Prevention strategies to reduce future impact of low back pain: a systematic review and meta-analysis

Tarcisio F de Campos; Chris G Maher; Joel T Fuller; Daniel Steffens; Stephanie Attwell; Mark J Hancock

doi:10.1136/bjsports-2019-101436

Prevention strategies to reduce future impact of low back pain: a systematic review and meta-analysis

Br J Sports Med. 2021 May;55(9):468-476. doi: 10.1136/bjsports-2019-101436. Epub 2020 Jul 9.

Authors

Tarcisio F de Campos¹, Chris G Maher^{2

3}, Joel T Fuller⁴, Daniel Steffens^{5

6}, Stephanie Attwell⁴, Mark J Hancock⁴

Affiliations

¹ Department of Health Professions, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia tarcisiofolly@gmail.com.
² Sydney School of Public Health, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.
³ Institute for Musculoskeletal Health, The University of Sydney, Sydney, New South Wales, Australia.
⁴ Department of Health Professions, Faculty of Medicine, Health and Human Sciences, Macquarie University, Sydney, New South Wales, Australia.
⁵ Royal Prince Alfred Hospital, Surgical Outcomes Research Centre (SOuRCe), Sydney, New South Wales, Australia.
⁶ Central Clinical School, Faculty of Medicine and Health, The University of Sydney, Sydney, New South Wales, Australia.

PMID: 32646887
DOI: 10.1136/bjsports-2019-101436

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.

Keywords: lower back; meta-analysis; prevention; randomised controlled trial; review.

Publication types

Meta-Analysis
Systematic Review

MeSH terms

Adult
Bias
Child
Confidence Intervals
Disability Evaluation
Ergonomics
Exercise*
Female
Humans
Low Back Pain / physiopathology
Low Back Pain / prevention & control*
Male
Middle Aged
Pain Measurement
Patient Education as Topic*
Pregnancy
Quality of Life
Randomized Controlled Trials as Topic
Secondary Prevention*