Exercise therapy for chronic nonspecific low-back pain.

Authors: van Middelkoop M (1) , Rubinstein SM (2) , Verhagen A (1) , Ostelo R (2) , Koes BW (1) , van Tulder MW (2)
(1) Department of General Practice, Erasmus Medical Centre University (2) Department of Epidemiology and Biostatistics, EMGO Institute for Health and Care Research, VU University Medical Center
Source: Best Pract Res Clin Rheumatol. 2010 Apr;24(2):193-204
DOI: 10.1016/j.berh.2010.01.002. Publication date: 2010 Apr E-Publication date: Not specified Availability: abstract Copyright: Published by Elsevier Ltd.
Language: English Countries: Not specified Location: Not specified Correspondence address: Marienke van Middelkoop,
Department of General Practice, Room Wk-109, PO Box 2040, 3000 CA Rotterdam, The Netherlands. Tel.: fax: +31 10 7032127.
Email : m.vanmiddelkoop@erasmusmc.nl


Article abstract

Exercise therapy is the most widely used type of conservative treatment for low back pain. Systematic reviews have shown that exercise therapy is effective for chronic but not for acute low back pain. During the past 5 years, many additional trials have been published on chronic low back pain. This articles aims to give an overview on the effectiveness of exercise therapy in patients with low back pain. For this overview, existing Cochrane reviews for the individual interventions were screened for studies fulfilling the inclusion criteria, and the search strategy outlined by the Cochrane Back Review Group (CBRG) was followed. Studies were included if they fulfilled the following criteria: (1) randomised controlled trials,(2) adult (> or =18 years) population with chronic (> or =12 weeks) nonspecific low back pain and (3) evaluation of at least one of the main clinically relevant outcome measures (pain, functional status, perceived recovery or return to work). Two reviewers independently selected studies and extracted data on study characteristics, risk of bias and outcomes at short-term, intermediate and long-term follow-up. The GRADE approach (GRADE, Grading of Recommendations Assessment, Development and Evaluation) was used to determine the quality of evidence. In total, 37 randomised controlled trials met the inclusion criteria and were included in this overview. Compared to usual care, exercise therapy improved post-treatment pain intensity and disability, and long-term function. The authors conclude that evidence from randomised controlled trials demonstrated that exercise therapy is effective at reducing pain and function in the treatment of chronic low back pain. There is no evidence that one particular type of exercise therapy is clearly more effective than others. However, effects are small and it remains unclear which subgroups of patients benefit most from a specific type of treatment.

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