Exercise therapy is effective for chronic low back pain, but should be individually prescribed and supervised.

Hayden JA, van Tulder MW, Malmivaara AV, Koes B. Meta-analysis:

Exercise therapy for non-specific chronic low back pain. Annals of

Internal Medicine Annals of Internal Medicine (Ann Intern Med) is an academic medical journal published by the American College of Physicians (ACP). It publishes research articles and reviews in the area of internal medicine. Its current editor is Harold C. Sox. . 2005. 142:765-775

(Abstracts prepared by J. Haxby Abbott)

Design: A systematic review of studies evaluating the effectiveness

of exercise therapy in adults with non-specific low back pain (LBP LBP

In currencies, this is the abbreviation for the Lebanese Pound.

The currency market, also known as the Foreign Exchange market, is the largest financial market in the world, with a daily average volume of over US $1 trillion. )

identified 61 randomised Adj. 1. randomised – set up or distributed in a deliberately random way

irregular – contrary to rule or accepted order or general practice; “irregular hiring practices” , controlled trials meeting the inclusion

criteria For Wikipedia’s inclusion criteria, see: What Wikipedia is not.

Inclusion criteria are a set of conditions that must be met in order to participate in a clinical trial. . Studies were divided into acute, subacute, and chronic LBP

categories. The authors performed both quality rating of the studies,

and pooling of the data in a meta-analysis.

Main outcome Measures: Pain and functioning were the most

consistent outcome measures across included trials. Return to work,

absenteeism, and global improvement were also reported in some studies.

Results: Most (43) included studies were of chronic LBP. In this

group, exercise therapy was more effective than other conservative

treatments for reducing pain (6 points more improvement, on a 0-100 pain

rating scale), and even more effective than no treatment (10 points more

improvement with exercise therapy). Exercise therapy was superior to

comparison groups over the short-, intermediate- and long-terms.

Functional outcomes also favoured exercise therapy over comparisons (by

2.5 points). Subacute and acute populations did not fare as well. Only 6

studies involved patients in the subacute stage, finding exercise

therapy equivalent to comparison groups for both pain and functioning,

over the short- and intermediate-term. There was, however, moderate

evidence of reduced absenteeism. Studies involving patients with acute

LBP (11) were conflicting, but generally showed no benefit of exercise

therapy over non-exercise comparison groups, for either pain or

functioning. Trends at long-term follow-up were similar.

Conclusions: In acute LBP, exercise offers no benefit over other

interventions or no intervention. In subacute LBP, graded-activity

exercises are effective in reducing absenteeism in occupational

settings. In chronic LBP, evidence strongly suggests that exercise

therapy significantly improves pain and functional outcomes.

Hayden JA, van Tulder MW, Tomlinson G. Systematic review:

Strategies for using exercise therapy to improve outcomes in chronic low

back pain. Annals of Internal Medicine. 2005. 142:776-785

Design: A systematic review examining the exercise intervention

characteristics of studies evaluating the effectiveness of exercise

therapy in adults with chronic LBP.

Studies included: Forty-three randomised, controlled trials

involving patients with LBP of >12 weeks duration.

Main outcome measures: Pain and function.

Exercise intervention characteristics: The authors looked at the

type of exercises, mode of delivery, dose or intensity, and additional


Statistical methods: Meta-analysis and meta-regression, to assess

the the independent influence of each level of characteristics. These

methods allow ranking of exercise characterists from best to worst.

Results: Individually-designed exercise interventions were more

effective than standardised sets of exercises (8.4 points versus -4.3

for pain, 1.7 vs -2.0 for function). Partially individually-designed

programmes were ineffective (0.6 points for pain, 1.3 for function).

Supervised su·per·vise

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