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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    • "Systematic literature reviews indicate that physical exercises are effective in reducing pain and disability in patients suffering from low back pain (LBP)[1]. Although previous research has not succeeded in showing the superiority of one type of exercise program over an- other[2], a recent meta-analysis provides more support to strength/resistance and coordination/stabilisation programs[3]. Lumbar coordination/stabilization exercises are designed to restore the neuromuscular control of the lumbar spine. "
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    ABSTRACT: Background Lumbar stabilization exercises have gained popularity and credibility in patients with non-acute low back pain. Previous research provides more support to strength/resistance and coordination/stabilisation programs. Some authors also suggest adding strength/resistance training following motor control exercises. However, the effect of such a lumbar stabilization program on lumbar proprioception has never been tested so far. The present study investigated the effects of an 8-week stabilization exercise program on lumbar proprioception in patients with low back pain (LBP) and assessed the 8-week test-retest reliability of lumbar proprioception in control subjects. Methods Lumbar proprioception was measured before and after an 8-week lumbar stabilization exercise program for patients with LBP. Control subjects participated in the same protocol but received no treatment. Results The lumbar proprioception measure showed moderate reliability. Patients with LBP and control subjects demonstrated no differences in lumbar proprioception at baseline. Participants from both groups showed better proprioception following the 8-week interval, demonstrating the presence of learning between testing days. Conclusions The improvement of lumbar proprioception seen in both groups was ascribed to motor learning of the test itself. The effect of lumbar stabilization exercises on lumbar proprioception remains unknown because the LBP group did not show lumbar proprioception impairments.
    Full-text · Article · Dec 2016 · BMC Musculoskeletal Disorders
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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. "

    Full-text · Article · Jan 2015 · Journal of Bodywork and Movement Therapies
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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.
    Preview · Article · Oct 2014 · Occupational Therapy International
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