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Are group-based and individual physiotherapy exercise programmes equally effective for musculoskeletal conditions? A systematic review and meta-analysis
  1. Mary O'Keeffe1,
  2. Amy Hayes1,
  3. Karen McCreesh1,
  4. Helen Purtill2,
  5. Kieran O'Sullivan1
  1. 1Department of Clinical Therapies, University of Limerick, Limerick, Ireland
  2. 2Department of Mathematics and Statistics, University of Limerick, Limerick, Ireland
  1. Correspondence to Mary O'Keeffe, Department of Clinical Therapies, University of Limerick, Health Sciences Building, Castletroy, Limerick, Ireland; Mary.OKeeffe{at}


Background Musculoskeletal pain is common and its treatment costly. Both group and individual physiotherapy interventions which incorporate exercise aim to reduce pain and disability. Do the additional time and costs of individual physiotherapy result in superior outcomes?

Objective To compare the effectiveness of group and individual physiotherapy including exercise on musculoskeletal pain and disability.

Methods Eleven electronic databases were searched by two independent reviewers. Randomised controlled trials (RCTs) including participants with musculoskeletal conditions which compared group and individual physiotherapy interventions that incorporated exercise were eligible. Study quality was assessed using the PEDro scale by two independent reviewers, and treatment effects were compared by meta-analyses.

Results Fourteen RCTs were eligible, including patients with low back pain (7 studies), neck pain (4), knee pain (2) and shoulder pain (1). We found no clinically significant differences in pain and disability between group and individual physiotherapy involving exercise.

Conclusions Only small, clinically irrelevant differences in pain or disability outcomes were found between group and individual physiotherapy incorporating exercise. Since all but one study included other interventions together with exercise in either the group or individual arm, deciphering the unique effect of the way in which exercise is delivered is difficult. Group interventions may need to be considered more often, given their similar effectiveness and potentially lower healthcare costs.

  • Exercise
  • Physiotherapy
  • Evidence based review
  • Meta-analysis

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  • Twitter Follow Mary O'Keeffe at @MaryOKeeffe1990

  • Contributors MO, KO, KM and AH were involved in conception and design. MO and AH independently performed the search and reviewed the literature; carried out the data extraction; rated the quality of the studies. HP performed the meta-analysis. All authors were involved in data analysis and interpretation, and in preparing the manuscript for publication.

  • Funding MO is supported by an Irish Research Council postgraduate scholarship.

  • Competing interests KO receives income from delivering educational courses and workshops on the use of an individualised, multidimensional approach to managing chronic low back pain. KM has received funding to conduct research into the use of a group exercise approach for people with shoulder pain.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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