TY - JOUR T1 - Exercise treatment effect modifiers in persistent low back pain: an individual participant data meta-analysis of 3514 participants from 27 randomised controlled trials JF - British Journal of Sports Medicine JO - Br J Sports Med SP - 1277 LP - 1278 DO - 10.1136/bjsports-2019-101205 VL - 54 IS - 21 AU - Jill A Hayden AU - Maria N Wilson AU - Samuel Stewart AU - Jennifer L Cartwright AU - Andrea O Smith AU - Richard D Riley AU - Maurits van Tulder AU - Tom Bendix AU - Francesca Cecchi AU - Leonardo O P Costa AU - Ninna Dufour AU - Manuela L Ferreira AU - Nadine E Foster AU - Maruti R Gudavalli AU - Jan Hartvigsen AU - Pieter Helmhout AU - Jan Kool AU - George A Koumantakis AU - Francisco M Kovacs AU - Tiina Kuukkanen AU - Audrey Long AU - Luciana G Macedo AU - Luciana A C Machado AU - Chris G Maher AU - Wolf Mehling AU - Giovanni Morone AU - Tom Peterson AU - Eva Rasmussen-Barr AU - Cormac G Ryan AU - Tuulikki Sjögren AU - Rob Smeets AU - J Bart Staal AU - Monica Unsgaard-Tøndel AU - Henry Wajswelner AU - Ella W Yeung A2 - , Y1 - 2020/11/01 UR - http://bjsm.bmj.com/content/54/21/1277.abstract N2 - Background Low back pain is one of the leading causes of disability worldwide. Exercise therapy is widely recommended to treat persistent non-specific low back pain. While evidence suggests exercise is, on average, moderately effective, there remains uncertainty about which individuals might benefit the most from exercise.Methods In parallel with a Cochrane review update, we requested individual participant data (IPD) from high-quality randomised clinical trials of adults with our two primary outcomes of interest, pain and functional limitations, and calculated global recovery. We compiled a master data set including baseline participant characteristics, exercise and comparison characteristics, and outcomes at short-term, moderate-term and long-term follow-up. We conducted descriptive analyses and one-stage IPD meta-analysis using multilevel mixed-effects regression of the overall treatment effect and prespecified potential treatment effect modifiers.Results We received IPD for 27 trials (3514 participants). For studies included in this analysis, compared with no treatment/usual care, exercise therapy on average reduced pain (mean effect/100 (95% CI) −10.7 (−14.1 to –7.4)), a result compatible with a clinically important 20% smallest worthwhile effect. Exercise therapy reduced functional limitations with a clinically important 23% improvement (mean effect/100 (95% CI) −10.2 (−13.2 to –7.3)) at short-term follow-up. Not having heavy physical demands at work and medication use for low back pain were potential treatment effect modifiers—these were associated with superior exercise outcomes relative to non-exercise comparisons. Lower body mass index was also associated with better outcomes in exercise compared with no treatment/usual care. This study was limited by inconsistent availability and measurement of participant characteristics.Conclusions This study provides potentially useful information to help treat patients and design future studies of exercise interventions that are better matched to specific subgroups.Protocol publication https://doi.org/10.1186/2046-4053-1-64 ER -