Abstract
Exercise therapy for the treatment of non-specific low back painj br_270 164..165 Question How effective is exercise therapy for adult non-specific acute, subacute and chronic low-back pain compared with no treatment (sham or placebo) and other conservative treatments? Relevance to nursing care In the Western world, about 60% to 80% of people will experience low-back pain at some point in their lives. 1 Although many will recover, low-back pain causes suffering, is a leading cause of disability and results in economic hardship. Exercise therapy, which includes a variety of types of flexibility and stretching exercises, general physical fitness or aerobic exercise and muscle strengthening, is widely used as an intervention to decrease pain and improve function. Although studies have previously assessed this topic, there is a need for an updated review to facilitate evidence-based practice regarding exercise therapy for adults with low-back pain compared with no treatment and other conservative treatments. Study characteristics This summary is based on a Cochrane review containing 61 randomized controlled trials. Of these, 11 evaluated adults with acute low-back pain, 6 evaluated subacute low-back pain and 43 evaluated chronic low-back pain, with 1 trial being unclear. 2 Exercise therapy groups were included if the trial included an independent no treatment or other conservative treatment comparison group. Ten of 11 trials of adults with low-back pain (1192 subjects) had non-exercise comparisons with one study provided by a therapist. Of the six studies involving adults with subacute low-back pain (881 subjects), seven exercise groups had non-exercise comparisons. Forty-three trials involving adults with chronic low-back pain (3907 participants) had 33 non-exercise comparisons. Exercise therapy was defined as 'a series of specific movements with the aim of training or developing the body by a routine practice or as physical training to promote good physical health.' 3 Pain and function were analysed using the visual analogue scales (VAS) and the 24-point Roland Morris Disability Questionnaire or the Oswestry Disability Index. Individual trial outcomes for pain and function were rescaled to 0 to 100 points. For example, a VAS pain score (standard deviation) of 5.1 (2.3) out of 10 was re-scaled to 51 (23) out of 100, where positive mean effect sizes indicated improvements (decreased pain or functional limitation). A 20-point improvement in pain ratings and 10-point improvement in functional outcomes ratings were considered clinically important. Participants were adults (ages 18 to 44 years) in health-care, occupational, general or mixed populations whose non-specific low-back pain lasted less than 6 weeks (acute), 6 to 12 weeks (subacute) or longer than 12 weeks (chronic). The primary outcome of interest was that clinically important improvements are more likely in healthcare populations (primary, secondary or tertiary care centres) compared to studies from general or mixed populations (e.g. including individuals recruited by newspaper advertisements) (mean 9.96 points 95% CI: 1.6 to 18.4 more improvement in pain, and 5.52 points 95% CI: 0.6 to 10.4 greater improvement in functioning). While the overall mean improvements in these outcomes across all research settings are small, they are significant. Results indicated: • For acute low-back pain, exercises were not more effective than other conservative treatments, and there were no advantages over no treatment for pain and function. Data failed to show a difference in short-term pain relief This is a summary of a Cochrane Review. The full citation and the names of the researchers who conducted the Review are listed in the Reference section below.