You are here

Article Text

Article menu

Download PDFPDF

Review
Prevention strategies to reduce future impact of low back pain: a systematic review and meta-analysis
Free
  1. Tarcisio F de Campos1,
  2. Chris G Maher2,3,
  3. Joel T Fuller1,
  4. Daniel Steffens4,5,
  5. Stephanie Attwell1,
  6. Mark J Hancock1
  1. 1 Department of Health Professions, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
  2. 2 Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
  3. 3 Institute for Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia
  4. 4 Royal Prince Alfred Hospital, Surgical Outcomes Research Centre (SOuRCe), Sydney, New South Wales, Australia
  5. 5 Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Tarcisio F de Campos, Department of Health Professions, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, 2109, Australia; tarcisiofolly{at}gmail.com

Abstract

Objective To evaluate the evidence from randomised controlled trials (RCTs) on the effectiveness of prevention strategies to reduce future impact of low back pain (LBP), where impact is measured by LBP intensity and associated disability.

Design Systematic review with meta-analysis.

Data sources MEDLINE, Embase, CINAHL, PEDro and The Cochrane (CENTRAL) databases from inception to 22 October 2018.

Eligibility criteria RCTs evaluating any intervention aiming to prevent future impact of LBP, reporting an outcome measure of LBP intensity and/or disability measured at least 3 months post-randomisation, and the intervention group must be compared with a group that received no intervention/placebo or minimal intervention. Trials restricting recruitment to participants with current LBP were excluded.

Results 27 published reports of 25 different trials including a total of 8341 participants fulfilled the inclusion criteria. The pooled results, from three RCTs (612 participants), found moderate-quality evidence that an exercise programme can prevent future LBP intensity (mean difference (MD) −4.50; 95% CI −7.26 to −1.74), and from 4 RCTs (471 participants) that an exercise and education programme can prevent future disability due to LBP (MD −6.28; 95% CI −9.51 to −3.06). It is uncertain whether prevention programmes improve future quality of life (QoL) and workability due to the overall low-quality and very low-quality available evidence.

Conclusions This review provides moderate-quality evidence that an exercise programme, and a programme combining exercise and education, are effective to reduce future LBP intensity and associated disability. It is uncertain whether prevention programmes can improve future QoL and workability. Further high-quality RCTs evaluating prevention programmes aiming to reduce future impact of LBP are needed.

  • lower back
  • prevention
  • randomised controlled trial
  • review
  • meta-analysis

https://doi.org/10.1136/bjsports-2019-101436

Statistics from Altmetric.com

    Request Permissions

    If you wish to reuse any or all of this article please use the link below which will take you to the Copyright Clearance Center’s RightsLink service. You will be able to get a quick price and instant permission to reuse the content in many different ways.

    View Full Text

    Footnotes

    • Twitter @TF_Campos, @CGMMaher, @SOuRCe_RPA

    • Contributors TFdC and MH had full access to all the data in this systematic review and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: TFdC, CGM, JTF, DS, MH. Acquisition, analysis or interpretation of data: all authors. Drafting of the manuscript: TFdC, CGH, MH. Critical revision of the manuscript for important intellectual content: all authors. Statistical analysis: TFdC, CGM, JTF, MH. Administrative, technical or material support: TFdC, JTF, DS, SA, MH. Study supervision: TFdC, CGH, MH.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Not commissioned; externally peer reviewed.