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Clinician Article

Exercise interventions for the treatment of chronic low back pain: a systematic review and meta-analysis of randomised controlled trials.



  • Searle A
  • Spink M
  • Ho A
  • Chuter V
Clin Rehabil. 2015 Dec;29(12):1155-67. doi: 10.1177/0269215515570379. Epub 2015 Feb 13. (Review)
PMID: 25681408
Read abstract Read evidence summary
Disciplines
  • Family Medicine (FM)/General Practice (GP)
    Relevance - 7/7
    Newsworthiness - 5/7
  • General Internal Medicine-Primary Care(US)
    Relevance - 7/7
    Newsworthiness - 5/7
  • Physical Medicine and Rehabilitation
    Relevance - 6/7
    Newsworthiness - 5/7
  • Internal Medicine
    Relevance - 5/7
    Newsworthiness - 6/7
  • Special Interest - Pain -- Physician
    Relevance - 5/7
    Newsworthiness - 5/7
  • Neurology
    Relevance - 5/7
    Newsworthiness - 4/7

Abstract

OBJECTIVE: To determine, for adults with chronic low back pain, which exercise interventions are the most effective at reducing pain compared to other treatments.

DATA SOURCES: A search of MEDLINE, CINAHL, EMBASE, SPORTDiscus, PsycINFO and The Cochrane Library was conducted up to October 2014.

REVIEW METHODS: Databases were searched for published reports of randomised trials that investigated the treatment of chronic low back pain of non-specific origin with an exercise intervention. Two authors independently reviewed and selected relevant trials. Methodological quality was evaluated using the Downs and Black tool.

RESULTS: Forty-five trials met the inclusion criteria and thirty-nine were included in the meta-analysis. Combined meta-analysis revealed significantly lower chronic low back pain with intervention groups using exercise compared to a control group or other treatment group (Standard Mean Deviation (SMD) =-0.32, CI 95% -0.44 to -0.19, P<0.01). Separate exploratory subgroup analysis showed a significant effect for strength/resistance and coordination/stabilisation programs.

CONCLUSIONS: Our results found a beneficial effect for strength/resistance and coordination/stabilisation exercise programs over other interventions in the treatment of chronic low back pain and that cardiorespiratory and combined exercise programs are ineffective.


Clinical Comments

Family Medicine (FM)/General Practice (GP)

This is a useful review. Medication is still promoted more than exercise and physical treatments in my area so; although this is not entirely new information, I think is is good to have this "out there".

Internal Medicine

This is a well done meta-analysis. There are no large scale trials, however, there are good number of smaller studies. The findings do have relevance to primary care, but it would be helpful if there were more concrete descriptions of what the actual exercise programs involved.

Physical Medicine and Rehabilitation

It is a very good review. In sports medicine, we already know about the usefulness of specific exercises for the lumbar pain but GPs do not. So this paper should be very helpful for them.

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