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).