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Advice to Stay Active or Structured Exercise in the Management of Sciatica: A Systematic Review and Meta-analysis

updated

Tags: treatment, sciatica, exercise, back pain, pain problems, spine, butt, hip, self-treatment

One article on PainSci cites Fernandez 2015: A Guide to Sciatica Treatment for Patients

PainSci summary of Fernandez 2015: ?This page is one of thousands in the PainScience.com bibliography. It is not a general article: it is focused on a single scientific paper, and it may provide only just enough context for the summary to make sense. Links to other papers and more general information are provided at the bottom of the page, as often as possible.

A small review of just five trials of mixed quality showing that supervised, “structured” therapeutic exercise — allegedly tailored for the treatment of back pain and sciatica — was only slightly more effective than simply advising patients to stay active in the short term (and no difference at all in the long term).

~ Paul Ingraham

original abstract Abstracts here may not perfectly match originals, for a variety of technical and practical reasons. Some abstacts are truncated for my purposes here, if they are particularly long-winded and unhelpful. I occasionally add clarifying notes. And I make some minor corrections.

STUDY DESIGN: A systematic review and meta-analysis.

OBJECTIVE: To evaluate the evidence on comparative effectiveness of advice to stay active versus supervised structured exercise in the management of sciatica.

SUMMARY OF BACKGROUND DATA: Conservative management of sciatica usually includes interventions to promote physical activity in the form of advice to stay active or exercise, but there has been no systematic review directly comparing the effectiveness of these 2 approaches.

METHODS: Data Sources included MEDLINE, CINAHL, EMBASE, and PEDro databases. Studies were randomized controlled trials comparing advice with exercise. Two independent reviewers extracted data and assessed methodological quality using the PEDro scale. Pain and disability data were extracted for all time points and converted to a common 0 to 100 scale. Data were pooled with a random effects model for short, intermediate, and long-term follow-ups. The GRADE approach was used to summarize the strength of evidence.

RESULTS: Five trials were included in the meta-analysis, which showed a significant, although small effect favoring exercise over advice for reducing leg pain intensity in the short term (weighted mean difference: 11.43 [95% confidence interval, 0.71-22.16]) but no difference for disability (weighted mean difference: 1.45 [95% confidence interval, -2.86 to 5.76]). Furthermore, there was no difference at intermediate and long-term follow-ups between advice and exercise for patient-relevant outcomes.

CONCLUSION: There is low-quality evidence (GRADE) that exercise provides small, superior effects compared with advice to stay active on leg pain in the short term for patients experiencing sciatica. However, there is moderate-quality evidence showing no difference between advice to stay active and exercise on leg pain and disability status in people with sciatica in the long term.

LEVEL OF EVIDENCE: 1.

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