TY - JOUR T1 - Effectiveness of treatments for acute and subacute mechanical non-specific low back pain: a systematic review with network meta-analysis JF - British Journal of Sports Medicine JO - Br J Sports Med DO - 10.1136/bjsports-2020-103596 SP - bjsports-2020-103596 AU - Silvia Gianola AU - Silvia Bargeri AU - Gabriele Del Castillo AU - Davide Corbetta AU - Andrea Turolla AU - Anita Andreano AU - Lorenzo Moja AU - Greta Castellini Y1 - 2021/04/12 UR - http://bjsm.bmj.com/content/early/2021/10/21/bjsports-2020-103596.abstract N2 - Objective To assess the effectiveness of interventions for acute and subacute non-specific low back pain (NS-LBP) based on pain and disability outcomes.Design A systematic review of the literature with network meta-analysis.Data sources Medline, Embase and CENTRAL databases were searched from inception until 17 October 2020.Eligibility criteria for selecting studies Randomised clinical trials (RCTs) involving adults with NS-LBP who experienced pain for less than 6 weeks (acute) or between 6 and 12 weeks (subacute).Results Forty-six RCTs (n=8765) were included; risk of bias was low in 9 trials (19.6%), unclear in 20 (43.5%), and high in 17 (36.9%). At immediate-term follow-up, for pain decrease, the most efficacious treatments against an inert therapy were: exercise (standardised mean difference (SMD) −1.40; 95% confidence interval (CI) −2.41 to –0.40), heat wrap (SMD −1.38; 95% CI −2.60 to –0.17), opioids (SMD −0.86; 95% CI −1.62 to –0.10), manual therapy (SMD −0.72; 95% CI −1.40 to –0.04) and non-steroidal anti-inflammatory drugs (NSAIDs) (SMD −0.53; 95% CI −0.97 to –0.09). Similar findings were confirmed for disability reduction in non-pharmacological and pharmacological networks, including muscle relaxants (SMD -0.24; 95% CI -0.43 to -0.04). Mild or moderate adverse events were reported in the opioids (65.7%), NSAIDs (54.3%) and steroids (46.9%) trial arms.Conclusion With uncertainty of evidence, NS-LBP should be managed with non-pharmacological treatments which seem to mitigate pain and disability at immediate-term. Among pharmacological interventions, NSAIDs and muscle relaxants appear to offer the best harm–benefit balance.Data are available in a public, open access repository: https://osf.io/q24xh ER -