Response to Comment on: “Attempting to Separate Placebo Effects from Exercise in Chronic Pain: A Systematic Review and Meta-Analysis”

Owen, Patrick J; Saueressig, Tobias; Belavý, Daniel L.; Than, Christian; Ball, Jake; Sadler, Kate; Piedimonte, Alessandro; Miller, Clint T.

doi:10.1007/s40279-021-01622-7

Cited by 2 publications

(2 citation statements)

References 8 publications

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“…Twenty-two of the 75 included studies comprised qualitative research designs (12 patient perspective31 41–51; 5 physiotherapist perspective52–56; 5 mixed perspectives57–61), followed by quantitative designs (n=15) (longitudinal cohort studies n=11,22 62–71 secondary analysis of RCTs n=472–75), RCTs (n=15),76–90 systematic reviews (n=15),21 32 47 91–102 mixed methods (n=3),30 103 104 commentary (n=2),105 106 case reports (n=2)107 108 and narrative reviews (n=1) 109. See online supplement 4) for details of included studies and their quality appraisal.…”

Section: Resultsmentioning

confidence: 99%

“…Trust emerged as a mechanism from 27 well-conducted studies22 31 32 41 43 48 50–52 54 56 58 62 65 67 70 74 81 90 93 95 96 98 100 101 103 110 and was identified as a key mechanism to all identified outcomes (adherence, engagement and clinical outcomes). Consistently high confidence underpinned the CMOcs as seen in table 1, with moderate confidence in only 3 of the 10 CMOcs.…”

Section: Resultsmentioning

confidence: 99%

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Contexts, behavioural mechanisms and outcomes to optimise therapeutic exercise prescription for persistent low back pain: a realist review

Wood,

Foster,

Dean

et al. 2024

Br J Sports Med

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ObjectiveTherapeutic exercises are a core treatment for low back pain (LBP), but it is uncertain how rehabilitative exercise facilitates change in outcomes. Realist reviews explore how the context (C) of certain settings or populations and underlying mechanisms (M) create intended or unintended outcomes (O). Our objective was to explore and understand the behavioural mechanisms by which therapeutic exercise creates change in outcomes of adherence, engagement and clinical outcomes for patients with LBP.MethodsThis was a realist review reported following the Realist and Meta-narrative Evidence Syntheses: Evolving Standards guidance. We developed initial programme theories, modified with input from a steering group (experts, n=5), stakeholder group (patients and clinicians, n=10) and a scoping search of the published literature (n=37). Subsequently, an information specialist designed and undertook an iterative search strategy, and we refined and tested CMO configurations.ResultsOf 522 initial papers identified, 75 papers were included to modify and test CMO configurations. We found that the patient–clinician therapeutic consultation builds a foundation of trust and was associated with improved adherence, engagement and clinical outcomes, and that individualised exercise prescription increases motivation to adhere to exercise and thus also impacts clinical outcomes. Provision of support such as timely follow-up and supervision can further facilitate motivation and confidence to improve adherence to therapeutic exercises for LBP.ConclusionsEngagement in and adherence to therapeutic exercises for LBP, as well as clinical outcomes, may be optimised using mechanisms of trust, motivation and confidence. These CMO configurations provide a deeper understanding of ways to optimise exercise prescription for patients with LBP.

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