Exercise interventions for persistent non-specific low back pain – does matching outcomes to treatment targets make a difference? A systematic review and meta-analysis

Review written by Ben Cormack info

Key Points

  1. Current exercise research does not regularly match treatment targets and outcomes.
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BACKGROUND & OBJECTIVE

Low back pain is a major global burden for both pain and disability (1). Exercise is a frequently studied and recommended intervention for chronic low back pain that features in the majority of treatment guidelines for this common complaint. Exercise can have a wide variety of effects across physical, physiological, psychological and social domains and can be considered a complex intervention.

The treatment targets of exercise can be poorly defined, infrequently measured and changes in these treatment targets are often not well matched to the outcome measures used. Outcome measures used in RCTs for exercise and back pain should reflect the treatment targets and hypothesized mechanisms of action, and this systematic review looked at the extent to which treatment targets and outcomes had a relationship.

The review aimed to: describe treatment targets and outcome measures for exercise based RCTs, explore the extent to which outcome measures and treatment targets aligned, and determine how much this affected the size of the between-group difference.

Exercise can have a wide variety of effects across physical, physiological, psychological and social domains.
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By matching treatment targets and outcomes, we can provide a more mechanistic link and rationale to exercise therapy.

METHODS

The review protocol was published on the PROSPERO register and was performed in accordance with PRISMA guidelines. The authors used the Cochrane risk of bias tool to assess for risk of bias.

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