Exercise treatment effect modifiers in persistent low back pain: an individual participant data meta-analysis of 3514 participants from 27 randomised controlled trials
Year: 2019
Type: review
Study designs: Systematic Review, Meta-Analysis
Abstract: BACKGROUND: Low back pain is one of the leading causes of disability worldwide. Exercise therapy is widely recommended to treat persistent non-specific low back pain. While evidence suggests exercise is, on average, moderately effective, there remains uncertainty about which individuals might benefit the most from exercise. METHODS: In parallel with a Cochrane review update, we requested individual participant data (IPD) from high-quality randomised clinical trials of adults with our two primary outcomes of interest, pain and functional limitations, and calculated global recovery. We compiled a master data set including baseline participant characteristics, exercise and comparison characteristics, and outcomes at short-term, moderate-term and long-term follow-up. We conducted descriptive analyses and one-stage IPD meta-analysis using multilevel mixed-effects regression of the overall treatment effect and prespecified potential treatment effect modifiers. RESULTS: We received IPD for 27 trials (3514 participants). For studies included in this analysis, compared with no treatment/usual care, exercise therapy on average reduced pain (mean effect/100 (95% CI) -10.7 (-14.1 to -7.4)), a result compatible with a clinically important 20% smallest worthwhile effect. Exercise therapy reduced functional limitations with a clinically important 23% improvement (mean effect/100 (95% CI) -10.2 (-13.2 to -7.3)) at short-term follow-up. Not having heavy physical demands at work and medication use for low back pain were potential treatment effect modifiers-these were associated with superior exercise outcomes relative to non-exercise comparisons. Lower body mass index was also associated with better outcomes in exercise compared with no treatment/usual care. This study was limited by inconsistent availability and measurement of participant characteristics. CONCLUSIONS: This study provides potentially useful information to help treat patients and design future studies of exercise interventions that are better matched to specific subgroups. PROTOCOL PUBLICATION: https://doi.org/10.1186/2046-4053-1-64.
Authors: Jill A Hayden, Maria N Wilson, Samuel Stewart, Jennifer L Cartwright, Andrea O Smith, Richard D Riley, Maurits van Tulder, Tom Bendix, Francesca Cecchi, Leonardo O P Costa, Ninna Dufour, Manuela L Ferreira, Nadine E Foster, Maruti R Gudavalli, Jan Hartvigsen, Pieter Helmhout, Jan Kool, George A Koumantakis, Francisco M Kovacs, Tiina Kuukkanen, Audrey Long, Luciana G Macedo, Luciana A C Machado, Chris G Maher, Wolf Mehling, Giovanni Morone, Tom Peterson, Eva Rasmussen-Barr, Cormac G Ryan, Tuulikki Sjögren, Rob Smeets, J Bart Staal, Monica Unsgaard-Tøndel, Henry Wajswelner, Ella W Yeung
Institutions: Dalhousie University, Keele University, Vrije Universiteit Amsterdam, University of Copenhagen, Rigshospitalet, Don Carlo Gnocchi Foundation, Universidade Cidade de São Paulo, The University of Sydney, Arthritis UK, Keiser University, University of Southern Denmark, Nordisk Institut for Kiropraktik og Klinisk Biomekanik, Valens Clinics, Manchester Royal Infirmary, University of Manchester, JAMK University of Applied Sciences, McMaster University, Universidade Federal de Minas Gerais, Institute for Musculoskeletal Health, University of California, San Francisco, Fondazione Santa Lucia, Karolinska Institutet, Teesside University, University of Jyväskylä, Maastricht University, Care and Public Health Research Institute, Radboud University Medical Center, Radboud Institute for Health Sciences, Norwegian University of Science and Technology, La Trobe University, Hong Kong Polytechnic University
Language: English
Field: Health Professions
Domain: Health Sciences
Open Access status: bronze
OpenAlex ID: W2991244705