures [0–100]: mean difference [MD] = -2.65, 95% confidence interval [CI]: -10.42 to 5.12, P = 0.504, n = 5; self-reported reduction in pain: pooled odds ratio [OR] = 1.07, 95% CI: 0.35 to 3.26, P = 0.906, n = 5) or placebo/no intervention for individuals with LBP (continuous pain measures: MD = 1.29, 95% CI: -3.81 to 6.39, P = 0.620, n = 4; self-reported reduction in pain: pooled OR = 1.53, 95% CI: 0.38 to 6.20, P = 0.550, n = 4), where ‘n’ is the number of studies included in the meta-analysis. These results did not change when we stratified the meta-analyses by the type of vitamin supplementation (vitamin D3 vs. alfacalcidol) or the type of LBP (non-specific vs. LBP resulting from osteoporosis or vertebral fractures). Limitations: The overall quality of evidence was “very low” due to the poor methodological quality and small sample sizes of the included studies. Conclusions: Vitamin D supplementation is not more effective than placebo, no intervention, or other conservative/pharmacological interventions for LBP (based on very low quality evidence). These results are consistent, regardless of the type of LBP or vitamin D supplementation. Until well-designed and adequately powered clinical trials suggest otherwise, the prescription of vitamin D for LBP cannot be recommended. PROSPERO Registration No: CRD42016046874. www.crd.york.ac.uk/PROSPERO/display_record. asp?ID = CRD42016046874 Key words: Vitamin D, low back pain, chronic low back pain, alfacalcidol, osteoporosis, vertebral fractures, serum 25-hydroxyvitamin D, systematic review

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Section: Methodological Qualitymentioning

confidence: 99%

Is Vitamin D Supplementation Effective for Low Back Pain? A Systematic Review and Meta-Analysis

Zadro

2018

Pain Phys

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“…In this way, the final sample size involved in this study was 35 computer officer workers divided into two subgroups: workers with MSP [(WMSP; n = 17) and without MSP report (WOMSP; n = 18)]. The eligibility criteria for the group WMSP were: self-reported MSP (complaint section of the MUEQ-Br revised [21]) and chronic MSP [22] -at least 3-month duration of pain symptoms [22,23]. Only workers who did not report any MSP in the last three months were included in the WOMSP group.…”

Section: Samplementioning

confidence: 99%

Differences in ergonomic and workstation factors between computer office workers with and without reported musculoskeletal pain

Rodrigues

Leite

Lelis

et al. 2017

WOR

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Our results demonstrated that computer office workers who reported MSP had worse ergonomics indexes for chair workstation and worse physical risk related to upper limb (RULA upper limb section) than workers without pain. However, there were no observed differences in workers with and without MSP regarding work-related psychosocial factors. The results suggest that inadequate workstation conditions, specifically the chair height, arm and back rest, are linked to improper upper limb postures and that these factors are contributing to MSP in computer office workers.

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“…Despite pleas for a ‘Move for Movement’ and ‘Exercise is Medicine’, our attempts to get people with LBP more active are failing 8. Physical activity is beneficial but it is not being widely adopted in clinical care.…”

mentioning

confidence: 99%

Unlocking the potential of physical activity for back health

2017

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Physical Activity Interventions for Increasing Objectively Measured Physical Activity Levels in Patients With Chronic Musculoskeletal Pain: A Systematic Review

Cited by 42 publications

References 44 publications

Is Vitamin D Supplementation Effective for Low Back Pain? A Systematic Review and Meta-Analysis

Is Vitamin D Supplementation Effective for Low Back Pain? A Systematic Review and Meta-Analysis

Differences in ergonomic and workstation factors between computer office workers with and without reported musculoskeletal pain

Unlocking the potential of physical activity for back health

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