Characteristics of included studies [ordered by study ID]
Cherkin 1998
|
| Methods | Randomised, controlled, concealed allocation, and intention-to-treat basis. No blinding. |
|
| | Participants | Adults with LBP for 7 days.
Total participants eligible for the study was 323. After excluding 2 participants, the further intervention and analysis were performed on the following distribution:
Booklet group, N = 66;
Chiropractic group, N = 122;
Physical therapy group, N = 133;
Inclusion criteria: all who did not meet exclusion criteria.
Exclusion criteria: mild or no pain 7 days after the visit to the physician, history of back surgery, sciatica, or severe concurrent illnesses.
169 men and 154 women, mean age 41 years in exercise group, 40 years in both Chiropractic manipulation group and control group. |
|
| | Interventions | Exercise group: Subjects received McKenzie exercise class by physiotherapists within four days after randomisation for first visit and up to eight more visits. Patients received a self-learning book and a lumbar cushion.
Chiropractic manipulation group: Subjects received chiropractic manipulation by chiropractors within four days after randomisation for first visit and up to eight more visits. Chiropractors could suggest exercises and activity restriction as their usual practices.
Minimal-intervention control group: Subjects received an educational booklet only. |
|
| | Outcomes | |
|
| | Notes | |
|
| | Risk of bias |
| | Bias | Authors' judgement | Support for judgement |
| | Adequate sequence generation? | Low risk | After baseline assessment, subjects were randomly assigned without stratification. |
| | Allocation concealment? | Low risk | Adequate, the use of sealed and opaque envelopes. |
| Blinding?
All outcomes | High risk | No blinding reported. |
| Incomplete outcome data addressed?
All outcomes - drop-outs? | Low risk | Between 89 and 96 percent of the subjects responded to the follow-up questionnaires. |
| Incomplete outcome data addressed?
All outcomes - ITT analysis? | Low risk | ITT was used to address the loss of follow-up outcomes. |
| | Similarity of baseline characteristics? | Low risk | Most baseline characteristics were similar except that subjects in the physical therapy group had more bothersome symptoms and subjects in the educational-booklet group reported fewer days with restricted activity. |
| | Co-interventions avoided or similar? | Low risk | The reported use of exercise was almost identical in all groups at baseline and 1 month. |
| | Compliance acceptable? | Low risk | Around 96 percent of the subjects complied with their assigned visits to the care provider at least once. |
| | Timing of outcome assessments similar? | Low risk | Outcomes were assessed 1, 4, 12, 52 and 104 weeks after the beginning of study in all groups. |
|
|
Donchin 1990
|
| Methods | Randomised, controlled, and intention-to-treat basis. No reports of concealed allocation and blinding. |
|
| | Participants | Hospital employees reporting at least 3 annual episodes of LBP.
Total of 142 hospital employees were assigned to:
Calisthetics for the back (CAL) group, N = 46;
Back school group, N = 46;
Control group, N = 50;
48 men and 94 women, mean age 45 years in Calisthenics group, 48 years in Back school group, and 45 years in Control group.
All who agreed took part in the study. |
|
| | Interventions | Post- treatment Calisthenics exercise group: Subjects underwent 45 minutes exercise, bi-weekly for 3 months. Flexion and pelvic tilt exercise, based on the Williams method, aimed at strengthening the abdominal muscles, expanding spinal forward flexion, and rectifying the general posture.
Back school group: Subjects received four 90 minutes sessions during a 2-week period plus a fifth session after 2 months. The physiotherapist taught proper body mechanics and exercises for back and abdominal muscles. Home exercise was encouraged for the subjects.
Control group: No intervention. |
|
| | Outcomes | Number of subjects with recurrent low-back pain. |
|
| | Notes | |
|
| | Risk of bias |
| | Bias | Authors' judgement | Support for judgement |
| | Adequate sequence generation? | Low risk | The subjects were allocated to the three groups by a systematic random sampling method. |
| | Allocation concealment? | Unclear risk | Unclear. |
| Blinding?
All outcomes | High risk | No blinding reported. |
| Incomplete outcome data addressed?
All outcomes - drop-outs? | High risk | Not stated. |
| Incomplete outcome data addressed?
All outcomes - ITT analysis? | Low risk | ITT analysis was used. |
| | Similarity of baseline characteristics? | High risk | Calisthenics group had more subjects with a more recent episode and more painful days before intervention. |
| | Co-interventions avoided or similar? | Low risk | |
| | Compliance acceptable? | Unclear risk | Not stated. |
| | Timing of outcome assessments similar? | Low risk | Outcomes were assessed after 3 months of intervention and after an additional 6 months of follow-up. |
|
|
Faas 1998
|
| Methods | Randomised, placebo-controlled, concealed allocation, and intention-to-treat basis. |
|
| | Participants | Patients who consulted their general practitioner for a new LBP episode.
Total of 473 participants were assigned to:
Exercise group, N = 156;
Usual care group, N = 155;
Placebo group, N = 162;
270 men and 203 women, mean age 36 years in exercise group, 36 years in usual care group and 38 years in sham Ultrasound group.
Inclusion criteria: pain between T-12 and the gluteal folds with or without radiation into the upper leg, pain for 3 weeks or less and age between 16 and 65 years.
Exclusion criteria: Radiation pain below the knee, nerve compression, previous back episode within 2 moths before entry, and back surgery. |
|
| | Interventions | Exercise group: Subjects were instructed individually by a physiotherapist for 20 minutes twice a week for 5 weeks. The exercises consisted of semi-fowler resting position, a resting position with knees on the chest, a limbering exercise by alternating side movements with knees bent, a stretching exercise of the iliopsoas , pelvic flexion in supine position, in hand-knee and in up-right position, and isometric abdominal exercises. Advices on daily activities were suggested.
Usual care group: Subjects received information on back pain and was given analgesics on demand without further therapy.
Sham Ultrasound group: Subjects received Ultrasonography for 20 minutes by a physiotherapist, twice a week for 5 weeks with the lowest possible dose next to zero (0.1 watt/cm2, intermittent, no heat effect). |
|
| | Outcomes | Number of subjects with recurrent LBP, and duration of recurrent LBP. |
|
| | Notes | |
|
| | Risk of bias |
| | Bias | Authors' judgement | Support for judgement |
| | Adequate sequence generation? | Low risk | Random assignment was performed in blocks of six for each general practitioner. |
| | Allocation concealment? | Low risk | Adequate, The doctor's assistant handed to the patient a sealed envelope containing the kind of therapy. |
| Blinding?
All outcomes | Unclear risk | No blinding reported. |
| Incomplete outcome data addressed?
All outcomes - drop-outs? | Low risk | 23 subjects in usual care group, 17 in placebo group and 20 in exercise group dropped out. |
| Incomplete outcome data addressed?
All outcomes - ITT analysis? | Low risk | ITT analysis was used. |
| | Similarity of baseline characteristics? | Low risk | All baseline characteristics were not significantly different. |
| | Co-interventions avoided or similar? | Low risk | Close to zero dose of Ultrasonography was given in placebo group. |
| | Compliance acceptable? | Low risk | 75% of intervention group and 89% of placebo group complied with the treatment. |
| | Timing of outcome assessments similar? | Low risk | Outcomes were assessed 2 and 4 weeks, 1 year after the beginning of study in all groups. |
|
|
Hagen 2003
|
| Methods | Randomised, controlled, concealed allocation, and intention-to-treat basis. |
|
| | Participants | Patients sick-listed for at least 8 weeks for LBP, mean age 41 years.
Total 437 participants were randomised into:
Intervention group, N = 237;
Control group, N = 220;
Inclusion criteria: age 18 to 60 years, a sick leave of 8 to 12 weeks.
Exclusion criteria: pregnancy, recent low-back trauma, and concurrent disorders. |
|
| | Interventions | Exercise group: Subjects were advised and instructed individually by physiotherapists in how to train and stretch at home, coping with daily activities at home and work, and how to resume normal activities.
Control group: Subjects were treated within the primary health care. |
|
| | Outcomes | Number of subjects with recurrent LBP, and days of sick leaves due to LBP. |
|
| | Notes | 510 people were randomised. The study analysis is based on the following distribution:
Intervention, N = 237;
Control, N = 220;
It appears that 53 participants dropped out after being randomised, which is 10.4% of the population, but before the beginning of the intervention. |
|
| | Risk of bias |
| | Bias | Authors' judgement | Support for judgement |
| | Adequate sequence generation? | Low risk | |
| | Allocation concealment? | Low risk | Adequate. |
| Blinding?
All outcomes | High risk | Patients and providers not blinded; unclear if outcome assessors were blinded: 'data from the National Insurance Office'. |
| Incomplete outcome data addressed?
All outcomes - drop-outs? | Low risk | |
| Incomplete outcome data addressed?
All outcomes - ITT analysis? | Low risk | |
| | Similarity of baseline characteristics? | Low risk | |
| | Co-interventions avoided or similar? | Low risk | There were no significant differences between the intervention and the control group in the use of analgesics, contacting the physician and relaxation as coping strategies to reduce LBP. |
| | Compliance acceptable? | Low risk | |
| | Timing of outcome assessments similar? | Low risk | |
|
|
Hides 2001
|
| Methods | Randomised, controlled, concealed allocation, and single-blinded (outcome assessor). |
|
| | Participants | Patients with acute, first-episode LBP.
For this study, total of 39 participants were accepted. 16 men and 23 women, mean age 31 years.
Intervention group, N = 20;
Control group, N = 19;
Inclusion criteria: participants of both genders, age 18 to 45 years, first episode of LBP for less than 3 weeks, presented to the accident and emergency department.
Exculsion criteria: provided elsewhere. |
|
| | Interventions | Exercise group: Subjects performed specific localized exercises aimed at restoring the stabilizing protective function of the multifidus, twice a week for 4 weeks.
Usual care group: Subjects received medical management, including advice on bed rest, absence from work, prescription of medication, and advice to resume normal activity as tolerated. |
|
| | Outcomes | Number of subjects with recurrent LBP, number of recurrences of LBP, and number of subjects with sick leave due to LBP. |
|
| | Notes | This is a follow-up study. The original study is not included in the review. It is possible that the N participants in the original study was greater than N=39 identified for the follow-up. |
|
| | Risk of bias |
| | Bias | Authors' judgement | Support for judgement |
| | Adequate sequence generation? | Low risk | |
| | Allocation concealment? | Low risk | Adequate. |
| Blinding?
All outcomes | High risk | Patient's and Providers not blinded; Outcome assessor blinded: 'research assistant who was blinded to group allocation'. |
| Incomplete outcome data addressed?
All outcomes - drop-outs? | Low risk | |
| Incomplete outcome data addressed?
All outcomes - ITT analysis? | Low risk | Outcomes for patients lost to follow-up imputed. |
| | Similarity of baseline characteristics? | Low risk | |
| | Co-interventions avoided or similar? | Low risk | |
| | Compliance acceptable? | Low risk | |
| | Timing of outcome assessments similar? | Low risk | |
|
|
Kellett 1991
|
| Methods | No reports of randomisation process, concealed allocation, and blinding. |
|
| | Participants | Employees of Scandinavia's major producer of kitchen units.
Inclusion criteria: self-reported current or previous back pain.
Exclusion criteria: any period of sick leave longer than 50 days.
59 men and 26 women, mean age 41 years in exercise group and 42 years in control group.
Total 125 participants were recruited. After initial dropouts, 58 were randomly selected to form an exercise group, and 53 for a control group. |
|
| | Interventions | Post-treatment exercise group: Subjects participated in the exercise programme once a week during working hours for one and half years. Intensity of exercise was progressively increased according to the comfort of subjects. Each session started with a warm-up and gentle stretching exercises and continued with strengthening, cardiovascular fitness exercises, and coordination exercises.
Control group: No report. |
|
| | Outcomes | Number of recurrences of LBP, number of subjects with sick leave due to LBP, and days of sick leaves due to LBP. |
|
| | Notes | After random selection, the further analysis is based on the following distribution of participants:
Intervention group, N = 37;
Control group, N = 48. |
|
| | Risk of bias |
| | Bias | Authors' judgement | Support for judgement |
| | Adequate sequence generation? | Unclear risk | No other information provided than '58 individuals were randomly selected to form the exercise group'. |
| | Allocation concealment? | High risk | No other information provided than '58 individuals were randomly selected to form the exercise group'. |
| Blinding?
All outcomes | High risk | Outcome assessor: 'sick leave data from the National Insurance Board'. Patients and providers not blinded. |
| Incomplete outcome data addressed?
All outcomes - drop-outs? | Low risk | |
| Incomplete outcome data addressed?
All outcomes - ITT analysis? | High risk | 14 control participants dropped out after randomisation and before intervention. |
| | Similarity of baseline characteristics? | Low risk | |
| | Co-interventions avoided or similar? | Unclear risk | No information provided about medical treatment even though all participants reported current or previous back pain. |
| | Compliance acceptable? | Low risk | |
| | Timing of outcome assessments similar? | Low risk | |
|
|
Ljunggren 1997
|
| Methods | Randomised, concealed allocation, and intention-to-treat basis. No control and blinding. |
|
| | Participants | The study was conducted at four physiotherapy centres in southern Norway.
Participants were selected after ordinary physio treatment for LBP.
Inclusion criteria: both genders, age 18 to 65 years, and history of back problems.
Exclusion criteria: participants for whom any of exercises were contraindicated.
Total of 153 participants were included and 126 completed. The analysis is based on 126 participants.
Terapimaster group, N = 62;
Conventional Training group, N = 64;
70 men and 56 women, mean age 40 years in Conventional exercise group and 39 years in TerapiMaster exercise group. |
|
| | Interventions | Post- treatment TerapiMaster programme group: Subjects underwent an exercise programme for one year, which consisted of 9 back, abdominal and whole body strengthening exercises by TerapiMaster device in 3 sets of 10 repetitions for 15 to 30 minutes each session, 3 sessions a week at home. Progression in the programme, decided in cooperation with the physiotherapist, was done by adding extra weights.
Conventional exercise programme: Subjects underwent a conventional exercise programme for one year, without TerapiMaster device at home. The exercise programme was consisted of 9 back, abdominal and whole body strengthening exercises in 3 sets of 10 repetitions for 15 to 30 minutes each session, 3 sessions a week. |
|
| | Outcomes | Days of sick leaves due to LBP. |
|
| | Notes | There was no mentioning of the initial numbers of participants randomised into Intervention group and a control group. Dropout rate is 17.6%. |
|
| | Risk of bias |
| | Bias | Authors' judgement | Support for judgement |
| | Adequate sequence generation? | Low risk | |
| | Allocation concealment? | Low risk | Adequate. |
| Blinding?
All outcomes | High risk | Patients and providers not blinded; outcome assessment was by self-report. |
| Incomplete outcome data addressed?
All outcomes - drop-outs? | Low risk | |
| Incomplete outcome data addressed?
All outcomes - ITT analysis? | Low risk | |
| | Similarity of baseline characteristics? | High risk | Fewer men in the intervention group. |
| | Co-interventions avoided or similar? | Unclear risk | No information provided on regular medical treatment. |
| | Compliance acceptable? | Low risk | |
| | Timing of outcome assessments similar? | Low risk | |
|
|
Soukup 1999
|
| Methods | Randomised, controlled, and intention-to-treat basis. No reports of concealed allocation and blinding. |
|
| | Participants | Most subjects were recruited from outpatient medical, chiropractic and physiotherapy practices in south-east Norway.
Supervised Mensendieck arm: total 77 participants were randomised into a Mensendieck exercise group (N = 39).
12 month follow-up: During the 12 month of follow-up treatment, 5 participants dropped out. Analysis is performed on N = 34.
3-year follow-up: the analysis included Mensendieck group, N = 31.
Control group for both intervention and all follow-ups was (N = 38). During the 12 month of follow-up treatment, 3 participants dropped out. Dropouts are discussed, but excluded from the analysis. Analysis is performed on N = 35.
Inclusion criteria: men and women 18 to 50 years old who had experienced one or more episodes of pain localised to the lumber region, with or without pain radiation to the lower extremities. It was required that patients had finished their treatment for LBP episode prior to enrolment.
Exclusion criteria: back surgery, pregnancy, specific diseases, and spinal fracture. |
|
| | Interventions | Post-treatment Mensendieck exercise group: Subjects received exercises and biomechanical/ ergonomic education in 20 sessions of 60 minutes each for 13 weeks, twice a week for first 7 weeks and once a week for the last 6 weeks. Each session was consisted of warm-up and stretching exercises for 15 minutes, a combination of ergonomic education and pelvic, hip, back, and abdominal exercises for 35 minutes, and stretching and relaxation exercises for 10 minutes.
Control group: Subjects did not receive any attention but were free to choose other treatments for LBP or engage in other physical activities. Apart from the follow-up assessments, the group did not receive any further attention or information. |
|
| | Outcomes | Number of subjects with recurrent LBP, number of recurrences of LBP, time to LBP recurrences, number of subjects with sick leave due to LBP, and days of sick leaves due to LBP. |
|
| | Notes | |
|
| | Risk of bias |
| | Bias | Authors' judgement | Support for judgement |
| | Adequate sequence generation? | Low risk | Subjects were randomised in blocks of six to maintain a consistent class size. |
| | Allocation concealment? | Unclear risk | Unclear. |
| Blinding?
All outcomes | High risk | No blinding reported. |
| Incomplete outcome data addressed?
All outcomes - drop-outs? | Low risk | No significant difference was found between the two groups with regard to drop-out rate and time until drop out (5 in intervention and 3 in control). |
| Incomplete outcome data addressed?
All outcomes - ITT analysis? | High risk | No ITT analysis. |
| | Similarity of baseline characteristics? | Low risk | No statistically significant difference between the intervention and control group was found in baseline characteristics. |
| | Co-interventions avoided or similar? | Low risk | No exercise was given in control group. |
| | Compliance acceptable? | Low risk | Average compliance: 85%; Range: 65-100%. |
| | Timing of outcome assessments similar? | Low risk | Outcomes were measured at baseline and 1 year. |
|
|
Stankovic 1990
|
| Methods | Randomised, controlled, concealed allocation, and intention-to-treat basis. No report of blinding. |
|
| | Participants | Patients with acute LBP. Total of 100 participants were randomised into:
Initially, McKenzie group (group 1) consisted of (N = 50) and a "Mini Back School" (group2) of (N = 50).
Statistical analysis is performed on McKenzie group, N = 49, and a"Mini Back School", N = 46.
Inclusion criteria: being employed.
Exclusion criteria: participants with chronic LBP, pregnancy, and back surgery.
77 men and 23 women, mean age 34 years.
5-year follow-up included 89 of the initial subjects: 67 men and 22 women, mean age 40 years.
McKenzie group (group 1), N = 47;
a "Mini Back School" (group2), N = 42. |
|
| | Interventions | McKenzie exercise group: The patients received 20 minutes session with emphasis on maintaining the lordosis at all times with or without lumbar support. Subjects were instructed to do back extension exercise in prone position by repeated full elbows extended while keeping the pelvis, hips and legs relaxed on a table, then in standing position. After 2 weeks training, subjects continued with flexion in lying, in sitting and in standing. Postural and ergonomic instructions were given. Subjects were instructed to continue the training programme by themselves.
Mini-back school group: Subjects only received back school education without exercises, consisting one 45 minutes lesson to discuss back anatomy and function, strain-relieving positions and the importance of staying active.
5-year follow-up included:
McKenzie exercise group (N = 47): the same exercise as described the above;
Mini-back school group (N = 42): the same education as described the above. |
|
| | Outcomes | Number of subjects with recurrent LBP, and days of sick leaves due to LBP. |
|
| | Notes | Dropouts are not discussed. |
|
| | Risk of bias |
| | Bias | Authors' judgement | Support for judgement |
| | Adequate sequence generation? | Low risk | 100 subjects were randomised into two groups by drawing a sealed envelope with random numbers, which had been produced by a random-number generator. |
| | Allocation concealment? | Unclear risk | Not mentioned. |
| Blinding?
All outcomes | High risk | No blinding reported. |
| Incomplete outcome data addressed?
All outcomes - drop-outs? | Low risk | It was observed from the result table for 1 year follow-up that there were 4 dropouts.
For 5-year follow-up the dropout rate increased to 11 participants. |
| Incomplete outcome data addressed?
All outcomes - ITT analysis? | High risk | No ITT analysis. |
| | Similarity of baseline characteristics? | Low risk | It was reported that no difference in several demographical variables (age, occupation and derangements). |
| | Co-interventions avoided or similar? | Unclear risk | Not mentioned. |
| | Compliance acceptable? | Unclear risk | Not mentioned. |
| | Timing of outcome assessments similar? | Low risk | Outcomes were measured at baseline and 5 years. |
|
|
Characteristics of excluded studies [ordered by study ID]
|
| Study | Reason for exclusion |
|---|
| | Alexandre 2001 | The exercise group received other intervention (back school). |
| | Amako 2003 | All of the included subjects had no low-back pain at entry of the study. |
| | Buchbinder 2002 | The article is a synopsis. |
| | Cairns 2006 | The exercise group received other interventions such as manual therapy, electrotherapy, and lumbar traction. |
| | Gundewall 1993 | The subjects did not experience back pain before. Impossible to extract recurrences from the data. |
| | Helewa 1999 | All of the included subjects had no low-back pain at entry of the study. |
| | Hides 1996 | The exercise group received other non-exercise interventions such as medications (analgesics). No interest outcomes were found in the study. |
| | Hlobil 2005 | Behavioural approach was co-intervention. |
| | Kofotolis 2005 | The article is a review. |
| | Koumantakis 2005 | No relevant outcome was found in the study. |
| | Koumantakis 2005a | No relevant outcome was found in the study. |
| | Kuukkanen 2000 | No relevant outcome was found in the study. |
| | Leclaire 1996 | In both arms physiotherapy was a co-intervention. |
| | Maul 2005 | No relevant outcome was found in the study. |
| | Medina 1995 | The exercise group received other non-exercise interventions. |
| | Sjogren 2006 | No relevant outcomes were found in the study. |
| | Staal 2004 | Behavioural approach was co-intervention. |
| | Suni 2006 | No relevant outcome was found in the study. |
|
|
Comparison 1. Post-treatment Exercise vs No Intervention
|
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
|---|
| | 1 Number of subjects with recurrent LBP | 2 | | Risk Ratio (M-H, Random, 95% CI) | Subtotals only |
| | | 2 | 130 | Risk Ratio (M-H, Random, 95% CI) | 0.50 [0.34, 0.73] |
| | | 1 | 66 | Risk Ratio (M-H, Random, 95% CI) | 0.75 [0.53, 1.07] |
| | 2 Time to LBP recurrence | 1 | | Hazard Ratio (Random, 95% CI) | Subtotals only |
| | | 1 | | Hazard Ratio (Random, 95% CI) | 0.43 [0.21, 0.87] |
| | | 1 | | Hazard Ratio (Random, 95% CI) | 0.50 [0.28, 0.90] |
| | 3 Number of recurrences of LBP | 2 | | Mean Difference (IV, Random, 95% CI) | Subtotals only |
| | | 2 | 154 | Mean Difference (IV, Random, 95% CI) | -0.35 [-0.60, -0.10] |
| | | 1 | 66 | Mean Difference (IV, Random, 95% CI) | -1.97 [-3.84, -0.10] |
| | 4 Number of subjects with sick leave due to recurrent LBP | 2 | | Risk Ratio (M-H, Random, 95% CI) | Subtotals only |
| | | 2 | 154 | Risk Ratio (M-H, Random, 95% CI) | 0.84 [0.50, 1.41] |
| | | 1 | 66 | Risk Ratio (M-H, Random, 95% CI) | 0.82 [0.48, 1.38] |
| | 5 Days of sick leave due to recurrent LBP | 2 | | Mean Difference (IV, Fixed, 95% CI) | Subtotals only |
| | | 2 | 154 | Mean Difference (IV, Fixed, 95% CI) | -4.37 [-7.74, -0.99] |
| | | 1 | 66 | Mean Difference (IV, Fixed, 95% CI) | -11.5 [-54.24, 31.24] |
|
|
Comparison 2. Post treatment Exercise plus Terapimaster machine vs General exercise
Comparison 3. Exercise Treatment vs Usual care
|
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
|---|
| | 1 Number of subjects with recurrent LBP | 3 | | Risk Ratio (M-H, Random, 95% CI) | Subtotals only |
| | | 2 | 348 | Risk Ratio (M-H, Random, 95% CI) | 0.63 [0.23, 1.76] |
| | | 2 | 493 | Risk Ratio (M-H, Random, 95% CI) | 0.74 [0.35, 1.55] |
| | 2 Duration of recurrent LBP | 1 | | Mean Difference (IV, Random, 95% CI) | Subtotals only |
| | 3 Number of recurrences of LBP | 1 | | Mean Difference (IV, Random, 95% CI) | Subtotals only |
| | | 1 | 39 | Mean Difference (IV, Random, 95% CI) | -1.40 [-3.16, 0.36] |
| | | 1 | 36 | Mean Difference (IV, Random, 95% CI) | -0.40 [-3.88, 3.08] |
| | 4 Number of subjects with sick leave due to recurrent LBP | 1 | | Risk Ratio (M-H, Random, 95% CI) | Subtotals only |
| | | 1 | 39 | Risk Ratio (M-H, Random, 95% CI) | 0.36 [0.11, 1.15] |
| | | 1 | 36 | Risk Ratio (M-H, Random, 95% CI) | 0.8 [0.24, 2.71] |
|
|
Comparison 4. Exercise Treatement vs Sham Ultrasound
Comparison 5. Specific McKenzie Exercise Treatment vs Minimal booklet/back school
|
| Outcome or subgroup title | No. of studies | No. of participants | Statistical method | Effect size |
|---|
| | 1 Number of subjects with recurrent LBP | 2 | | Risk Ratio (M-H, Random, 95% CI) | Subtotals only |
| | | 2 | 294 | Risk Ratio (M-H, Random, 95% CI) | 0.75 [0.42, 1.35] |
| | | 1 | 89 | Risk Ratio (M-H, Random, 95% CI) | 0.72 [0.57, 0.92] |
| | 2 Number of sick leaves caused by recurrent LBP | 1 | | Mean Difference (IV, Random, 95% CI) | Subtotals only |
| | | 1 | 95 | Mean Difference (IV, Random, 95% CI) | -13.10 [-30.79, 4.59] |
| | | 1 | 93 | Mean Difference (IV, Random, 95% CI) | -19.80 [-86.53, 46.93] |
|
|
Summary of findings for the main comparison. Post-treatment exercise compared to no intervention for preventing recurrences of low-back pain
|
| Post-treatment exercise compared to no intervention for preventing recurrences of low-back pain |
| Patient or population: patients with recurrences of low-back pain
Settings:
Intervention: post-treatment exercise
Comparison: no intervention |
| | Outcomes | Illustrative comparative risks* (95% CI) | Relative effect
(95% CI) | No of Participants
(studies) | Quality of the evidence
(GRADE) | Comments |
| | Assumed risk | Corresponding risk |
| | no intervention | post-treatment exercise |
| Number of subjects with recurrent LBP
Follow-up: 0.5 to 2 years | Low risk population | RR 0.5
(0.34 to 0.73) | 130
(2 studies) | ⊕⊕⊕⊝
moderate1 | |
| | 10 per 100 | 5 per 100
(3 to 7) |
| | High risk population |
| | 70 per 100 | 35 per 100
(24 to 51) |
| Number of subjects with recurrent LBP
Follow-up: 2 to 5 years | Low risk population | RR 0.75
(0.53 to 1.07) | 66
(1 study) | ⊕⊕⊕⊝
moderate2 | |
| | 10 per 100 | 8 per 100
(5 to 11) |
| | High risk population |
| | 70 per 100 | 52 per 100
(37 to 75) |
| Time to LBP recurrence
self-report
Follow-up: 0.5 to 2 years | Medium risk population | HR 0.43
(0.21 to 0.87) | 69
(1 study) | ⊕⊕⊕⊝
moderate3 | |
| | 57 per 100 | 30 per 100
(16 to 52) |
| Time to LBP recurrence
self-report
Follow-up: 2 to 5 years | Medium risk population | HR 0.5
(0.28 to 0.9) | 66
(1 study) | ⊕⊕⊕⊝
moderate3 | |
| | 77 per 100 | 52 per 100
(34 to 73) |
| Number of recurrences of LBP
recurrences. Scale from: 0 to 10.
Follow-up: 0.5 to 2 years | The mean number of recurrences of lbp in the control groups was
1.4 4 | The mean Number of recurrences of LBP in the intervention groups was
0.35 lower
(0.6 to 0.1 lower) | | 154
(2 studies) | ⊕⊕⊕⊝
moderate5 | |
| Number of recurrences of LBP
Scale from: 0 to 10.
Follow-up: 2 to 5 years | The mean number of recurrences of lbp in the control groups was
1.6 | The mean Number of recurrences of LBP in the intervention groups was
1.97 lower
(3.84 to 0.1 lower) | | 66
(1 study) | ⊕⊕⊕⊝
moderate3 | |
| *The basis for the assumed risk (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI).
CI: Confidence interval; RR: Risk ratio; HR: Hazard ratio; |
| GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect.
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate.
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate.
Very low quality: We are very uncertain about the estimate. |
|
|
1 The studies of Donchin and Soukup had both an unclear risk of bias
2 Soukup 1999 95% CI included both negligible and appreciable benefit
3 Only one small study included
4 The average recurrence in studies with 0.5 to 2 years follow-up was 1.5 per person
5 Kellett 1991 had a high risk of bias and Soukup 1999 unclear risk of bias
|
Table 1. Clinical relevance
|
| Study | Patient Description | Treatment description | All outcomes reported | Outcome size clinically important | Benefits worth the harms |
| | Cherkin 1998 | yes | yes | yes | no | yes |
| | Doncin 1990 | no | no | no | unclear | unclear |
| | Faas 1998 | yes | yes | yes | yes | yes |
| | Hagen 2003 | yes | no | yes | yes | yes |
| | Hides 2001 | yes | yes | yes | yes | yes |
| | Kellett 1991 | yes | yes | yes | unclear | yes |
| | Ljungren 1997 | yes | yes | no | yes | yes |
| | Soukup 1999 | yes | yes | yes | yes | yes |
| | Stankovic 1995 | no | yes | no | unclear | yes |
|
|
Table 2. Details of exercise intervention
|
| Study | Exercise protocol | Back stretching | Leg stretching | Leg mobilization | Back mobilization | Abdomen strength | Back strength | Relaxation exercise | Back care advice |
| | Cherkin 1998 | 9 times, supervision by physiotherapist | ++ | ? | ? | ++ | ? | ++ | ? | - |
| | Donchin 1990 | 45 minutes each session, 24 sessions, twice a week for 3 months, supervision by physical education instructor | - | - | - | ++ | ++ | + | - | + |
| | Faas 1998 | 20 minutes each session, 10 sessions, twice a week for 5 weeks, supervision by physiotherapist | + | + | - | + | + | + | - | ++ |
| | Hagen 2003 | Protocol not mentioned, supervision by a physiotherapist | ? | ? | ++ | ? | ? | ? | - | +++ |
| | Hides 2001 | 8 sessions, twice a week | - | - | - | ? | +++ | +++ | - | ++ |
| | Kellett 1991 | 35-45 minutes each session, supervision by physiotherapist and physical fitness instructor | + | + | + | + | + | + | + | + |
| | Ljunggren 1997 | 15-30 minutes each session, 144 sessions, triple a week for a year, supervision by physiotherapist | + | - | ++ | ++ | ++ | ++ | ++ | - |
| | Soukup 1999 | 1 hour each session, 20 sessions, twice a week for first 7 weeks; once a week for last 6 weeks, supervision by physiotherapist | + | ++ | - | ++ | ++ | ++ | + Breathing relaxation | ++ |
| | Stankovic 1990 | 20 minutes each session, 2 sessions, separated by 2 weeks | + | - | - | ++ | ++ | ++ | - | + |
|
|
Key: - does not contain; + contains some of it; ++ consists mostly of it; +++ consists entirely of it
|
