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Exercise therapy for treatment of acute non-specific low back pain: a Cochrane systematic review and meta-analysis of randomised controlled trials

PainSci » bibliography » IJzelenberg et al 2024
Tags: treatment, exercise, back pain, self-treatment, pain problems, spine

One article on PainSci cites IJzelenberg 2024: The Complete Guide to Low Back Pain

PainSci notes on IJzelenberg 2024:

This Cochrane review of exercise for back pain may still have some useful implications despite the “very low quality evidence” it had to work with. Garbage in, garbage out? Certainly a concern with all reviews like this, but it’s also just kind of interesting how crappy the evidence is on this topic!

“Many RCTs had a high risk of bias, were small in size and/or there was substantial heterogeneity [all over the place].”

Bias in trials tends to lead to overstating results, so if you can’t produce a positive result with your thumb on the scale, that’s somewhat telling in itself. And these studies, despite being biased in a pro-exercise direction (likely), showed … bupkis, just no effect at all:

“No clinically relevant effect on pain or functional status in the short term.”

This is just one analysis, and obviously the It Depends factor here is huge, but presumably all of these studies looked at some kind of exercise that was a good idea for back pain in some way. While a lack of short term results isn’t exactly shocking, it’s still at odds with the popular idea that exercise is good for back pain. Bear in mind that people are routinely prescribed all kinds of exercises for acute back pain, and everyone — realistically or not — hopes for results within days or weeks, not months.

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.

OBJECTIVE: To assess the effectiveness of exercise for acute non-specific low back pain (LBP) versus our main comparisons: 1) sham treatment, and 2) no treatment at short-term (main follow-up time). DATA SOURCES AND STUDY SELECTION: A comprehensive search up till November 2021 was conducted in numerous databases for randomised controlled trials (RCTs) on the effectiveness of exercise in adults with acute LBP (< 6 weeks). Studies examining LBP with a specific aetiology were excluded. The primary outcomes were back pain, back-specific functional status and recovery. DATA EXTRACTION: Two review authors independently conducted the study selection, risk of bias assessment and data extraction. GRADE was used to assess the certainty of the evidence. DATA SYNTHESIS: We identified 23 RCTs (2674 participants). There is very low-certainty evidence that exercise therapy compared with sham/placebo treatment has no clinically relevant effect on pain (mean difference (MD) -0.80, 95% confidence interval (CI) -5.79 to 4.19; 1 study, 299 participants) and on functional status (MD 2.00, 95% CI -2.20 to 6.20; 1 study, 299 participants) in the short term. There is very low-quality evidence which suggests no difference in effect on pain and functional status for exercise vs. no treatment (2 studies; n=157, not pooled due to heterogeneity) at short-term follow-up. Similar results were found for the other follow-up moments. The certainty of the evidence was downgraded because many RCTs had a high risk of bias, were small in size and/or there was substantial heterogeneity. CONCLUSION: Exercise therapy compared to sham/placebo and no treatment may have no clinically relevant effect on pain or functional status in the short term in people with acute non-specific LBP, but the evidence is very uncertain. Owing to insufficient reporting of adverse events, we were unable to reach any conclusions on the safety or harms related to exercise therapy.

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