The (cost-)effectiveness of combined lifestyle interventions for people with persistent low-back pain who are overweight or obese: A systematic review

J C J Huijbers; P Coenen; G L B Burchell; M W Coppieters; I H M Steenhuis; J H Van Dieën; B W Koes; D H R Kempen; J R Anema; I Kingma; L Voogt; C M Williams; J M Van Dongen; H P Van der Ploeg; R W J G Ostelo; G G M Scholten-Peeters

doi:10.1016/j.msksp.2023.102770

The (cost-)effectiveness of combined lifestyle interventions for people with persistent low-back pain who are overweight or obese: A systematic review

Musculoskelet Sci Pract. 2023 Jun:65:102770. doi: 10.1016/j.msksp.2023.102770. Epub 2023 May 4.

Authors

J C J Huijbers¹, P Coenen², G L B Burchell³, M W Coppieters⁴, I H M Steenhuis⁵, J H Van Dieën¹, B W Koes⁶, D H R Kempen⁷, J R Anema⁸, I Kingma¹, L Voogt⁹, C M Williams¹⁰, J M Van Dongen¹¹, H P Van der Ploeg¹², R W J G Ostelo¹³, G G M Scholten-Peeters¹

Affiliations

¹ Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences Vrije Universiteit Amsterdam, Amsterdam Movement Sciences Program Musculoskeletal Health, the Netherlands.
² Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Amsterdam, the Netherlands. Electronic address: p.coenen@amsterdamumc.nl.
³ Medical Library, Vrije Universiteit Amsterdam, the Netherlands.
⁴ Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences Vrije Universiteit Amsterdam, Amsterdam Movement Sciences Program Musculoskeletal Health, the Netherlands; Menzies Health Institute Queensland, Griffith University, Brisbane & Gold Coast, Australia.
⁵ Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences Vrije Universiteit Amsterdam, Amsterdam Movement Sciences Program Musculoskeletal Health, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.
⁶ Erasmus Medical Center, University Medical Center Rotterdam, Department of General Practice, the Netherlands.
⁷ Department of Orthopedic Surgery, Joint Research, OLVG Amsterdam, Amsterdam, the Netherlands.
⁸ Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam, the Netherlands.
⁹ NVVR, Dutch Society of Back Pain, the Netherlands.
¹⁰ School of Health Sciences, University of Sydney, Australia; Research and Knowledge Translation Directorate, Mid-North Coast Local Health District, Australia.
¹¹ Faculty of Science and the Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Faculty of Science and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.
¹² Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam, the Netherlands.
¹³ Department of Health Sciences, Faculty of Science and Amsterdam Movement Sciences, Vrije Universiteit, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, Vrije Universiteit Medical Center, Amsterdam, the Netherlands.

PMID: 37167807
DOI: 10.1016/j.msksp.2023.102770

Abstract

Introduction: Lifestyle factors are expected to contribute to the persistence and burden of low-back pain (LBP). However, there are no systematic reviews on the (cost-)effectiveness of combined lifestyle interventions for overweight or obese people with LBP.

Aim: To assess whether combined lifestyle interventions are (cost-)effective for people with persistent LBP who are overweight or obese, based on a systematic review.

Design: Systematic review METHOD: PubMed, Cochrane, Embase, CINAHL, PsycINFO and the Wiley/Cochrane Library were searched from database inception till January 6^th 2023. Two independent reviewers performed study selection, data-extraction and risk of bias scoring using the Cochrane RoB tool 2 and/or the Consensus Health Economic Criteria list. GRADE was used to assess the level of certainty of the evidence.

Results: In total 2510 records were screened, and 4 studies on 3 original RCTs with 216 participants were included. Low certainty evidence (1 study) showed that combined lifestyle interventions were not superior to usual care for physical functioning, pain and lifestyle outcomes. Compared to usual care, moderate certainty evidence showed that healthcare (-$292, 95%CI: 872; -33), medication (-$30, 95% CI -65; -4) and absenteeism costs (-$1000, 95%CI: 3573; -210) were lower for the combined lifestyle interventions.

Conclusion: There is low certainty evidence from 3 studies with predominantly small sample sizes, short follow-up and low intervention adherence that combined lifestyle interventions are not superior to physical functioning, pain and lifestyle outcomes compared to usual care, but are likely to be cost-effective.

Keywords: Economic evaluation; Healthy lifestyle; Musculoskeletal pain; Obesity; Physical therapy; Rehabilitation.

Publication types

Systematic Review
Review

MeSH terms

Cost-Benefit Analysis
Cost-Effectiveness Analysis
Healthy Lifestyle*
Low Back Pain* / rehabilitation
Low Back Pain* / therapy
Obesity* / therapy
Overweight* / therapy
Physical Therapy Modalities