Systematic Review: Strategies for Using Exercise Therapy To Improve Outcomes in Chronic Low Back Pain

Institute for Work & Health and University of Toronto, Toronto, Ontario, Canada.
Annals of internal medicine (Impact Factor: 17.81). 05/2005; 142(9):776-85. DOI: 10.7326/0003-4819-142-9-200505030-00014
Source: PubMed


Exercise therapy encompasses a heterogeneous group of interventions. There continues to be uncertainty about the most effective exercise approach in chronic low back pain.
To identify particular exercise intervention characteristics that decrease pain and improve function in adults with nonspecific chronic low back pain.
MEDLINE, EMBASE, PsychInfo, CINAHL, and Cochrane Library databases to October 2004 and citation searches and bibliographic reviews of previous systematic reviews.
Randomized, controlled trials evaluating exercise therapy in populations with chronic (>12 weeks duration) low back pain.
Two reviewers independently extracted data on exercise intervention characteristics: program design (individually designed or standard program), delivery type (independent home exercises, group, or individual supervision), dose or intensity (hours of intervention time), and inclusion of additional conservative interventions.
43 trials of 72 exercise treatment and 31 comparison groups were included. Bayesian multivariable random-effects meta-regression found improved pain scores for individually designed programs (5.4 points [95% credible interval (CrI), 1.3 to 9.5 points]), supervised home exercise (6.1 points [CrI, -0.2 to 12.4 points]), group (4.8 points [CrI, 0.2 to 9.4 points]), and individually supervised programs (5.9 points [CrI, 2.1 to 9.8 points]) compared with home exercises only. High-dose exercise programs fared better than low-dose exercise programs (1.8 points [CrI, -2.1 to 5.5 points]). Interventions that included additional conservative care were better (5.1 points [CrI, 1.8 to 8.4 points]). A model including these most effective intervention characteristics would be expected to demonstrate important improvement in pain (18.1 points [CrI, 11.1 to 25.0 points] compared with no treatment and 13.0 points [CrI, 6.0 to 19.9 points] compared with other conservative treatment) and small improvement in function (5.5 points [CrI, 0.5 to 10.5 points] compared with no treatment and 2.7 points [CrI, -1.7 to 7.1 points] compared with other conservative treatment). Stretching and strengthening demonstrated the largest improvement over comparisons.
Limitations of the literature, including low-quality studies with heterogeneous outcome measures and inconsistent and poor reporting; publication bias.
Exercise therapy that consists of individually designed programs, including stretching or strengthening, and is delivered with supervision may improve pain and function in chronic nonspecific low back pain. Strategies should be used to encourage adherence. Future studies should test this multivariable model and further assess specific patient-level characteristics and exercise types.

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    • "However, the direct cause-effect relationship between MCI and NSLBP remains unclear. While exercise as a treatment modality has been shown to be ineffective in the acute phase of LBP (<6 weeks) (Airaksinen et al., 2006; Hayden et al., 2005a, 2005b, 2005c), several studies support the positive effect of exercise on pain and function in sub-acute and chronic pain patients (Hayden et al., 2005c). The question remains which exercises are most beneficial for which patients. "
    Journal of Bodywork and Movement Therapies 01/2015; DOI:10.1016/j.jbmt.2015.08.001
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    • "Conflicting results have been reported on the effectiveness of an exercise programme in the management of LBP (Hayden et al., 2005a; van Middelkoop et al., 2011). Current literature reports several extension-oriented treatment approaches involving combinations of active or passive movements to favour lumbar spine extension (Delitto et al., 1995; Garcia et al., 2011) and strengthening exercises of the primary spinal stabilizers (McGill, 2001; Hayden et al., 2005b). Several authors as well as most clinical practice guidelines claim that supervised exercise therapy has proven to be effective in reducing pain and improving functional performance in the treatment of patients with chronic non-specific low back pain (Airaksinen et al., 2006; van Middelkoop et al., 2010; Garcia et al., 2011). "
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    ABSTRACT: The objectives of this study were to determine the effectiveness of a programme of prevention exercises conducted in a corporate environment in poultry industry slaughterers suffering from musculoskeletal disorders. Forty workers, 70% female (mean ± SD age: 44.4 ± 8.4 years) were consecutively, in an alternative way, assigned to one of two groups receiving either set of 10 sessions (experimental or control group). The experimental group followed an exercise programme for a period of five weeks and a protocol of home exercises. The control group performed the exercise protocol only at home. The Roland Morris Disability Questionnaire (RMDQ) and the Oswestry Disability Index (ODI) to measure disability, the Visual Analogue Scale (VAS) score and the Pain Drawing to measure pain were used as outcome evaluations. A significant effect of time interaction (all P <0.001 and; F = 40.673; F = 33.907 and F = 25.447) existed for lumbar VAS, RMDQ and ODI immediately after the intervention (all P < 0.006). No significant group effect or group-by-time interaction was detected for any of them, which suggests that both groups improved in the same way. This study shows that a programme of prevention exercises may have a positive effect in improving musculoskeletal disorders of slaughterhouse workers. Pain decreased in the lumbar region, and there was an almost significant reduction in disability. Copyright © 2014 John Wiley & Sons, Ltd.
    Occupational Therapy International 10/2014; 22(1). DOI:10.1002/oti.1382 · 0.78 Impact Factor
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    • "This heterogeneity increases difficulty while researching the topic or treating patients. However, exercise therapy seems to be effective for chronic cases not related to red flags(5). Postural models for pain treatment state that poor posture alters the joint position and causes pain(6,7), which is more evident in a region with a high degree of mobility, such as the spine. "
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    ABSTRACT: IntroductionBack pain can be one of the most common health problems, causing suffering, disabilities, and financial losses. Postural models for pain treatment state that poor posture alters the joint position and causes pain, such as back pain. Muscular Chain Therapy (MCT) is a technique that is used to treat posture pathologies, among others.PurposeThe aim of the present study was to assess the efficiency of a single session of Muscular Chain Therapy (MCT) on complaints of undiagnosed musculoskeletal spinal pain.SettingPhysical therapy clinic of the University of Center-West (Guarapuava, Brazil).Participants100 subjects, aged between 20 and 39 years, with complaints of spinal musculoskeletal pain.Research DesignRandomized controlled trial.InterventionThe participants were randomly assigned by a non-care provider into two groups: The MCT Group that received Muscular Chain Treatment and the Control Group that received a placebo treatment of 15 minutes turned off ultrasound therapy. All volunteers were assessed before and after treatment using an analog pain scale. A score of 0 indicated no pain and 10 was the maximum degree of pain on the scale.Main Outcome MeasureDegree of pain measured by analog scaleResultsThe chi-square goodness of fit test was used to compare gender distribution among groups displayed a p value = .25. Subject age had differences analyzed using the unpaired t test (p = .44). Pain assessment for treatment and placebo control groups was analyzed using a paired t test and unpaired t test. The paired t test was used for intragroup before/after treatment comparison (MCT p = .00001; Control Group p = .0001). The unpaired t test was used for comparing the difference of the pain level before and after treatment between groups (p = .0001). A priori statistical significance was set a p = .05.ConclusionIt is possible to conclude that one MCT session is an effective treatment of undiagnosed spinal musculoskeletal pain.
    International Journal of Therapeutic Massage & Bodywork Research Education & Practice 09/2014; 7(3):2-6. DOI:10.3822/ijtmb.v7i3.214
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