Systematic Review to Inform a World Health Organization (WHO) Clinical Practice Guideline: Benefits and Harms of Structured Exercise Programs for Chronic Primary Low Back Pain in Adults

Author: Leslie Verville1, Rachel Ogilvie2, Cesar A Hincapié3,4,5, Danielle Southerst1, Hainan Yu1, André Bussières6,7, Douglas P Gross8, Paulo Pereira9, Silvano Mior1,10, Andrea C Tricco11,12,13, Christine Cedraschi14,15, Ginny Brunton1,16,17, Margareta Nordin18, Gaelan Connell1, Jessica J Wong1, Heather M Shearer1,10,19, Joyce G B Lee10, Dan Wang1, Jill A Hayden2, Carol Cancelliere20
Affiliation:
1 Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada.
2 Department of Community Health and Epidemiology, Dalhousie University, Halifax, Canada.
3 EBPI-UWZH Musculoskeletal Epidemiology Research Group, University of Zurich and Balgrist University Hospital, Zurich, Switzerland. cesar.hincapie@uzh.ch.
4 Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland. cesar.hincapie@uzh.ch.
5 University Spine Centre Zurich (UWZH), Balgrist University Hospital and University of Zurich, Zurich, Switzerland. cesar.hincapie@uzh.ch.
6 Département Chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières (Québec), Canada.
7 School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Montreal, Canada.
8 Department of Physical Therapy, University of Alberta, Edmonton, Canada.
9 Department of Neurosurgery, Centro Hospitalar Universitário São João, Faculty of Medicine, University of Porto, Porto, Portugal.
10 Department of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Canada.
11 Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada.
12 Epidemiology Division and Institute for Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
13 Queen's Collaboration for Health Care Quality Joanna Briggs Institute Centre of Excellence, Queen's University, Kingston, Canada.
14 Division of General Medical Rehabilitation, Geneva University and University Hospitals, Geneva, Switzerland.
15 Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Centre, Geneva University Hospitals, Geneva, Switzerland.
16 EPPI-Centre, UCL Institute of Education, University College London, London, England, UK.
17 McMaster Midwifery Research Centre, McMaster University, Hamilton, Canada.
18 Department of Orthopedic Surgery and Environmental Medicine, NYU Grossman School of Medicine, New York University, New York, United States.
19 Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.
20 Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada. carolina.cancelliere@ontariotechu.ca.
Conference/Journal: J Occup Rehabil
Date published: 2023 Nov 22
Other: Special Notes: doi: 10.1007/s10926-023-10124-4. , Word Count: 261

Purpose:
Evaluate benefits and harms of structured exercise programs for chronic primary low back pain (CPLBP) in adults to inform a World Health Organization (WHO) standard clinical guideline.

Methods:
We searched for randomized controlled trials (RCTs) in electronic databases (inception to 17 May 2022). Eligible RCTs targeted structured exercise programs compared to placebo/sham, usual care, or no intervention (including comparison interventions where the attributable effect of exercise could be isolated). We extracted outcomes, appraised risk of bias, conducted meta-analyses where appropriate, and assessed certainty of evidence using GRADE.

Results:
We screened 2503 records (after initial screening through Cochrane RCT Classifier and Cochrane Crowd) and 398 full text RCTs. Thirteen RCTs rated with overall low or unclear risk of bias were synthesized. Assessing individual exercise types (predominantly very low certainty evidence), pain reduction was associated with aerobic exercise and Pilates vs. no intervention, and motor control exercise vs. sham. Improved function was associated with mixed exercise vs. usual care, and Pilates vs. no intervention. Temporary increased minor pain was associated with mixed exercise vs. no intervention, and yoga vs. usual care. Little to no difference was found for other comparisons and outcomes. When pooling exercise types, exercise vs. no intervention probably reduces pain in adults (8 RCTs, SMD = - 0.33, 95% CI - 0.58 to - 0.08) and functional limitations in adults and older adults (8 RCTs, SMD = - 0.31, 95% CI - 0.57 to - 0.05) (moderate certainty evidence).

Conclusions:
With moderate certainty, structured exercise programs probably reduce pain and functional limitations in adults and older people with CPLBP.

Keywords: Exercise; Low back pain; Meta-analysis; Rehabilitation; Systematic review.

PMID: 37991647 DOI: 10.1007/s10926-023-10124-4

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