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Exercise alone and exercise combined with education both prevent episodes of low back pain and related absenteeism: systematic review and network meta-analysis of randomised controlled trials (RCTs) aimed at preventing back pain
  1. Rongzhong Huang1,2,
  2. Jie Ning1,
  3. Vivienne H Chuter3,
  4. Jeffrey Bruce Taylor4,5,
  5. Demoulin Christophe6,
  6. Zengdong Meng7,
  7. Yu Xu8,
  8. Lihong Jiang1
  1. 1Department of Cardiothoracic Surgery, The First People’s Hospital of YunNan Province, Kunming, China
  2. 2Department of Gerontology, The Second Affiliated Hospital of Chongqing Medical University, Chongqing, China
  3. 3School of Health Sciences, University of Newcastle, Ourimbah, New South Wales, Australia
  4. 4Physical Therapy, High Point University, High Point, North Carolina, USA
  5. 5Kinesiology, University of North Carolina at Greensboro, Greensboro, North Carolina, USA
  6. 6Department of Sport and Rehabilitation Sciences, University of Liege, Liege, Belgium
  7. 7Department of Orthopedics, First People’s Hospital of YunNan Province, YunNan, China
  8. 8Statistical Laboratory, Chongqing Chuangxu Lifescience Institute, Chongqing, China
  1. Correspondence to Dr Lihong Jiang, The First People’s Hospital of YunNan Province, Kunming 650000, China; lihong-jiang{at}


Objectives We aimed to investigate which prevention strategies for low back pain (LBP) are most effective.

Design We completed a Bayesian network meta-analysis to summarise the comparative effectiveness of LBP prevention strategies. The primary outcomes were an episode of LBP and LBP-associated work absenteeism represented as ORs with associated 95% credibility intervals (CrIs). We ranked all prevention strategies with surface under the cumulative ranking curve (SUCRA) analysis.

Data sources PubMed, EMBASE and CENTRAL databases were searched along with manual searches of retrieved articles. We only included randomised controlled trials (RCTs) that reported an episode of LBP and/or LBP-associated work absenteeism evaluating LBP prevention strategies were included.

Eligibility criteria for selecting studies Data were independently extracted by two investigators, and RCT quality was assessed using the Cochrane Risk of Bias tool.

Results and summary Forty RCTs were included. Exercise combined with education (OR: 0.59, CrI: 0.41 to 0.82) and exercise alone (OR: 0.59, CrI: 0.36 to 0.92) both prevented LBP episodes; exercise combined with education and education alone both had large areas under the curve (SUCRA: 81.3 and 79.4, respectively). Additionally, exercise (OR: 0.04, CrI: 0.00 to 0.34) prevented LBP-associated work absenteeism, with exercise and the combination of exercise and education ranking highest (SUCRA: 99.0 and 60.2, respectively).

Conclusions Exercise alone and exercise combined with education can prevent episodes of LBP and LBP-related absenteeism.

Trial registration number PROSPERO 42017056884.

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  • Contributors RH, JN, YX and ZM screened titles and abstracts. VHC, JBT, DC, YX and RH performed methodological quality assessments and data extraction, methodological quality assessments and data analyses. RH, JN, VHC, JBT, DC and LJ wrote the initial draft of the manuscript and all review authors critically reviewed the manuscript.

  • Funding This work was supported by the National Natural Science Foundation of China (grant no. 31300137).

  • Competing interests None declared.

  • Patient consent for publication Not required.

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

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