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Prevention strategies to reduce future impact of low back pain: a systematic review and meta-analysis
  1. Tarcisio F de Campos1,
  2. Chris G Maher2,3,
  3. Joel T Fuller1,
  4. Daniel Steffens4,5,
  5. Stephanie Attwell1,
  6. Mark J Hancock1
  1. 1Department of Health Professions, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia
  2. 2Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
  3. 3Institute for Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia
  4. 4Royal Prince Alfred Hospital, Surgical Outcomes Research Centre (SOuRCe), Sydney, New South Wales, Australia
  5. 5Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia
  1. Correspondence to Tarcisio F de Campos, Department of Health Professions, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, 2109, Australia; tarcisiofolly{at}gmail.com

Abstract

Objective To evaluate the evidence from randomised controlled trials (RCTs) on the effectiveness of prevention strategies to reduce future impact of low back pain (LBP), where impact is measured by LBP intensity and associated disability.

Design Systematic review with meta-analysis.

Data sources MEDLINE, Embase, CINAHL, PEDro and The Cochrane (CENTRAL) databases from inception to 22 October 2018.

Eligibility criteria RCTs evaluating any intervention aiming to prevent future impact of LBP, reporting an outcome measure of LBP intensity and/or disability measured at least 3 months post-randomisation, and the intervention group must be compared with a group that received no intervention/placebo or minimal intervention. Trials restricting recruitment to participants with current LBP were excluded.

Results 27 published reports of 25 different trials including a total of 8341 participants fulfilled the inclusion criteria. The pooled results, from three RCTs (612 participants), found moderate-quality evidence that an exercise programme can prevent future LBP intensity (mean difference (MD) −4.50; 95% CI −7.26 to −1.74), and from 4 RCTs (471 participants) that an exercise and education programme can prevent future disability due to LBP (MD −6.28; 95% CI −9.51 to −3.06). It is uncertain whether prevention programmes improve future quality of life (QoL) and workability due to the overall low-quality and very low-quality available evidence.

Conclusions This review provides moderate-quality evidence that an exercise programme, and a programme combining exercise and education, are effective to reduce future LBP intensity and associated disability. It is uncertain whether prevention programmes can improve future QoL and workability. Further high-quality RCTs evaluating prevention programmes aiming to reduce future impact of LBP are needed.

  • lower back
  • prevention
  • randomised controlled trial
  • review
  • meta-analysis

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Footnotes

  • Twitter @TF_Campos, @CGMMaher, @SOuRCe_RPA

  • Contributors TFdC and MH had full access to all the data in this systematic review and take responsibility for the integrity of the data and the accuracy of the data analysis. Study concept and design: TFdC, CGM, JTF, DS, MH. Acquisition, analysis or interpretation of data: all authors. Drafting of the manuscript: TFdC, CGH, MH. Critical revision of the manuscript for important intellectual content: all authors. Statistical analysis: TFdC, CGM, JTF, MH. Administrative, technical or material support: TFdC, JTF, DS, SA, MH. Study supervision: TFdC, CGH, MH.

  • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

  • Competing interests None declared.

  • Patient consent for publication Not required.

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