Is a positive clinical outcome after exercise therapy for chronic non-specific low back pain contingent upon a corresponding improvement in the targeted aspect(s) of performance? A systematic review

Abstract

Introduction

The effect size for exercise therapy in the treatment of chronic non-specific low back pain (cLBP) is only modest. This review aims to analyse the specificity of the effect by examining the relationship between the changes in clinical outcome (pain, disability) and the changes in the targeted aspects of physical function (muscle strength, mobility, muscular endurance) after exercise therapy.

Methods

We searched for exercise therapy trials for cLBP published up to 15 April 2010 in Medline, Embase, Cochrane Library, Cinahl, and PEDro. Two independent reviewers selected studies according to the inclusion criteria. Data extraction: one author extracted the data of the articles.

Results

Data synthesis: 16 studies with a total of 1,476 participants met the inclusion criteria. There was little evidence supporting a relationship between the changes in pain or physical function and the changes in performance for the following measures: mobility (no correlation in 9 studies, weak correlation in 1 study), trunk extension strength (7 and 2, respectively), trunk flexion strength (4 and 1, respectively) and back muscle endurance (7 and 0, respectively). Changes in disability showed no correlation with changes in mobility in three studies and a weak correlation in two; for strength, the numbers were four (no correlation) and two (weak correlation), respectively.

Conclusions

The findings do not support the notion that the treatment effects of exercise therapy in cLBP are directly attributable to changes in the musculoskeletal system. Future research aimed at increasing the effectiveness of exercise therapy in cLBP should explore the coincidental factors influencing symptom improvement.

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Acknowledgments

We acknowledge the financial support of the Institute of Human Movement Sciences and Sport, Swiss Federal Institute of Technology, Zürich, Switzerland. We would like to thank the librarians of the Swiss Federal Institute of Technology Library, Zürich, for their assistance with the literature search.

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Correspondence to A. F. Mannion.

Appendices

Appendix 1: Search strategies used in Ovid, Cochrane, Embase, Cinahl and PEDro databases

Ovid Medline Database search

figurea

Cochrane search with Wiley InterScience

figureb

Embase search

figurec

Cinahl search

figured

PEDro search

figuree

Appendix 2

See Table 4:

Table 4 Excluded studies after full text consultation

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Steiger, F., Wirth, B., de Bruin, E.D. et al. Is a positive clinical outcome after exercise therapy for chronic non-specific low back pain contingent upon a corresponding improvement in the targeted aspect(s) of performance? A systematic review. Eur Spine J 21, 575–598 (2012). https://doi.org/10.1007/s00586-011-2045-6

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Keywords

  • Chronic non-specific low back pain
  • Correlation
  • Clinical outcome
  • Physical performance
  • Exercise therapy