Patient education materials for non-specific low back pain and sciatica: a protocol for a systematic review and meta-analysis

IntroductionLow back pain accounts for more disability than any other musculoskeletal condition and is associated with severe economic burden. Patients commonly present with negative beliefs about low back pain and this can have detrimental effects on their health outcomes. Providing evidence-based, patient-centred education that meets patient needs could help address these negative beliefs and alleviate the substantial low back pain burden. The primary aim of this review is to investigate the effectiveness of patient education materials on immediate process, clinical and health system outcomes.Methods and analysisThe search strategy was developed in collaboration with a librarian and systematic searches will be performed in MEDLINE, EMBASE, CINAHL, PsycINFO and SPORTDiscus. We will also search trial registries and grey literature through the OpenGrey database. Study selection will include a title and abstract scan and full-text review by two authors. Only randomised controlled trials will be included in this review. Trials must include patients with low back pain or sciatica and investigate educational interventions with at least one of the following contrasts: (1) education alone versus no intervention; (2) education alone versus another intervention; (3) education in addition to another intervention versus the same intervention with no education. Data extraction, risk of bias and grading of the quality of evidence will be performed independently by two reviewers. Risk of bias will be assessed using the PEDro scale, and the quality of evidence will be assessed with the Grades of Recommendation, Assessment, Development and Evaluation approach. A random-effects model will be used for each contrast, and results will be pooled if the participants, interventions, and outcomes are homogeneous. If heterogeneity is high (I2 >75%), we will evaluate the magnitude and direction of the differences in effect sizes across studies to determine if it remains reasonable to pool the results. Analyses of acute and subacute low back pain (less than 12 weeks duration) will be performed separately from chronic low back pain (12 weeks or greater duration). Likewise, analyses of short-term (less than 6 months) and long-term (6 months or greater) follow-up will be performed separately. Subgroup analyses will be performed on non-specific low back pain, sciatica and mixed populations.Ethics and disseminationEthical approval is not required for this review. This study, along with its results, will be published in a peer-reviewed journal.

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Physical Activity for the Treatment of Chronic Low Back Pain in Elderly Patients: A Systematic Review

Journal of Clinical Medicine ◽

10.3390/jcm9041023 ◽

2020 ◽

Vol 9 (4) ◽

pp. 1023 ◽

Cited By ~ 2

Author(s):

Gianluca Vadalà ◽

Fabrizio Russo ◽

Sergio De Salvatore ◽

Gabriele Cortina ◽

Erika Albo ◽

...

Keyword(s):

Physical Activity ◽

Low Back Pain ◽

Back Pain ◽

Chronic Low Back Pain ◽

Risk Of Bias ◽

Controlled Trials ◽

Low Back ◽

Quality Of Evidence ◽

Randomized Controlled

Chronic low back pain (CLBP) affects nearly 20–25% of the population older than 65 years, and it is currently the main cause of disability both in the developed and developing countries. It is crucial to reach an optimal management of this condition in older patients to improve their quality of life. This review evaluates the effectiveness of physical activity (PA) to improve disability and pain in older people with non-specific CLBP. The Preferred Reporting Items for Systematic reviews and Meta-Analyses (PRISMA) guidelines were used to improve the reporting of the review. Individual risk of bias of single studies was assessed using Rob 2 tool and ROBINS-I tool. The quality of evidence assessment was performed using GRADE analysis only in articles that presents full data. The articles were searched in different web portals (Medline, Scopus, CINAHL, EMBASE, and CENTRAL). All the articles reported respect the following inclusion criteria: patients > 65 years old who underwent physical activities for the treatment of CLBP. A total of 12 studies were included: 7 randomized controlled trials (RCT), 3 non-randomized controlled trials (NRCT), 1 pre and post intervention study (PPIS), and 1 case series (CS). The studies showed high heterogeneity in terms of study design, interventions, and outcome variables. In general, post-treatment data showed a trend in the improvement for disability and pain. However, considering the low quality of evidence of the studies, the high risk of bias, the languages limitations, the lack of significant results of some studies, and the lack of literature on this argument, further studies are necessary to improve the evidences on the topic.

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No. 46 Improvement in Pain, Function and Quality of Life in Subacute Low Back Pain a Controlled Clinical Trial of Exercise vs. NSAIDS

PM&R ◽

10.1016/j.pmrj.2014.08.333 ◽

2014 ◽

Vol 6 (8) ◽

pp. S92

Author(s):

Jesus Alberto Plata Contreras ◽

Luz Elena Lugo Agudelo ◽

Fabio Alonso Salinas Duran ◽

Kelly De S. Payares

Keyword(s):

Quality Of Life ◽

Clinical Trial ◽

Low Back Pain ◽

Back Pain ◽

Controlled Clinical Trial ◽

Low Back ◽

Subacute Low Back Pain

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Power Point Therapy: An Effective and Simple Treatment for Subacute Back Pain – A Randomized Controlled Trial

Complementary Medicine Research ◽

10.1159/000494458 ◽

2019 ◽

Vol 26 (2) ◽

pp. 80-92

Author(s):

Michael Ofner ◽

Martin Liebhauser ◽

Harald Walach

Keyword(s):

Quality Of Life ◽

Low Back Pain ◽

Back Pain ◽

Secondary Outcome ◽

Controlled Study ◽

Low Back ◽

Subacute Low Back Pain ◽

Functional Scores ◽

Power Point

Objective: Subacute low back pain is a frequent problem with the danger of chronification. Conventional treatment options are not always effective. Power Point therapy (PPT) is a novel approach that uses reflexological insights and can be easily applied by practitioners and patients. Methods: Randomized, active controlled study comparing 10 units of PPT of 10 min each, with 10 units of standard physiotherapy of 30 min each. Outcomes were functional scores (Roland Morris Disability, Oswestry, McGill Pain Questionnaire, Linton-Halldén – primary outcome) and health-related quality of life (SF-36), as well as blinded assessments by clinicians (secondary outcome). Results: Eighty patients consented and were randomized, 41 to PPT, 39 to physiotherapy. Measurements were taken at baseline, after the first and after the last treatment (approximately 5 weeks after enrolment). Multivariate linear models of covariance showed significant effects of time and group (p < 0.001) and for the quality of life variables also a significant interaction of time by group (p < 0.001). Clinician-documented variables showed significant differences at follow-up (p = 0.05 to p < 0.0001). Discussion: Both physiotherapy and PPT improve subacute low back pain significantly. PPT is likely more effective and should be studied further.

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How does spinal movement variability change in people with low back pain?: protocol for a systematic review

10.1101/2020.04.07.20053538 ◽

2020 ◽

Author(s):

Hiroki Saito ◽

Hiroshi takasaki ◽

Yoshiteru Watanabe ◽

Toshiki Kutsuna ◽

Toshihiro Futohashi ◽

...

Keyword(s):

Systematic Review ◽

Low Back Pain ◽

Back Pain ◽

Meta Analysis ◽

Grey Literature ◽

Risk Of Bias ◽

Low Back ◽

Movement Variability ◽

Trunk Movements ◽

Spinal Movement

AbstractLow back pain(LBP) is the number one cause of disability worldwide. One factor which might potentially contribute to ongoing pain is impaired spinal movement variability. It is uncertain how movement variability changes during trunk movements in the presence of LBP. In this protocol, we will systematically investigate and compare both the amount and structure of spinal movement variability during repeated trunk motions between people with and without LBP. The results will be reported in line with the PRISMA(Preferred Reporting Items for Systematic Review and Meta-Analysis). Searches will be conducted on CENTRAL, PubMed, MEDLINE, EMBASE, and CINAHL databases, along with a comprehensive review of grey literature and key journals.Three pairs of two independent reviewers will screen potential studies and two independent reviewers assess the risk of bias within studies which meet the inclusion criteria. The Newcastle-Ottawa risk of bias tool will be used to assess the quality of the data.

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Spinal manipulative therapy and acupuncture for chronic low back pain: a systematic review and meta-analysis of RCTs

10.21203/rs.3.rs-1192409/v1 ◽

2021 ◽

Author(s):

Ting Yue ◽

Jingjing Li ◽

Jiaman Yang ◽

Dehui Fan

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Adverse Events ◽

Chronic Low Back Pain ◽

Meta Analysis ◽

Cochrane Library ◽

Low Back ◽

Quality Of Evidence ◽

Moderate Quality

Abstract Background Spinal manipulation therapy (SMT) and acupuncture are commonly used for low back pain (LBP) among complementary and alternative therapies. However, it remains unclear which of the two therapies is more effective for LBP. Therefore, the purpose of this meta-analysis was to evaluate the effectiveness of SMT and acupuncture on LBP. Methods Four electronic databases were searched for randomized controlled trials (all years until July 2021), including PubMed, Embase, Web of Science, and Cochrane Library. Two reviewers independently abstracted data, assessed risk of bias, and rated the quality of evidence. The primary outcome was pain; secondary outcomes included functional status and adverse events. Review Manager 5.3 software and Stata 12.0 were used for all statistical analyses. Results 9 RCTs with a total of 714 participants were identified, who were on average middle aged (39-60 years) without signs of radiating pain. These trials included patients with mild to moderate pain. Overall, moderate quality of evidence suggested that SMT had better effects for pain relief (MD: 0.32, 95%CI: 0.09 to 0.55, I2=34%) and similar effects in function (MD: 0.24, 95%CI: -0.45 to 0.94, I2=21%) when compared to acupuncture. Moderate quality of evidence showed SMT reduced pain better than acupuncture at month 2 (MD: 0.61, 95%CI: 0.08 to 1.14, I2=0%) and at month 12 (MD: 1.02, 95%CI: 0.28 to 1.75, I2=42%). In addition, Low quality of evidence showed SMT may provide better improvement in pain at month 3 (MD: 0.74, 95%CI: 0.09 to 1.39, I2=42%) and in function at month 4 (MD: 3.50, 95%CI: 0.71 to 6.29). Adverse events associated with SMT and acupuncture were rare and mild. Conclusions SMT showed better effects than acupuncture for chronic low back pain, while SMT and acupuncture had similar effects in functional improvement. Although SMT and acupuncture were tolerable and safe, patients should be informed about the potential risks of adverse events before starting therapy.

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Emergency department interventions for adult patients with low back pain: a systematic review of randomised controlled trials

Emergency Medicine Journal ◽

10.1136/emermed-2020-209588 ◽

2020 ◽

Vol 38 (1) ◽

pp. 59-68

Author(s):

Crystian B Oliveira ◽

Hugo E Amorim ◽

Danielle M Coombs ◽

Bethan Richards ◽

Marco Reedyk ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Risk Of Bias ◽

Low Back ◽

Pharmacological Treatments ◽

Moderate Quality ◽

Intravenous Paracetamol ◽

Randomised Controlled ◽

Quality Evidence

BackgroundMost low back pain trials have limited applicability to the emergency department (ED) because they provide treatment and measure outcomes after discharge from the ED. We investigated the efficacy and safety of pharmacological and non-pharmacological interventions delivered in the ED to patients with non-specific low back pain and/or sciatica on patient-relevant outcomes measured during the emergency visit.MethodsLiterature searches were performed in MEDLINE, EMBASE and CINAHL from inception to week 1 February 2020. We included all randomised controlled trials investigating adult patients (≥18 years) with non-specific low back pain and/or sciatica presenting to ED. The primary outcome of interest was pain intensity. Two reviewers independently screened the full texts, extracted the data and assessed risk of bias of each trial using the Physiotherapy Evidence Database (PEDro) scale. The overall quality of evidence, or certainty, provided by a set of trials evaluating the same treatment was evaluated using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach, which considers imprecision, inconsistency, indirectness and bias in the evidence.ResultsFifteen trials (1802 participants) were included with 12 of 15 at low risk of bias (ie, PEDro score >6). Based on results from individual trials and moderate quality evidence, ketoprofen gel was more effective than placebo for non-specific low back pain at 30 min (mean difference (MD) −15.0, 95% confidence interval (CI) −21.0 to −9.0). For those with sciatica (moderate quality evidence), intravenous paracetamol (acetaminophen) (MD −15.7, 95% CI −19.8 to −11.6) and intravenous morphine (MD −11.4, 95% CI −21.6 to −1.2) were both superior to placebo at 30 min. Based on moderate quality of evidence, corticosteroids showed no benefits against placebo at emergency discharge for non-specific low back pain (MD 9.0, 95% CI −0.71 to 18.7) or sciatica (MD −6.8, 95% CI −24.2 to 10.6). There were conflicting results from trials comparing different pharmacological options (moderate quality evidence) or investigating non-pharmacological treatments (low quality evidence).ConclusionKetoprofen gel for non-specific low back pain and intravenous paracetamol or morphine for sciatica were superior to placebo, whereas corticosteroids were ineffective for both conditions. There was conflicting evidence for comparisons of different pharmacological options and those involving non-pharmacological treatments. Additional trials measuring important patient-related outcomes to EDs are needed.

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Addition of specific hip strengthening exercises to conventional rehabilitation therapy for low back pain: a systematic review and meta-analysis

Clinical Rehabilitation ◽

10.1177/0269215520941914 ◽

2020 ◽

Vol 34 (11) ◽

pp. 1368-1377

Author(s):

Fabio Luciano Arcanjo de Jesus ◽

Thiago Yukio Fukuda ◽

Camila Souza ◽

Janice Guimarães ◽

Leticia Aquino ◽

...

Keyword(s):

Low Back Pain ◽

Back Pain ◽

Random Effect ◽

Cochrane Central Register ◽

Low Back ◽

Quality Of Evidence ◽

Rehabilitation Therapy ◽

Strengthening Exercises ◽

Hip Strengthening

Objective: To examine the effectiveness of hip strengthening exercises in reducing pain and disability in persons with low back pain. Methods: We searched for randomized controlled clinical trials on MEDLINE, the Physiotherapy Evidence Database, the Cochrane Central Register of Controlled Trials, LILACS, Scielo and CINAHL from the earliest date available to June 2020. Studies that included hip strengthening exercises for persons with low back pain and included pain and/or disability as an outcome measure were evaluated by two independent reviewers. Mean difference (MD), and 95% confidence interval (CI) were estimated by random effect models. Results: Five studies met the eligibility criteria (309 patients). Four studies included hip strengthening in conjunction with other interventions, while one study evaluated hip strengthening as a standalone intervention. Hip strengthening exercises improved pain (MD −5.4 mm, 95% CI: −8.9 to −1.8 mm), and disability (MD −2.9; 95% CI: −5.6 to −0.1) in persons with low back pain compared to interventions in which hip strengthening was not utilized. The quality of evidence for the pain outcome, was assessed as being moderate. The quality of evidence for the outcome of self-reported disability, was assessed as being low. Conclusion: Addition of specific hip strengthening exercises to conventional rehabilitation therapy may be beneficial for improving pain and disability in persons with low back pain.

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Clinical course of patients with low back pain following an emergency department presentation: a systematic review and meta-analysis

Emergency Medicine Journal ◽

10.1136/emermed-2019-209294 ◽

2020 ◽

pp. emermed-2019-209294 ◽

Cited By ~ 1

Author(s):

Danielle M Coombs ◽

Gustavo C Machado ◽

Bethan Richards ◽

Crystian B Oliveira ◽

Robert D Herbert ◽

...

Keyword(s):

Emergency Department ◽

Low Back Pain ◽

Back Pain ◽

Pain Intensity ◽

Clinical Course ◽

Meta Analysis ◽

Risk Of Bias ◽

Low Back ◽

Pain Experience

IntroductionLow back pain, and especially non-specific low back pain, is a common cause of presentation to the emergency department (ED). Although these patients typically report relatively high pain intensity, the clinical course of their pain and disability remains unclear. Our objective was to review the literature and describe the clinical course of non-specific low back pain after an ED visit.MethodsElectronic searches were conducted using MEDLINE, CINAHL and EMBASE from inception to March 2019. We screened for cohort studies or randomised trials investigating pain or disability in patients with non-specific low back pain presenting to EDs. We excluded studies that enrolled participants with minimal pain or disability scores at baseline. Two reviewers independently screened the full texts, extracted the data and assessed risk of bias and quality of evidence. Estimates of pain and disability were converted to a common 0–100 scale. We estimated pooled means and 95% CIs of pain and disability as a function of time since ED presentation.ResultsEight studies (nine publications) with a total of 1994 patients provided moderate overall quality evidence of the expected clinical course of low back pain after an ED visit. Seven of the eight studies were assessed to have a low risk of bias. At the time of the ED presentation, the pooled estimate of the mean pain score on a 0–100 scale was 71.0 (95% CI 64.2–77.9). This reduced to 46.1 (95% CI 37.2–55.0) after 1 day, 41.8 (95% CI 34.7 to 49.0) after 1 week and 13.5 (95% CI 5.8–21.3) after 26 weeks. The course of disability followed a similar pattern.ConclusionsPatients presenting to EDs with non-specific low back pain experience rapid reductions in pain intensity, but on average symptoms persisted 6 months later. This review can be used to educate patients so they can have realistic expectations of their recovery.

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The effect of chronic, non-specific low back pain on superficial lumbar muscle activity: a protocol for a systematic review and meta-analysis

BMJ Open ◽

10.1136/bmjopen-2019-029850 ◽

2019 ◽

Vol 9 (10) ◽

pp. e029850 ◽

Cited By ~ 2

Author(s):

Andy Sanderson ◽

Alison B Rushton ◽

Eduardo Martinez Valdes ◽

Nicola R Heneghan ◽

Alessio Gallina ◽

...

Keyword(s):

Systematic Review ◽

Low Back Pain ◽

Back Pain ◽

Muscle Activity ◽

Meta Analysis ◽

Grey Literature ◽

Risk Of Bias ◽

Low Back ◽

Comprehensive Review ◽

Lumbar Muscle

IntroductionChronic, non-specific low back pain is a major global cause of disability. One factor which might potentially contribute to ongoing pain is maladaptive variation in the level of activity in the lumbar musculature. Several studies have investigated this activity using surface electromyography, in varied muscles and during a number of functional activities. Due to differences in the applied methodology, the results have been difficult to compare, and previous reviews have been limited in scope. In this protocol, we aim to perform a comprehensive review of the effect of chronic low back pain on lumbar muscle activity.Methods and analysisThis protocol was informed by the Preferred Reporting Items for Systematic Review and Meta-analysis Protocols (PRISMA-P) and results will be reported in line with the PRISMA. Searches will be conducted on the Web of Science, PubMed, MEDLINE, EMBASE, ZETOC and CINAHL databases, along with a comprehensive review of grey literature and key journals. One reviewer will conduct the searches, but two independent reviewers will screen potential studies and assess the risk of bias within studies which meet the inclusion criteria. The Newcastle-Ottawa risk of bias tool, and the Grading of Recommendations, Assessment, Development and Evaluation (GRADE) guidelines will be used to assess the quality of the data. Meta-analysis will be conducted where appropriate on groups of studies with homogenous methodology. Where studies are too heterogeneous to allow for meta-analysis, meta-synthesis will instead be completed, comparing results in terms of net increases or decreases of activity.Ethics and disseminationThis review aims to identify common adaptations of muscle activity in people with low back pain and it is expected that the results will influence future research directions and future rehabilitation approaches. The results will be submitted for publication in a peer-reviewed journal and presented at conferences.Prospero registration numberCRD42019125156

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