Exercise therapy for treatment of non-specific low back pain

 

Characteristics of included studies [ordered by study ID]

Alexandre 2001

---

Methods	See Comparisons and Data Table 05: Methodological Quality of Included Studies for detailed information.
Participants	Chronic population; Occupational; N=33
Interventions	‡E1. Multiple components: exercise, plus home exercises; Time :24; Deliv:Group; Other:Advice to stay active/ education; C1. No treatment
Outcomes	§Pain (VAS/10)
Notes	See footnote for explanation of symbols, terms and abbreviations
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B - Unclear

---

Aure (ex2)

---

Methods
Participants
Interventions
Outcomes
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	D - Not used

---

Aure 2003

---

Methods	See Comparisons and Data Table 05:
Participants	Chronic population; Occupational; N=49
Interventions	E1. Stretching exercises (2/3); passive manipulation (1/3); Time:10; Deliv:Individual; independent; Other:Manual therapy; analgesics/NSAIDS; E2. Individually designed: strengthening, stretching, mobilizing, coordination, stabilizing exercises for abdominal, back, pelvic, lower limb; equipment; Time:10; Deliv:Individual; independent; Other:Analgesics/NSAIDS;
Outcomes	Pain (VAS), function (Osw), RTW
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A - Adequate

---

Bendix_a (ex2)

---

Methods
Participants
Interventions
Outcomes
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	D - Not used

---

Bendix_a 2000

---

Methods	See Comparisons and Data Table 05:
Participants	Chronic population; Occupational; N=138
Interventions	E1. Aerobics and strengthening (machines); Time:36; Deliv:Group; Other:None; E2. Functional restoration; comprehensive multidisciplinary approach including aerobics, strengthening, stretching; Time:36; Deliv:Group; Other:Behavioural therapy; backschool;
Outcomes	Pain (NRS), function (MRS), RTW, global
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B - Unclear

---

Bendix_b (ex2)

---

Methods
Participants
Interventions
Outcomes
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	D - Not used

---

Bendix_b 1995

---

Methods	See Comparisons and Data Table 05:
Participants	Chronic population; Secondary or tertiary care (referred); N=106
Interventions	E1. Functional restoration; comprehensive multidisciplinary approach including aerobics, strengthening, stretching; Time:24; Deliv:Group; Other:Behavioural therapy; backschool; E2. Aerobics and strengthening ; Time:24; Deliv:Group; Other:Backschool; C1. Other conservative
Outcomes	Pain (VAS/10), function (ADL/30), RTW
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B - Unclear

---

Bentsen (ex2)

---

Methods
Participants
Interventions
Outcomes
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	D - Not used

---

Bentsen 1997

---

Methods	See Comparisons and Data Table 05:
Participants	Chronic population; General population; N=74
Interventions	E1. Dynamic strength back exercises: at gym and home; Time:21.8; Deliv:Individual; independent; Other:None; E2. Home exercises; Time:21.8; Deliv:Independent only; Other:None;
Outcomes	Function (Million), RTW
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A - Adequate

---

Bronfort (ex2)

---

Methods
Participants
Interventions
Outcomes
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	D - Not used

---

Bronfort 1996

---

Methods	See Comparisons and Data Table 05:
Participants	Chronic population; General population; N=103
Interventions	E1. Dynamic trunk (Manniche) and abdominal strengthening; Time:20; Deliv:Individual; Other:Manual therapy; E2. Same exercise plus NSAIDS; Time:20; Deliv:Individual; Other:Analgesics/NSAIDS; C1. Other conservative
Outcomes	Pain (VAS/10), function (RMDQ)
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A - Adequate

---

Buswell (ex2)

---

Methods
Participants
Interventions
Outcomes
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	D - Not used

---

Buswell 1982

---

Methods	See Comparisons and Data Table 05:
Participants	Chronic population; Primary care; N=50
Interventions	E1. Extension exercise program (cites McKenzie); Time:11; Deliv:Individual; Other:Manual therapy; advice to stay active/ education; E2. Flexion program (mobilizing exercises plus posture); Time:11; Deliv:Individual; Other:Manual therapy; advice to stay active/ education;
Outcomes	Pain (unknown measure)
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B - Unclear

---

Calmels (ex2)

---

Methods
Participants
Interventions
Outcomes
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	D - Not used

---

Calmels 2004

---

Methods	See Comparisons and Data Table 05:
Participants	Chronic population; Secondary or tertiary care (referred); N=17
Interventions	E1. Isokinetic strengthening exercises (Cybex machines); Time:4.5; Deliv:Individual; Other:Manual therapy; E2. Physiotherapy exercises: series of three groups of exercises (whole body); Time:4.5; Deliv:Individual; Other:None;
Outcomes	Pain (VAS), function (QDI)
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B - Unclear

---

Cherkin 1998

---

Methods	See Comparisons and Data Table 05:
Participants	Subacute population; Secondary or tertiary care (referred); N=321
Interventions	E1. McKenzie exercise program (trained physiotherapists, centralize symptoms); Time:7.3; Deliv:Individual; Other:Advice to stay active/ education; C1. No treatment; C2. Other conservative
Outcomes	Pain (VAS/10), function (RMDQ /23), RTW
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A - Adequate

---

Chok 1999

---

Methods	See Comparisons and Data Table 05:
Participants	Acute population; Secondary or tertiary care (referred); N=54
Interventions	E1. Extensor endurance program: aerobics, stretching, strengthening; Time:13.5; Deliv:Individual; Other:Advice to stay active/ education; passive modality; C1. No treatment
Outcomes	Pain (VAS), function (RMDQ)
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B - Unclear

---

Dalichau (ex2)

---

Methods
Participants
Interventions
Outcomes
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	D - Not used

---

Dalichau 2000

---

Methods	See Comparisons and Data Table 05:
Participants	Chronic population; Secondary or tertiary care (referred); N=63
Interventions	E1. Strengthening: warm up aerobic exercises, 60 min equipment training (total body); Time:12; Deliv:Individual; Other:Lumbar support; E2. Same as above with no lumbar support during exercises; Time:12; Deliv:Individual; Other:None; C1. No treatment
Outcomes	Pain (VAS/10), function (Osw)
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B - Unclear

---

Davies (ex2)

---

Methods
Participants
Interventions
Outcomes
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	D - Not used

---

Davies 1979

---

Methods	See Comparisons and Data Table 05:
Participants	Subacute population; Primary care; N=43
Interventions	E1. Extension exercises (‘prone, raising trunk’ – described as back muscle strengthening); Time:9.6; Deliv:Individual; Other:Passive modality; E2. Flexion exercises (described as ‘mobilizing’) ; Time:9.6; Deliv:Individual; Other:Passive modality; C1. Other conservative
Outcomes	Pain (VAS), RTW, global
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B - Unclear

---

Delitto (ex2)

---

Methods
Participants
Interventions
Outcomes
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	D - Not used

---

Delitto 1993

---

Methods	See Comparisons and Data Table 05:
Participants	Acute population; Secondary or tertiary care (referred); N=24
Interventions	E1. Williams flexion exercise regimen with home exercises; Time:7.3; Deliv:Individual; Other:Manual therapy; E2. McKenzie regimen plus long-lever manipulation; Time:7.3; Deliv:Individual; Other:Manual therapy;
Outcomes	Function (Osw)
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B - Unclear

---

Descarreaux (ex2)

---

Methods
Participants
Interventions
Outcomes
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	D - Not used

---

Descarreaux 2002

---

Methods	See Comparisons and Data Table 05:
Participants	Chronic population; General population; N=20
Interventions	E1. Standard stretching/ strengthening program; Time:18.3; Deliv:Independent; Other:None; E2. Force, extensibility exercises of trunk and hip muscles based on initial evaluation; targeted increased ; Time:18.3; Deliv:Independent with FU; Other:None;
Outcomes	Pain (VAS), function (Osw)
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	High risk	C - Inadequate

---

Deyo 1990

---

Methods	See Comparisons and Data Table 05:
Participants	Chronic population; General population; N=125
Interventions	E1. 12 sequential relaxation and stretching exercises (improve flexibility) (home exercises with repeated instruction); exercises plus TENS; Time:10.6; Deliv:Independent with FU; Other:Advice to stay active/ education; passive modality; C1. Other conservative
Outcomes	Pain (VAS), function (SIP), global
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A - Adequate

---

Elnaggar (ex2)

---

Methods
Participants
Interventions
Outcomes
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	D - Not used

---

Elnaggar 1991

---

Methods	See Comparisons and Data Table 05:
Participants	Chronic population; Secondary or tertiary care (referred); N=56
Interventions	E1. Extension exercises (‘prone, raising trunk’ – described as back muscle strengthening); Time:7; Deliv:Independent with FU; Other:None; E2. Flexion exercises (described as ‘mobilizing’); Time:7; Deliv:Independent with FU; Other:None;
Outcomes	Pain (MPQ)
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A - Adequate

---

Faas 1993

---

Methods	See Comparisons and Data Table 05:
Participants	Acute population; Primary care; N=473
Interventions	E1. Eight exercises: ‘resting position’, side bending, stretching, isometric abdominal strengthening; Time:3.3; Deliv:Individual; Other:Advice to stay active/ education; analgesics/NSAIDS; C1. Sham treatment; C2. Usual GP care
Outcomes	Pain (VAS/85), function (LOM), RTW
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A - Adequate

---

Farrell 1982

---

Methods	See Comparisons and Data Table 05:
Participants	Acute population; Unclear; N=48
Interventions	E1. Isometric abdominal exercises, ergonomic advice, home abdominal exercises; Time:2.7; Deliv:Individual; independent; Other:Advice to stay active/ education; passive modality; C1. Other conservative
Outcomes	Pain (VAS/10), function (BU), global
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B - Unclear

---

Frost 1995

---

Methods	See Comparisons and Data Table 05:
Participants	Chronic population; Primary care; N=71
Interventions	E1. Warm-up, stretching, progressive exercises, light aerobic and advice, plus backschool; Time:8; Deliv:Group; Other:Advice to stay active/ education; backschool; C1. Other conservative
Outcomes	Pain (VAS), function (Osw)
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A - Adequate

---

Frost 2004

---

Methods	See Comparisons and Data Table 05:
Participants	Chronic population; Secondary or tertiary care (referred); N=286
Interventions	E1. Standard physiotherapy: 94% received exercises (stretching, strengthening, mobility exercises); Time:3.5; Deliv:Individual; Other:Manual therapy; advice to stay active/ education; C1. Other conservative
Outcomes	Function (Osw), global
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A - Adequate

---

Galantino 2004

---

Methods	See Comparisons and Data Table 05:
Participants	Chronic population; Mixed; N=22
Interventions	E1. Hatha yoga: sequence of postures that leads to a state of relaxation (strength, flexibility, balance); Time:19.5; Deliv:Group; independent; Other:None; C1. No treatment
Outcomes	Function (Osw)
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B - Unclear

---

Gilbert (ex2)

---

Methods
Participants
Interventions
Outcomes
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	D - Not used

---

Gilbert 1985

---

Methods	See Comparisons and Data Table 05:
Participants	Acute population; Primary care; N=187
Interventions	E1. Adapted Kendall’s flexion routine (home program), education plus analgesics; Time:4.8; Deliv:Independent; Other:Advice to stay active/ education; analgesics/NSAIDS; E2. Exercise, education plus bed rest four days; Time:4.8; Deliv:Independent; Other:Education; bed rest; C1. Usual GP care; C2. Other conservative
Outcomes	Pain (MPQ), function (ADS)
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B - Unclear

---

Gur (ex2)

---

Methods
Participants
Interventions
Outcomes
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	D - Not used

---

Gur 2003

---

Methods	See Comparisons and Data Table 05:
Participants	Chronic population; Secondary or tertiary care (referred); N=75
Interventions	E1. Stretching and strengthening exercises of lumbar and extremity muscle groups; Time:5; Deliv:Independent; Other:None; E2. Same exercises as above with additional intervention; Time:5; Deliv:Independent; Other:Low power laser therapy; C1. Other conservative
Outcomes	Pain (VAS/10), function (RMDQ)
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B - Unclear

---

Hansen 1993

---

Methods	See Comparisons and Data Table 05:
Participants	Chronic population; Mixed; N=180
Interventions	E1. Intensive dynamic back-muscle training: extension strengthening; Time:8; Deliv:Individual; Other:None; C1. Other conservative; C2. Other conservative
Outcomes	Pain (VAS/9), global
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A - Adequate

---

Hemmila 1997

---

Methods	See Comparisons and Data Table 05:
Participants	Chronic population; Mixed; N=114
Interventions	E1. Bending, rotation exercises; “auto-stretching when appropriate”; Time:13.8; Deliv:Independent; Other:None; C1. Other conservative; C2. Other conservative
Outcomes	Pain (VAS)
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A - Adequate

---

Hides 1996

---

Methods	See Comparisons and Data Table 05:
Participants	Acute population; Secondary or tertiary care (referred); N=41
Interventions	E1. Multifidus isometric retraining; Time:N/A; Deliv:N/A; Other:Advice to stay active/ education; analgesics/NSAIDS; C1. Usual GP care
Outcomes	Pain (VAS), function (RMDQ)
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A - Adequate

---

Hildebrandt 2000

---

Methods	See Comparisons and Data Table 05:
Participants	Chronic population; Primary care; N=222
Interventions	E1. Postural exercises (Cesar therapy); Time:10.5; Deliv:Individual; Other:None; C1. Usual GP care
Outcomes	Global
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A - Adequate

---

Johanssen (ex2)

---

Methods
Participants
Interventions
Outcomes
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	D - Not used

---

Johanssen 1995

---

Methods	See Comparisons and Data Table 05:
Participants	Chronic population; Secondary or tertiary care (referred); N=27
Interventions	E1. Aerobics, exercises emphasizing coordination, balance, stability, stretching; Time:24; Deliv:Group; Other:None; E2. Aerobics, dynamic exercises emphasizing muscle endurance: abdominal, shoulder, hip muscles stretching; Time:24; Deliv:Group; Other:None;
Outcomes	Pain (Likert/9), function (ADL/12), RTW
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B - Unclear

---

Jousset (ex2)

---

Methods
Participants
Interventions
Outcomes
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	D - Not used

---

Jousset 2004

---

Methods	See Comparisons and Data Table 05:
Participants	Chronic population; Occupational; N=85
Interventions	E1. Functional restoration; Time:150; Deliv:Group; Other:None; E2. Active individual therapy (strengthening, stretching, aerobics recommended); Time:19; Deliv:Individual; independent; Other:Advice to stay active/ education;
Outcomes	Pain (VAS/10), function (QDI), RTW
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B - Unclear

---

Kankaanpaa 1999

---

Methods	See Comparisons and Data Table 05:
Participants	Chronic population; Occupational; N=54
Interventions	E1. Strengthening (machines) with stretching, coordination; David Beck Clinic program (functional restoration); Time:36; Deliv:Group; Other:Behavioural therapy; advice to stay active/ education; C1. Other conservative
Outcomes	Pain (VAS), function (PDI)
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A - Adequate

---

Kendall (ex2)

---

Methods
Participants
Interventions
Outcomes
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	D - Not used

---

Kendall (ex3)

---

Methods
Participants
Interventions
Outcomes
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	D - Not used

---

Kendall 1968

---

Methods	See Comparisons and Data Table 05:
Participants	Chronic population; Primary care; N=42
Interventions	E1. Mobilizing, strengthening, posture; Time:7.9; Deliv:Independent; Other:Advice to stay active/ education; E2. Isometric flexion exercises: strengthening abdominal and trunk muscles (2 exercises); Time:7.9; Deliv:Independent; Other:Advice to stay active/ education; E3. Strengthening extension muscles, posture, lifting; Time:7.9; Deliv:Independent; Other:Advice to stay active/ education;
Outcomes	Global
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B - Unclear

---

Kuukkanen 2000

---

Methods	See Comparisons and Data Table 05:
Participants	Chronic population; Occupational; N=57
Interventions	E1. Strengthening, endurance, balance and coordination; Time:21; Deliv:Independent only; Other:None; C1. No treatment
Outcomes	Pain (VAS/11), function (Osw)
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B - Unclear

---

Lidström 1970

---

Methods	See Comparisons and Data Table 05:
Participants	Chronic population; Secondary or tertiary care (referred); N=62
Interventions	E1. Mobilizing (kneeling, and supine) and strengthening (isotonic abdom and back) exercises and home exercises; Time:4.8; Deliv:Individual; independent; Other:Passive modality; C1. Other conservative; C2. Other conservative
Outcomes	Global
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B - Unclear

---

Lie (ex2)

---

Methods
Participants
Interventions
Outcomes
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	D - Not used

---

Lie 1999

---

Methods	See Comparisons and Data Table 05:
Participants	Chronic population; Primary care; N=27
Interventions	E1. Mobilizing and stretching, walking in 'flexible way'; Time:15; Deliv:Group; independent; Other:None;
Outcomes	Global (COS), includes pain and function
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B - Unclear

---

Lindstrom 1992

---

Methods	See Comparisons and Data Table 05:
Participants	Subacute population; Occupational; N=103
Interventions	E1. Individually graded activity program (quota based): endurance, strengthening, aerobics; Time:133; Deliv:Individual; independent; Other:Advice to stay active/ education; backschool; C1. Usual GP care
Outcomes	Pain (VAS), RTW
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A - Adequate

---

Ljunggren (ex2)

---

Methods
Participants
Interventions
Outcomes
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	D - Not used

---

Ljunggren 1997

---

Methods	See Comparisons and Data Table 05:
Participants	Unclear population; Primary care; N=126
Interventions	E1. Terapi-Master device for general exercise: strengthening, stretching; Time:39; Deliv:Independent with FU; Other:None; E2. Conventional PT exercises: low-tech strengthening, stretching; Time:39; Deliv:Independent with FU; Other:None;
Outcomes	RTW
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A - Adequate

---

Malmivaara 1995

---

Methods	See Comparisons and Data Table 05:
Participants	Acute population; Occupational; N=186
Interventions	E1. Flexibility/mobilizing exercises: back extension, lateral bending movements; Time:10; Deliv:Independent; Other:Advice to stay active/ education; analgesics/ NSAIDS; C1. No treatment; C2. Other conservative
Outcomes	Pain (VAS/10), function (Osw), RTW
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A - Adequate

---

Manniche (ex2)

---

Methods
Participants
Interventions
Outcomes
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	D - Not used

---

Manniche (ex3)

---

Methods
Participants
Interventions
Outcomes
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	D - Not used

---

Manniche 1988

---

Methods	See Comparisons and Data Table 05:
Participants	Chronic population; Secondary or tertiary care (referred); N=105
Interventions	E1. Intensive strengthening: trunk, back strengthening routine; Time:45; Deliv:Individual; Other:None; E2. Back strengthening routine; similar to intensive less dose; Time:45; Deliv:Individual; Other:None; E3. Isometric exercises for L/S ; Time:45; Deliv:Individual; Other:Manual therapy; passive modality;
Outcomes	Pain (VAS/30), function (ADL/15)
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A - Adequate

---

Mannion (ex2)

---

Methods
Participants
Interventions
Outcomes
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	D - Not used

---

Mannion (ex3)

---

Methods
Participants
Interventions
Outcomes
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	D - Not used

---

Mannion 1999

---

Methods	See Comparisons and Data Table 05:
Participants	Chronic population; General population; N=148
Interventions	E1. Aerobics, stretching; Time:24; Deliv:Group; Other:None; E2. Controlled progressive exercises with machines; David Beck Clinic program (functional restoration); Time:24; Deliv:Group; Other:None; E3. Physiotherapy including exercises using Therabands and general strength training; Time:17.6; Deliv:Individual; Other:Ergonomic advice; passive modality;
Outcomes	Pain (VAS/10), function (RMDQ)
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A - Adequate

---

Moffett 1999

---

Methods	See Comparisons and Data Table 05:
Participants	Subacute population; Primary care; N=187
Interventions	E1. Aerobics, strengthening, stretching; Time:8; Deliv:Group; Other:Behavioural therapy; advice to stay active / education; C1. Usual GP care
Outcomes	Pain (APS), function (RMDQ), RTW
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A - Adequate

---

Moseley 2002

---

Methods	See Comparisons and Data Table 05:
Participants	Chronic population; Primary care; N=57
Interventions	E1. Specific trunk muscle training: individualized with home exercise program (Richardson&Jull); Time:12; Deliv:Individual; independent; Other:Manual therapy; advice to stay active/ education; C1. Usual GP care
Outcomes	Pain (NRS), function (RMDQ /18)
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A - Adequate

---

Niemisto 2003

---

Methods	See Comparisons and Data Table 05:
Participants	Chronic population; General population; N=204
Interventions	E1. Stablizing exercises aiming to correct lumbopelvic rhythm'; Time:4; Deliv:Individual; independent; Other:Manual therapy; advice to stay active/ education; C1. Usual GP care
Outcomes	Pain (VAS), function (Osw), RTW
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A - Adequate

---

Petersen (ex2)

---

Methods
Participants
Interventions
Outcomes
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	D - Not used

---

Petersen 2002

---

Methods	See Comparisons and Data Table 05:
Participants	Chronic population; Secondary or tertiary care (referred); N=260
Interventions	E1. Strengthening training: stationary bike, intensive dynamic back strengthening in flexion and extension; Time:6.9; Deliv:Group; Other:None; E2. McKenzie therapy; Time:6.9; Deliv:Individual; Other:None;
Outcomes	Pain (VAS/60), function (MRS), RTW, global
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A - Adequate

---

Preyde (ex2)

---

Methods
Participants
Interventions
Outcomes
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	D - Not used

---

Preyde 2000

---

Methods	See Comparisons and Data Table 05:
Participants	Chronic population; Mixed; N=98
Interventions	E1. Stretching, flexion/extension, 'general strengthening or mobility'; Time:2; Deliv:Individual; Other:Manual therapy; E2. Comprehensive massage (massage + exercises); Time:2; Deliv:Individual; Other:Advice to stay active/ education; C1. Sham treatment; C2. Other conservative
Outcomes	Pain (PPI), function (RMDQ)
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	High risk	C - Inadequate

---

Rasmussen-Barr 2003

---

Methods	See Comparisons and Data Table 05:
Participants	Chronic population; Primary care; N=47
Interventions	E1. Stablizing exercises: activation and control deep abdominal, multifidus muscles; Time:7; Deliv:Individual; independent with follow-up; Other:Advice to stay active/ education; C1. Other conservative
Outcomes	Pain (VAS), function (Osw)
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B - Unclear

---

Risch 1993

---

Methods	See Comparisons and Data Table 05:
Participants	Chronic population; Secondary or tertiary care (referred); N=54
Interventions	E1. Dynamic extension strengthening program (machine); Time:11.4; Deliv:Individual; Other:None; C1. No treatment
Outcomes	Pain (WHY), function (SIP)
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	High risk	C - Inadequate

---

Rittweger (ex2)

---

Methods
Participants
Interventions
Outcomes
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	D - Not used

---

Rittweger 2002

---

Methods	See Comparisons and Data Table 05:
Participants	Chronic population; General population; N=60
Interventions	E1. Lumbar extension, repetitive contraction cycles, constant speed, load gradually increased; resistance exercise of the abdominal and thigh muscles ; Time:3; Deliv:Individual; Other:None; E2. Specific exercise: "platform that oscillates around a resting axis between the subjects feet ... during exercise units, the subject performed slow movements of the hip and waist, with bending in the sagittal and frontal planes and rotation in the horizontal plane"; Time:3; Deliv:Individual; Other:None;
Outcomes	Pain (VAS), function (VAS /70)
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A - Adequate

---

Seferlis 1998

---

Methods	See Comparisons and Data Table 05:
Participants	Acute population; Occupational; N=180
Interventions	E1. Intensive training program: information, muscle training and general conditioning; Time:130.5; Deliv:Group; Other:Advice to stay active/ education; C1. Other conservative; C2. Usual GP care
Outcomes	Pain (VAS/10), function (Osw), RTW
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B - Unclear

---

Soukup (ex2)

---

Methods
Participants
Interventions
Outcomes
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	D - Not used

---

Soukup 1999

---

Methods	See Comparisons and Data Table 05:
Participants	Chronic population; Mixed; N=120
Interventions	E1. Mensendiek exercise: aerobic, stretching, strength, coordination and ergonomic education; Time:20; Deliv:Group; Other:None; E2. Active Back School 30 min exercise session; Time:20; Deliv:Group; Other:Backschool; C1. No treatment
Outcomes	Pain (VAS), function (VAS)
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A - Adequate

---

Staal 2004

---

Methods	See Comparisons and Data Table 05:
Participants	Subacute population; Occupational; N=134
Interventions	E1. Graded activity program; Time:13; Deliv:Individual; Other:Advice to stay active/ education; C1. Usual GP care
Outcomes	Pain (NRS/10), function (RMDQ), RTW
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A - Adequate

---

Stankovic 1990

---

Methods	See Comparisons and Data Table 05:
Participants	Acute population; Unclear; N=100
Interventions	E1. McKenzie analysis and exercises; Time:2; Deliv:Individual; independent; Other:Advice to stay active/ education; C1. No treatment
Outcomes	Pain (VAS), RTW
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A - Adequate

---

Storheim 2003

---

Methods	See Comparisons and Data Table 05:
Participants	Subacute population; Occupational; N=93
Interventions	E1. Intensive training program: aerobic, strength, flexibility; Time:31; Deliv:Group; Other:None; C1. Other conservative; C2. Usual GP care
Outcomes	Pain (VAS), function (RMDQ), RTW
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A - Adequate

---

Torstensen (ex2)

---

Methods
Participants
Interventions
Outcomes
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	D - Not used

---

Torstensen 1998

---

Methods	See Comparisons and Data Table 05:
Participants	Chronic population; Occupational; N=208
Interventions	E1. Ordinary activity level: walking exercise program; Time:36; Deliv:Independent; Other:None; E2. MET (medical exercise therapy): mobilizing and strengthening with special equipment; aerobic exercise warm-up; Time:36; Deliv:Group; Other:None; C1. Other conservative
Outcomes	Pain (VAS), function (Osw), RTW
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A - Adequate

---

Tritilanunt (ex2)

---

Methods
Participants
Interventions
Outcomes
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	D - Not used

---

Tritilanunt 2001

---

Methods	See Comparisons and Data Table 05:
Participants	Chronic population; Secondary or tertiary care (referred); N=72
Interventions	E1. Aerobic exercises; Time:N/A; Deliv:N/A; Other:Advice to stay active/ education; E2. Flexion exercises, posture and behavioural; Time:N/A; Deliv:N/A; Other:Advice to stay active/ education;
Outcomes	Pain (VAS)
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B - Unclear

---

Turner (ex2)

---

Methods
Participants
Interventions
Outcomes
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	D - Not used

---

Turner 1990

---

Methods	See Comparisons and Data Table 05:
Participants	Chronic population; Mixed; N=96
Interventions	E1. Increasing aerobic fitness (fast walking, slow jogging); warm-up, cool-down stretching; Time:16; Deliv:Group; Other:None; E2. Behavioural/ exercise: same as exercise plus behavioral therapy (with spousal participation); Time:16; Deliv:Group; Other:Behavioural therapy; C1. No treatment; C2. Other conservative
Outcomes	Pain (MPQ), function (SIP)
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A - Adequate

---

Underwood 1998

---

Methods	See Comparisons and Data Table 05:
Participants	Acute population; Primary care; N=75
Interventions	E1. Education regarding McKenzie principles, teaching extension exercises plus general advice; Time:1.8; Deliv:Group; Other:Advice to stay active/ education; analgesics/ NSAIDS; C1. Usual GP care
Outcomes	Pain (VAS), function (Osw), RTW, global
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A - Adequate

---

Waterworth 1985

---

Methods	See Comparisons and Data Table 05:
Participants	Acute population; Primary care; N=108
Interventions	E1. Conservative physiotherapy including active flexion and extension exercises; Time:6.3; Deliv:Individual; Other:Advice to stay active/ education; C1. Other conservative; C2. Other conservative
Outcomes	Pain (Likert/4), global
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	High risk	C - Inadequate

---

Yelland 2004

---

Methods	See Comparisons and Data Table 05:
Participants	Chronic population; Mixed; N=110
Interventions	E1. Sagittal loading flexibility/ mobilizing exercises; Time:12; Deliv:Independent; Other:Passive modality; C1. Other conservative
Outcomes	Pain (VAS), function (RMDQ/23)
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A - Adequate

---

Yeung (ex2)

---

Methods
Participants
Interventions
Outcomes
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	D - Not used

---

Yeung 2003

---

Methods	See Comparisons and Data Table 05:
Participants	Chronic population; Primary care; N=52
Interventions	E1. Stretching, mobilizing, strengthening exercises; Time:7.5; Deliv:Group; independent; Other:Advice to stay active/ education; E2. Stretching, mobilizing, strengthening exercises plus electro-acupuncture; Time:7.5; Deliv:Group; independent; Other:Passive modality; advice to stay active/ education;
Outcomes	Pain (NRS/10), function (VAS)
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Low risk	A - Adequate

---

Yozbatiran (ex2)

---

Methods
Participants
Interventions
Outcomes
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	D - Not used

---

Yozbatiran 2004

---

Methods	See Comparisons and Data Table 05:
Participants	Chronic population; Secondary or tertiary care (referred); N=30
Interventions	E1. Warm-up, stretching, progressive exercises, light aerobics on land; Time:8; Deliv:Group; Other:None; E2. Warm-up, stretching, progressive exercises, light aerobics in water; Time:8; Deliv:Group; Other:None;
Outcomes	Pain (VAS/10), function (Osw)
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B - Unclear

---

Zylbergold 1981

---

Methods	See Comparisons and Data Table 05:
Participants	Chronic population; Primary care; N=28
Interventions	E1. Flexion exercises; Time:3.5; Deliv:Individual; Other:Passive modality; C1. No treatment; C2. Other conservative
Outcomes	Pain (Likert/5), function (Likert/5)
Notes
Risk of bias
Bias	Authors' judgement	Support for judgement
Allocation concealment?	Unclear risk	B - Unclear

---

 ‡ E=exercise group(s); C=comparison group(s); description of the exercise programs: Time is intervention time (in hours), calculated as 'best estimate' when a home exercise program was employed and study compliance information was not available (see text); Deliv describes the format in which the program was delivered; Other describes any interventions included in the treatment program in addition to exercise.
§ VAS=Visual analogue scale (unless otherwise noted, /100); RMDQ=Roland Morris Disability Questionnaire (unless otherwise noted /24); Osw=Oswestry Disability Questionnaire (/100); LOM=Loss of Mobility Dimension (/100); BU= Berquist-Ullman functional limitations; MPQ=McGill Pain Questionnaire (/78); ADS=Activity Discomfort Scale; APS=Aberdeen Pain Scale (/100); NRS=Numerical Rating Scale (11 point); MRS= Manniche's low back pain rating scale (/100); ADL=Activities of Daily Living scale; SIP=Sickness Impact Factor - physical (/100); COS=Clinical Overall Score (/1000); PPI=PPI of McGill Pain Questionnaire (/5); WHY=West Haven Yale questionnaire; OEP-VAS=Mean VAS of 13 pain-related questions.
Sensitivity analysis as 'Mixed' population

 

Characteristics of excluded studies [ordered by study ID]

---

Study	Reason for exclusion
Coxhead 1981	Patient population not meeting our inclusion criteria - specific cause of LBP, neurological symptoms
Danielsen 2000	Post-surgical patients
Danneels 2001	No primary outcome measures
Friedrich 1998	No clear contrast for exercise
Ghoname 1999	No clear contrast for exercise
Hagen 2000	Not true exercise therapy
Helewa 1999	Prevention study, no treatment information
Horneij 2001	Prevention study, no treatment information
Lang 2003	Not randomized
Little 2001	No true exercise therapy
Manniche 1993	Subjects with or without radiation after surgery for lumbar disc protrusion
Martin 1980	"Pseudorandom" allocation
Morton 1999	No clear contrast for exercise
Muller 2001	Prevention study; no treatment data available
Nwuga 1982	Acute LBP due to prolapsed intervertebral disc
Nwuga 1985	Acute LBP due to prolapsed intervertebral disc
O'Sullivan 1997	Chronic LBP with or without radiation, with radiologically confirmed spondylolysis or spondylolisthesis
Sachs 1994	Range of motion reported
Scrimshaw 2001	Post-surgical patients
Snook 1998	Not randomized: initial coin flip, followed by alternate assignments to treatment and control groups
Spratt 1993	There is no clear contrast for exercise in this study. The flexion treatment group received a flexion jacket and instructions for flexion exercises. The extension treatment group received a hyperextension brace and instructions for McKenzie-type extension exercises. The control group received a placebo brace.
Strand 2001	Not true exercise therapy
White 1966	Patient populations not meeting our inclusion criteria - specific cause for LBP including neurological symptoms, spondylolisthesis and spondylolysis

---

 

Comparison 1. Chronic populations

---

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

---

 1 Function measure (/100): Earliest follow-up

20

1710

Mean Difference (IV, Random, 95% CI)

-2.49 [-3.94, -1.04]

---

1.1 Exercise vs. No treatment/sham/placebo

7

337

Mean Difference (IV, Random, 95% CI)

-2.98 [-6.48, 0.53]

---

1.2 Exercise vs. Other conservative treatment

13

1373

Mean Difference (IV, Random, 95% CI)

-2.37 [-2.00, -0.74]

---

 2 Function measure (/100): Short-term follow-up (˜6 weeks post-randomization)

17

1370

Mean Difference (IV, Random, 95% CI)

-1.75 [-2.94, -0.56]

---

2.1 Exercise vs. No treatment/sham/placebo

6

268

Mean Difference (IV, Random, 95% CI)

-3.03 [-6.35, 0.28]

---

2.2 Exercise vs. Other conservative treatment

11

1102

Mean Difference (IV, Random, 95% CI)

-0.81 [-1.62, -0.00]

---

 3 Function measure (/100): Intermediate follow-up (˜6 months post-randomization)

15

1401

Mean Difference (IV, Random, 95% CI)

-4.64 [-5.00, -2.27]

---

3.1 Exercise vs. No treatment/sham/placebo

4

216

Mean Difference (IV, Random, 95% CI)

-3.84 [-7.06, -0.61]

---

3.2 Exercise vs. Other conservative treatment

11

1185

Mean Difference (IV, Random, 95% CI)

-5.07 [-7.91, -2.23]

---

 4 Function measure (/100): Long-term follow-up (˜12 months post-randomization)

11

1152

Mean Difference (IV, Random, 95% CI)

-4.31 [-7.41, -1.20]

---

4.1 Exercise vs. No treatment/sham/placebo

2

126

Mean Difference (IV, Random, 95% CI)

-4.22 [-7.99, -0.46]

---

4.2 Exercise vs. Other conservative treatment

9

1026

Mean Difference (IV, Random, 95% CI)

-4.34 [-6.00, -0.69]

---

 5 Pain measure (/100): Earliest follow-up

23

1697

Mean Difference (IV, Random, 95% CI)

-7.29 [-10.91, -3.67]

---

5.1 Exercise vs. No treatment/sham/placebo

8

370

Mean Difference (IV, Random, 95% CI)

-10.20 [-19.09, -1.31]

---

5.2 Exercise vs. Other conservative treatment

15

1327

Mean Difference (IV, Random, 95% CI)

-5.93 [-9.65, -2.21]

---

 6 Pain measure (/100): Short-term follow-up (˜6 weeks post-randomization)

19

1324

Mean Difference (IV, Random, 95% CI)

-5.64 [-9.02, -2.26]

---

6.1 Exercise vs. No treatment/sham/placebo

6

268

Mean Difference (IV, Random, 95% CI)

-8.58 [-18.46, 1.29]

---

6.2 Exercise vs. Other conservative treatment

13

1056

Mean Difference (IV, Random, 95% CI)

-4.47 [-7.41, -1.53]

---

 7 Pain measure (/100): Intermediate follow-up (˜6 months post-randomization)

16

1261

Mean Difference (IV, Random, 95% CI)

-8.42 [-12.98, -3.86]

---

7.1 Exercise vs. No treatment/sham/placebo

5

249

Mean Difference (IV, Random, 95% CI)

-12.48 [-22.69, -2.27]

---

7.2 Exercise vs. Other conservative treatment

11

1012

Mean Difference (IV, Random, 95% CI)

-6.55 [-11.52, -1.57]

---

 8 Pain measure (/100): Long-term follow-up (˜12 months post-randomization)

11

1032

Mean Difference (IV, Random, 95% CI)

-6.97 [-12.69, -1.24]

---

8.1 Exercise vs. No treatment/sham/placebo

2

126

Mean Difference (IV, Random, 95% CI)

-3.93 [-9.89, 2.02]

---

8.2 Exercise vs. Other conservative treatment

9

906

Mean Difference (IV, Random, 95% CI)

-7.62 [-14.45, -0.79]

---

 

Comparison 2. Subacute populations

---

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

---

 1 Function measure (/100): Earliest follow-up

4

579

Mean Difference (IV, Random, 95% CI)

-1.07 [-5.32, 3.18]

---

1.1 Exercise vs. No treatment/sham/placebo

1

194

Mean Difference (IV, Random, 95% CI)

-3.48 [-9.19, 2.23]

---

1.2 Exercise vs. Other conservative treatment

3

385

Mean Difference (IV, Random, 95% CI)

-0.18 [-5.99, 5.63]

---

 2 Function measure (/100): Short-term follow-up (˜6 weeks post-randomization)

3

515

Mean Difference (IV, Random, 95% CI)

-0.31 [-4.22, 3.60]

---

2.1 Exercise vs. No treatment/sham/placebo

1

194

Mean Difference (IV, Random, 95% CI)

-3.48 [-6.22, -0.74]

---

2.2 Exercise vs. Other conservative treatment

2

321

Mean Difference (IV, Random, 95% CI)

1.26 [-1.87, 4.38]

---

 3 Function measure (/100): Intermediate follow-up (˜6 months post-randomization)

4

579

Mean Difference (IV, Random, 95% CI)

-1.11 [-3.00, 2.78]

---

3.1 Exercise vs. No treatment/sham/placebo

1

194

Mean Difference (IV, Random, 95% CI)

-0.86 [-7.26, 5.54]

---

3.2 Exercise vs. Other conservative treatment

3

385

Mean Difference (IV, Random, 95% CI)

-1.08 [-6.90, 4.74]

---

 4 Function measure (/100): Long-term follow-up (˜12 months post-randomization)

2

381

Mean Difference (IV, Random, 95% CI)

-4.60 [-11.34, 2.14]

---

4.1 Exercise vs. No treatment/sham/placebo

1

194

Mean Difference (IV, Random, 95% CI)

-8.27 [-13.89, -2.65]

---

4.2 Exercise vs. Other conservative treatment

1

187

Mean Difference (IV, Random, 95% CI)

-1.38 [-5.81, 3.05]

---

 5 Pain measure (/100): Earliest follow-up

5

608

Mean Difference (IV, Random, 95% CI)

-1.89 [-4.91, 1.13]

---

5.1 Exercise vs. No treatment/sham/placebo

1

194

Mean Difference (IV, Random, 95% CI)

-8.0 [-17.25, 1.25]

---

5.2 Exercise vs. Other conservative treatment

4

414

Mean Difference (IV, Random, 95% CI)

-1.21 [-4.01, 1.59]

---

 6 Pain measure (/100): Short-term follow-up (˜6 weeks post-randomization)

4

544

Mean Difference (IV, Random, 95% CI)

-2.46 [-6.91, 1.99]

---

6.1 Exercise vs. No treatment/sham/placebo

1

194

Mean Difference (IV, Random, 95% CI)

-8.0 [-10.93, -5.07]

---

6.2 Exercise vs. Other conservative treatment

3

350

Mean Difference (IV, Random, 95% CI)

-0.69 [-2.78, 1.41]

---

 7 Pain measure (/100): Intermediate follow-up (˜6 months post-randomization)

4

579

Mean Difference (IV, Random, 95% CI)

-1.95 [-6.48, 2.57]

---

7.1 Exercise vs. No treatment/sham/placebo

1

194

Mean Difference (IV, Random, 95% CI)

-5.0 [-14.16, 4.16]

---

7.2 Exercise vs. Other conservative treatment

3

385

Mean Difference (IV, Random, 95% CI)

-1.54 [-7.36, 4.27]

---

 8 Pain measure (/100): Long-term follow-up (˜12 months post-randomization)

2

381

Mean Difference (IV, Random, 95% CI)

-4.36 [-10.06, 1.35]

---

8.1 Exercise vs. No treatment/sham/placebo

1

194

Mean Difference (IV, Random, 95% CI)

-8.0 [-14.37, -1.63]

---

8.2 Exercise vs. Other conservative treatment

1

187

Mean Difference (IV, Random, 95% CI)

-2.03 [-5.24, 1.18]

---

 

Comparison 3. Acute populations

---

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

---

 1 Pain measure (/100): Earliest follow-up

10

1097

Mean Difference (IV, Random, 95% CI)

-0.03 [-1.40, 1.34]

---

1.1 Exercise vs. No treatment/sham/placebo

3

491

Mean Difference (IV, Random, 95% CI)

0.59 [-11.51, 12.69]

---

1.2 Exercise vs. Other conservative treatment

7

606

Mean Difference (IV, Random, 95% CI)

-0.31 [-0.72, 0.10]

---

 2 Pain measure (/100): Short-term follow-up (˜6 weeks post-randomization)

10

1097

Mean Difference (IV, Random, 95% CI)

-0.03 [-1.40, 1.34]

---

2.1 Exercise vs. No treatment/sham/placebo

3

491

Mean Difference (IV, Random, 95% CI)

0.59 [-11.51, 12.69]

---

2.2 Exercise vs. Other conservative treatment

7

606

Mean Difference (IV, Random, 95% CI)

-0.31 [-0.72, 0.10]

---

 3 Pain measure (/100): Intermediate follow-up (˜6 months post-randomization)

5

686

Mean Difference (IV, Random, 95% CI)

-0.44 [-5.11, 4.23]

---

3.1 Exercise vs. No treatment/sham/placebo

3

491

Mean Difference (IV, Random, 95% CI)

-1.39 [-9.54, 6.76]

---

3.2 Exercise vs. Other conservative treatment

2

195

Mean Difference (IV, Random, 95% CI)

-0.32 [-7.79, 7.15]

---

 4 Pain measure (/100): Long-term follow-up (˜12 months post-randomization)

3

513

Mean Difference (IV, Random, 95% CI)

-0.79 [-3.00, 3.41]

---

4.1 Exercise vs. No treatment/sham/placebo

1

318

Mean Difference (IV, Random, 95% CI)

-0.82 [-7.18, 5.54]

---

4.2 Exercise vs. Other conservative treatment

2

195

Mean Difference (IV, Random, 95% CI)

-0.77 [-6.38, 4.84]

---

 5 Function measure (/100): Earliest follow-up

9

1025

Mean Difference (IV, Random, 95% CI)

-1.38 [-5.56, 2.79]

---

5.1 Exercise vs. No treatment/sham/placebo

3

491

Mean Difference (IV, Random, 95% CI)

-2.82 [-15.35, 9.71]

---

5.2 Exercise vs. Other conservative treatment

6

534

Mean Difference (IV, Random, 95% CI)

-1.34 [-5.50, 2.81]

---

 6 Function measure (/100): Short-term follow-up (˜6 weeks post-randomization)

9

1025

Mean Difference (IV, Random, 95% CI)

-1.38 [-5.56, 2.79]

---

6.1 Exercise vs. No treatment/sham/placebo

3

491

Mean Difference (IV, Random, 95% CI)

-2.82 [-15.35, 9.71]

---

6.2 Exercise vs. Other conservative treatment

6

534

Mean Difference (IV, Random, 95% CI)

-1.34 [-5.50, 2.81]

---

 7 Function measure (/100): Intermediate follow-up (˜6 months post-randomization)

5

684

Mean Difference (IV, Random, 95% CI)

1.52 [-0.72, 3.76]

---

7.1 Exercise vs. No treatment/sham/placebo

3

489

Mean Difference (IV, Random, 95% CI)

2.47 [-0.26, 5.21]

---

7.2 Exercise vs. Other conservative treatment

2

195

Mean Difference (IV, Random, 95% CI)

-0.41 [-4.30, 3.49]

---

 8 Function measure (/100): Long-term follow-up (˜12 months post-randomization)

3

511

Mean Difference (IV, Random, 95% CI)

0.57 [-2.17, 3.31]

---

8.1 Exercise vs. No treatment/sham/placebo

1

316

Mean Difference (IV, Random, 95% CI)

2.0 [-2.19, 6.19]

---

8.2 Exercise vs. Other conservative treatment

2

195

Mean Difference (IV, Random, 95% CI)

-0.51 [-4.13, 3.12]

---

 

Comparison 4. POPULATION SOURCE: Chronic populations (Exploratory analysis)

---

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

---

 1 Function measure (/100); Earliest follow-up: Indirect comparisons

21

Mean Difference (IV, Random, 95% CI)

Subtotals only

---

1.1 Health care population

8

645

Mean Difference (IV, Random, 95% CI)

-6.94 [-11.67, -2.22]

---

1.2 Occupational population

3

249

Mean Difference (IV, Random, 95% CI)

-0.98 [-3.72, 1.75]

---

1.3 General population or mixed population source

10

914

Mean Difference (IV, Random, 95% CI)

-1.39 [-2.73, -0.05]

---

 2 Pain measure (/100); Earliest follow-up: Indirect comparisons

23

Mean Difference (IV, Random, 95% CI)

Subtotals only

---

2.1 Health care population (primary or secondary care)

8

416

Mean Difference (IV, Random, 95% CI)

-13.33 [-21.13, -5.53]

---

2.2 Occupational population

4

282

Mean Difference (IV, Random, 95% CI)

-9.21 [-22.93, 4.52]

---

2.3 General population or mixed population source

11

999

Mean Difference (IV, Random, 95% CI)

-3.37 [-6.61, -0.13]

---

 

Comparison 5. Methodological Quality of Included Studies

---

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 criteria met			Other data	No numeric data

---

 

Analysis 5.1 Comparison 5 Methodological Quality of Included Studies, Outcome 1 criteria met.
criteria met

---

Study	randomization OK	allocation concealed	adequate follow-up	outcome assess blind
Alexandre 2001	unclear	unclear	yes	unclear
Aure 2003	yes	yes	yes	no
Bendix_a 2000	unclear	unclear	no	no
Bendix_b 1995	yes	unclear	no	no
Bentsen 1997	yes	yes	yes	no
Bronfort 1996	yes	yes	no	yes
Buswell 1982	no	unclear	no	no
Calmels 2004	unclear	unclear	yes	no
Cherkin 1998	yes	yes	yes	no
Chok 1999	yes	unclear	yes	no
Dalichau 2000	unclear	unclear	yes	no
Davies 1979	no	unclear	yes	yes
Delitto 1993	no	unclear	unclear	no
Descarreaux 2002	yes	no	yes	no
Deyo 1990	yes	yes	yes	yes
Elnaggar 1991	yes	yes	no	yes
Faas 1993	no	unclear	yes	yes
Farrell 1982	no	unclear	yes	yes
Frost 1995	yes	yes	yes	yes
Frost 2004	yes	yes	no	no
Galantino 2004	yes	unclear	no	no
Gilbert 1985	no	unclear	yes	no
Gur 2003	unclear	unclear	yes	no
Hansen 1993	yes	yes	yes	yes
Hemmila 1997	no	yes	yes	yes
Hides 1996	yes	yes	yes	no
Hildebrandt 2000	yes	yes	no	no
Johanssen 1995	no	unclear	no	no
Jousset 2004	yes	unclear	yes	no
Kankaanpaa 1999	yes	yes	yes	no
Kendall 1968	no	unclear	yes	no
Kuukkanen 2000	unclear	unclear	yes	no
Lidström 1970	no	unclear	yes	unclear
Lie 1999	yes	unclear	no	yes
Lindstrom 1992	yes	yes	yes	yes
Ljunggren 1997	yes	yes	yes	no
Malmivaara 1995	yes	yes	yes	yes
Manniche 1988	yes	yes	yes	yes
Mannion 1999	yes	yes	yes	yes
Moffett 1999	yes	yes	yes	no
Moseley 2002	yes	yes	no	no
Niemisto 2003	yes	yes	yes	no
Petersen 2002	yes	yes	no	yes
Preyde 2000	yes	no	yes	yes
Rasmussen-Barr 2003	unclear	unclear	no	no
Risch 1993	no	no	yes	no
Rittweger 2002	yes	yes	yes	no
Seferlis 1998	no	unclear	no	yes
Soukup 1999	yes	yes	yes	no
Staal 2004	yes	yes	yes	no
Stankovic 1990	yes	yes	yes	unclear
Storheim 2003	yes	yes	no	no
Torstensen 1998	yes	yes	yes	yes
Tritilanunt 2001	yes	unclear	yes	no
Turner 1990	yes	yes	no	no
Underwood 1998	yes	yes	yes	yes
Waterworth 1985	no	no	yes	no
Yelland 2004	yes	yes	yes	no
Yeung 2003	unclear	yes	yes	no
Yozbatiran 2004	unclear	unclear	yes	no
Zylbergold 1981	no	unclear	yes	no

---

 

Table 1. Summary of Included Studies

---

Characteristic	All Studies (n=61)	Acute (n=11)	Subacute (n=6)	Chronic (n=43)
Population source:
- Healthcare	33 (54)	7 (78)	3 (50)	22 (51)
- Occupational	12 (20)	2 (22)	3 (50)	7 (16)
- General Population	7 (11)	0	0	7 (16)
- Mixed	7 (11)	0	0	7 (16)
Age of study population: Mean years (95% CI)	41 (39 to 42)	38 (35 to 40)	38 (32 to 44)	42 (40 to 44)
% Male of study population	0.49 (0.45, 0.55)	0.56 (0.46, 0.66)	0.63 (0.42, 0.84)	0.46 (0.39, 0.52)
Observed duration of low back pain: Mean (95% CI)	4.5 years (2.6 to 6.3)	8 days (5 to 11)	12 weeks (n/a)	5.6 years (3.4 to 7.8)
Observed severity of pain at baseline: Mean /100 (95% CI)	47 (43, 51)	45 (36, 53)	56 (33, 78)	46 (41, 50)
Outcome measures assessed:
- Pain	52 (85)	10 (91)	6 (100)	36 (84)
- Functional abilities	46 (75)	9 (82)	4 (67)	33 (77)
- Work status	21 (34)	5 (45)	6 (100)	9 (21)
- Global assessment	13 (21)	3 (27)	1 (17)	7 (16)
Cost evaluation information presented	8 (13)	2 (18)	2 (33)	4 (9)
Adverse effects assessed:
Any reported	14 (23)	2 (18)	2 (33)	10 (23)
Negative reported	10 (16)	2 (18)	1 (17)	7 (16)
Study quality: Studies satisfying key items
All 4	8 (13)	1 (9)	1 (17)	6 (14)
Any 3	18 (30)	4 (36)	3 (50)	10 (23)
Any 2	15 (25)	2 (18)	2 (33)	11 (26)
Any 1	15 (25)	3 (27)	0	12 (28)
None	5 (8)	1 (9)	0	4 (9)
* Study populations were classified according to most appropriate category based on inclusion criteria and reported duration. Thirteen studies included subjects with mixed duration of low back pain.

---