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  • Response to Discussion: ‘Which specific modes of exercise training are most effective for treating low back pain? Network meta-analysis’

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Response to Discussion: ‘Which specific modes of exercise training are most effective for treating low back pain? Network meta-analysis’
  1. Daniel L Belavy1,
  2. Patrick J Owen1,
  3. Clint T Miller2,
  4. Niamh L Mundell2,
  5. Scott D Tagliaferri2,
  6. Helena Brisby3,
  7. Steven J Bowe4
  1. 1 Institute for Physical Activity and Nutrition, Deakin University, Burwood, Victoria, Australia
  2. 2 School of Exercise and Nutrition Sciences, Deakin University, Burwood, Victoria, Australia
  3. 3 Department of Orthopaedics, Institute of Clinical Sciences, University of Gothenburg, Gothenburg, Sweden
  4. 4 Biostatistics Unit, Faculty of Health, Deakin University, Burwood, Victoria, Australia
  1. Correspondence to A/Prof Daniel L Belavy, Institute for Physical Activity and Nutrition, Deakin University, Burwood 3217, Victoria, Australia; belavy{at}gmail.com, d.belavy{at}deakin.edu.au

http://dx.doi.org/10.1136/bjsports-2020-102673

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    We recently published1 a network meta-analysis (NMA) on the effect of different modes of exercise training in patients with chronic non-specific low back pain in the British Journal of Sports Medicine. We respond here to the questions posed by Maher et al.2

    The authors of the letter commented that potential effect-modifying covariates need more investigation (evaluation of transitivity). As per NMA guidelines,3 we investigated potential effect-modifying covariates. Baseline pain and disability are commonly4–6 identified as key predictors of prognosis and treatment outcome for back pain. In our NMA,1 we presented these analyses in Supplemental Figure 2 of the original manuscript. These potential effect-modifying covariates (baseline pain, baseline disability) did not differ across the groups investigated. There might be many opinions7 on how to assess potential effect-modifying covariates and how to account for them in an NMA, as yet there is no consensus. Our analyses and reporting were based on current practices for NMA.3

    The authors of the letter noted that forest plots/league tables were not provided. Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines state that forest plots and/or league tables ‘may be considered’ but are not required.8 9 The comment reflects a different view …

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    Footnotes

    • Twitter @BelavySpine

    • Contributors All authors contributed to this response.

    • Funding The network meta-analysis in discussion was funded by Musculoskeletal Australia (formerly MOVE muscle, bone and joint health; CONTR2017/00399; not-for-profit sector).

    • Competing interests None declared.

    • Patient consent for publication Not required.

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