Hayden, J A; Wilson, M N; Stewart, S; Cartwright, J L; Smith, A O; Riley, R D; van Tulder, M; Bendix, T; Cecchi, F; Costa, L O P; Dufour, N; Ferreira, M L; Foster, N E; Gudavalli, M R; Hartvigsen, J; Helmhout, P; Kool, J; Koumantakis, G A; Kovacs, F M; Kuukkanen, T; Long, A; Macedo, L G; Machado, L A C; Maher, C G; Mehling, W; Morone, G; Peterson, T; Rasmussen-Barr, E; Ryan, C G; Sjögren, T; Smeets, R; Staal, J B; Unsgaard-Tøndel, M; Wajswelner, H; Yeung, E W; Group, C L B P I M -A
@article{Hayden2020,
title = {Exercise treatment effect modifiers in persistent low back pain: an individual participant data meta-analysis of 3514 participants from 27 randomised controlled trials},
author = {J A Hayden and M N Wilson and S Stewart and J L Cartwright and A O Smith and R D Riley and M van Tulder and T Bendix and F Cecchi and L O P Costa and N Dufour and M L Ferreira and N E Foster and M R Gudavalli and J Hartvigsen and P Helmhout and J Kool and G A Koumantakis and F M Kovacs and T Kuukkanen and A Long and L G Macedo and L A C Machado and C G Maher and W Mehling and G Morone and T Peterson and E Rasmussen-Barr and C G Ryan and T Sjögren and R Smeets and J B Staal and M Unsgaard-Tøndel and H Wajswelner and E W Yeung and C L B P I M -A Group},
doi = {doi: 10.1136/bjsports-2019-101205},
year = {2020},
date = {2020-09-01},
journal = {Br J Sports Med},
volume = {54},
number = {21},
pages = {1277-1278},
abstract = {Background:
Low back pain is one of the leading causes of disability worldwide. Exercise therapy is widely recommended to treat persistent non-specific low back pain. While evidence suggests exercise is, on average, moderately effective, there remains uncertainty about which individuals might benefit the most from exercise.
Methods:
In parallel with a Cochrane review update, we requested individual participant data (IPD) from high-quality randomised clinical trials of adults with our two primary outcomes of interest, pain and functional limitations, and calculated global recovery. We compiled a master data set including baseline participant characteristics, exercise and comparison characteristics, and outcomes at short-term, moderate-term and long-term follow-up. We conducted descriptive analyses and one-stage IPD meta-analysis using multilevel mixed-effects regression of the overall treatment effect and prespecified potential treatment effect modifiers.
Results:
We received IPD for 27 trials (3514 participants). For studies included in this analysis, compared with no treatment/usual care, exercise therapy on average reduced pain (mean effect/100 (95% CI) −10.7 (−14.1 to –7.4)), a result compatible with a clinically important 20% smallest worthwhile effect. Exercise therapy reduced functional limitations with a clinically important 23% improvement (mean effect/100 (95% CI) −10.2 (−13.2 to –7.3)) at short-term follow-up. Not having heavy physical demands at work and medication use for low back pain were potential treatment effect modifiers—these were associated with superior exercise outcomes relative to non-exercise comparisons. Lower body mass index was also associated with better outcomes in exercise compared with no treatment/usual care. This study was limited by inconsistent availability and measurement of participant characteristics.
Conclusions:
This study provides potentially useful information to help treat patients and design future studies of exercise interventions that are better matched to specific subgroups.},
keywords = {chronic, exercise, low back pain, participants, physiotherapy},
pubstate = {published},
tppubtype = {article}
}
Background:
Low back pain is one of the leading causes of disability worldwide. Exercise therapy is widely recommended to treat persistent non-specific low back pain. While evidence suggests exercise is, on average, moderately effective, there remains uncertainty about which individuals might benefit the most from exercise.
Methods:
In parallel with a Cochrane review update, we requested individual participant data (IPD) from high-quality randomised clinical trials of adults with our two primary outcomes of interest, pain and functional limitations, and calculated global recovery. We compiled a master data set including baseline participant characteristics, exercise and comparison characteristics, and outcomes at short-term, moderate-term and long-term follow-up. We conducted descriptive analyses and one-stage IPD meta-analysis using multilevel mixed-effects regression of the overall treatment effect and prespecified potential treatment effect modifiers.
Results:
We received IPD for 27 trials (3514 participants). For studies included in this analysis, compared with no treatment/usual care, exercise therapy on average reduced pain (mean effect/100 (95% CI) −10.7 (−14.1 to –7.4)), a result compatible with a clinically important 20% smallest worthwhile effect. Exercise therapy reduced functional limitations with a clinically important 23% improvement (mean effect/100 (95% CI) −10.2 (−13.2 to –7.3)) at short-term follow-up. Not having heavy physical demands at work and medication use for low back pain were potential treatment effect modifiers—these were associated with superior exercise outcomes relative to non-exercise comparisons. Lower body mass index was also associated with better outcomes in exercise compared with no treatment/usual care. This study was limited by inconsistent availability and measurement of participant characteristics.
Conclusions:
This study provides potentially useful information to help treat patients and design future studies of exercise interventions that are better matched to specific subgroups.
