Exercise treatment effect modifiers in persistent low back pain: an individual participant data meta-analysis of 3514 participants from 27 randomised controlled trials. Issue 21 (28th November 2019)

• Record Type: Journal Article
• Authors: Hayden, Jill A; Wilson, Maria N; Stewart, Samuel; Cartwright, Jennifer L; Smith, Andrea O; Riley, Richard D; van Tulder, Maurits; Bendix, Tom; Cecchi, Francesca; Costa, Leonardo O P; Dufour, Ninna; Ferreira, Manuela L; Foster, Nadine E; Gudavalli, Maruti R; Hartvigsen, Jan; Helmhout, Pieter; Kool, Jan; Koumantakis, George A; Kovacs, Francisco M; Kuukkanen, Tiina; Long, Audrey; Macedo, Luciana G; Machado, Luciana A C; Maher, Chris G; Mehling, Wolf; Morone, Giovanni; Peterson, Tom; Rasmussen-Barr, Eva; Ryan, Cormac G; Sjögren, Tuulikki; Smeets, Rob; Staal, J Bart; Unsgaard-Tøndel, Monica; Wajswelner, Henry; Yeung, Ella W;
• Is Part Of: British journal of sports medicine. Volume 54:Issue 21(2020)
• Page Start: 1277
• Page End: 1278
• Publication Date: 2019-11-28
• Subjects: meta-analysis -- exercise rehabilitation -- intervention effectiveness -- lower back; Sports medicine -- Periodicals; 617.1027
• DOI: 10.1136/bjsports-2019-101205
• Languages: English
• ISSNs: 0306-3674

Abstract

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. Protocol publication: https://doi.org/10.1186/2046-4053-1-64