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

ABSTRACT 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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Available from: Maurits van Tulder, Sep 28, 2015
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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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    • "Stretching, spine stabilization, and proprioception exercise are generally recommended with or without manual therapy or massage. According to a recent Cochrane review [8], exercise therapy has evidence of being effective in the treatment of chronic nonspecific low back pain in the short and long term, especially individual exercise programs carried out "
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    ABSTRACT: Objective. Comparing global postural reeducation (GPR) to a standard physiotherapy treatment (PT) based on active exercises, stretching, and massaging for improving pain and function in chronic low back pain (CLBP) patients. Design. Prospective controlled study. Setting. Outpatient rehabilitation facility. Participants. Adult patients with diagnosis of nonspecific, chronic (>6 months) low back pain. Interventions. Both treatments consisted of 15 sessions of one hour each, twice a week including patient education. Measures. Roland Morris Disability Questionnaire to evaluate disability, and Numeric Analog Scale for pain. A score change >30% was considered clinically significant. Past treatments, use of medications, smoking habits, height, weight, profession, and physical activity were also recorded on baseline, on discharge, and 1 year after discharge (resp., T0, T1, and T2). Results. At T0 103 patients with cLBP (51 cases and 52 controls) were recruited. The treatment (T1) has been completed by 79 (T1) of which 60 then carried out the 1-year follow-up (T2). Both GPR and PT at T1 were associated with a significant statistical and clinical improvement in pain and function, compared to T0. At T2, only pain in GPR still registered a statistically significant improvement.
    The Scientific World Journal 08/2014; 2015. DOI:10.1155/2015/271436 · 1.73 Impact Factor
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    • "Regarding pain and disability, a previous systematic review proposed strategies consisting of individually designed programs to improve pain and disability for nonspecific chronic low back pain39). Rackwitz et al. stated that segmental stabilizing exercises are more effective than treatment by a general practitioner for reducing the pain and disability of patients with low back pain40). "
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    ABSTRACT: [Purpose] This study investigated effects of sling exercise for patients with chronic low back pain. [Methods] We reviewed all relevant papers indexed in PubMed, SCOPUS, and the Cochrane Registered Trials. Eligible trials were randomized controlled trials that compared sling exercise with any type of treatment. We extracted data on muscle thickness, muscle activation, pain, and disability, and assessed the methodological quality of the data. Seven studies met our inclusion criteria. [Results] When sling exercise had an impact on activation of the trunk muscles, increasing the trunk muscle thickness, and the reduction in pain and disability had been assessed shortly after the final exercise session, it was more effective than general exercise at activating trunk muscles, but not more effective at increasing trunk muscle thickness and improving pain and disability than general exercise. [Conclusion] As sling therapy studies are based on a small number of trials, we cannot draw conclusions about the therapeutic effects of sling exercise. When segmental stabilizing exercise and individually designed programs are added to sling exercise, it increases the effectiveness of sling exercise at improving low back pain. This should be the focus of future studies.
    Journal of Physical Therapy Science 08/2014; 26(8):1301-6. DOI:10.1589/jpts.26.1301 · 0.39 Impact Factor
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