Exercise therapy most effective for back pain in some patients

Takeaway

• Exercise therapy was effective at reducing pain and improving function in patients with persistent low back pain (LBP), according to a new meta-analysis.
• Among patients with limited heavy lifting at work and those who use medication to manage their LBP, exercise therapy was more effective than other treatments.

Why this matters

• LBP is one of the most common causes of disability worldwide.

Study design

• Individual participant data meta-analysis (persistent LBP, n=3514; 27 randomized controlled trials).
• Funding: The Nova Scotia Health Research Foundation.

Key results

• At short-term follow-up (posttreatment period closest to 3 months), exercise therapy vs no treatment/usual care was effective in:
  • pain outcomes (clinically important 20% smallest worthwhile effect)
    • mean difference (MD), −10.7 (95% CI, −14.1 to –7.4; 26 studies; n=2466).
  • functional limitations (a clinically important 23% improvement)
    • MD, −10.2 (95% CI, −13.1 to –7.3; 25 studies; n=2366).
  • global recovery
    • OR, 3.8 (95% CI, 2.6-5.7; 25 studies; n=2366).
• Exercise vs other treatment outcomes was better in:
  • patients with no heavy physical demands: adjusted MD, 6.0 (95% CI, 1.0-11.0; P=.019); and
  • those with medications for LBP: adjusted MD, −4.8 (95% CI, −8.7 to –0.9; P=.016).

Limitations

• The study may have missed some nonlinear relationships.

Coauthored with Chitra Ravi, MPharm