Exercises for prevention of recurrences of low‐back pain Edited (no change to conclusions)

Abstract

Abstract Background

Back pain is a common disorder that has a tendency to recur. It is unclear if exercises, either as part of treatment or as a post‐treatment programme, can reduce back pain recurrences.

Objectives

To investigate the effectiveness of exercises for preventing new episodes of low‐back pain or low‐back pain‐associated disability.

Search methods

We searched CENTRAL (The Cochrane Library 2009, issue 3), MEDLINE, EMBASE and CINAHL up to July 2009.

Selection criteria

Inclusion criteria were: participants who had experienced back pain before, an intervention that consisted of exercises without additional specific treatment and outcomes that measured recurrence of back pain or time to recurrence.

Data collection and analysis

Two review authors independently judged if references met the inclusion criteria. The same review authors independently extracted data and judged the risk of bias of the studies. Studies were divided into post‐treatment intervention programmes and treatment studies. Study results were pooled with meta‐analyses if participants, interventions, controls and outcomes were judged to be sufficiently homogenous.

Main results

We included 13 articles reporting on nine studies with nine interventions. Four studies with 407 participants evaluated post‐treatment programmes and five studies with 1113 participants evaluated exercise as a treatment modality. Four studies had a low risk of bias, one study a high risk and the remainder an unclear risk of bias.

We found moderate quality evidence that post‐treatment exercises were more effective than no intervention for reducing the rate of recurrences at one year (Rate Ratio 0.50; 95% Confidence Interval 0.34 to 0.73). There was moderate quality evidence that the number of recurrences was significantly reduced in two studies (Mean Difference ‐0.35; 95% CI ‐0.60 to ‐0.10) at one‐half to two years follow‐up. There was very low quality evidence that the days on sick leave were reduced by post‐treatment exercises (Mean Difference ‐4.37; 95% CI ‐7.74 to ‐0.99) at one‐half to two years follow‐up.

We found conflicting evidence for the effectiveness of exercise treatment in reducing the number of recurrences or the recurrence rate.

Authors' conclusions

There is moderate quality evidence that post‐treatment exercise programmes can prevent recurrences of back pain but conflicting evidence was found for treatment exercise. Studies into the validity of measurement of recurrences and the effectiveness of post‐treatment exercise are needed.

Author(s)

Brian KL Choi, Jos H Verbeek, Wilson Wai‐San Tam, Johnny Y Jiang

Abstract

Plain language summary

Exercises for the prevention of recurrences of episodes of low‐back pain

Back pain is a common disorder that has a tendency to recur. We conducted this review to see if exercises, either as part of treatment or as a post‐treatment programme could reduce back pain recurrences. We searched for studies that included persons with back pain experience, interventions consisting of only exercises and that measured recurrences of back pain.

There were nine studies with 1520 participants. There was moderate quality evidence that post‐treatment exercises can reduce both the rate and the number of recurrences of back pain. However, the results of exercise treatment studies were conflicting.

Adverse (side) effects of exercising were not mentioned in any of the studies. Limitations of this review include the difference in exercises across studies, thus making it difficult to specify the content of such a programme to prevent back pain recurrences.

Author(s)

Brian KL Choi, Jos H Verbeek, Wilson Wai‐San Tam, Johnny Y Jiang

Reviewer's Conclusions

Authors' conclusions

Implications for practice

It might be beneficial to have additional exercise programmes after formal treatment for back pain has been completed. The content of such a programme is difficult to specify because the contents varied and did not relate to the outcomes. Therefore, any general exercise such as stretching, strengthening, endurance training and posture education could be adequate.

Treatment does not seem to influence the number of recurrences in acute and sub‐acute back pain patients and is therefore best focused on the treatment outcome for the current episode.

Implications for research

Prevention of recurrences of back pain is a little studied but clinically relevant back pain outcome. Studies that better validate the measurement of recurrences of back pain are needed. Intervention studies should at least address the rate, the number of and the time to recurrences of LBP. Given the low number of studies found, more studies are needed to evaluate post‐treatment supervised and non‐supervised exercise programmes.

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