Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
Meta-Analysis
. 2022 Aug;30(4):207-227.
doi: 10.1080/10669817.2021.2024677. Epub 2022 Jan 24.

Treatment-based classification for low back pain: systematic review with meta-analysis

Robson Massi Bastos  1 , Claudia Regina Moya  1 , Rodrigo Antunes de Vasconcelos  2 , Leonardo Oliveira Pena Costa  1
Affiliations
Meta-Analysis

Treatment-based classification for low back pain: systematic review with meta-analysis

Robson Massi Bastos et al. J Man Manip Ther. 2022 Aug.

Abstract

Objective: To systematically review the effects of treatment-based classification (TBC) in patients with specific and nonspecific acute, subacute and chronic low back pain.

Methods: The following databases were searched: MEDLINE, EMBASE, PsycINFO, Global Health, CENTRAL, Web of Science, CINAHL, SPORTDiscus, PEDro and WHO from inception up to December 2021. We used the PEDro scale, the TIDieR checklist and the GRADE approach to evaluate the risk of bias, quality on reporting and the certainty of the evidence, respectively.

Results: Twenty-three trials (pooled n = 2,649) met the inclusion criteria. We have identified a total of 22 comparisons and 134 estimates of treatment effects. There was a very large heterogeneity with regards to the comparison groups. Most of individual trials had low risk of bias with a mean score of 6.8 (SD = 1.3) on a 0-10 scale. The certainty of evidence for most comparisons was low, which indicates that more high quality and robust trials are needed. We were able to pool the data using a meta-analysis approach for only two comparisons (TBC versus mobility exercises in patients with acute low back pain and traction for patients with sciatica). In general, the TBC approach seems to be useful for patients with acute low back pain, sciatica and with spinal stenosis. We strongly suggest readers to carefully read our summary of findings table for further details on each comparison.

Conclusion: The TBC approach seems to be useful for patients with acute low back pain, sciatica and with spinal stenosis.

Keywords: Low back pain; meta-analysis; physical therapy; subgroup; systematic review.

PubMed Disclaimer

Conflict of interest statement

Rodrigo Vasconcelos promotes TBC continuous education courses in Brazil .

Figures

Figure 1.
Figure 1.
Flow of studies through review.
Figure 2.
Figure 2.
(a) Short-term meta-analysis for pain in studies comparing directional preference exercises plus traction and directional preference exercises; (b) Short-term meta-analysis for disability in studies comparing directional preference exercises plus traction and directional preference exercises. (c) Short-term meta-analysis for pain in studies comparing TBC manipulation and mobility exercises. (d) Short-term meta-analysis for disability in studies comparing TBC manipulation and mobility exercises.
See this image and copyright information in PMC

References

    1. Hoy D, Bain C, Williams G, et al. A systematic review of the global prevalence of low back pain. Arthritis Rheumatism. 2012;64(6):2028–2037. - PubMed
    1. James SL, Abate D, Abate KH, et al. Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990–2017: a systematic analysis for the global burden of disease study 2017. Lancet. 2018;392(10159):1789–1858. - PMC - PubMed
    1. Dagenais S, Caro J, Haldeman S.. A systematic review of low back pain cost of illness studies in the United States and internationally. Spine J. 2008;8(1):8–20. - PubMed
    1. Qaseem A, Wilt TJ, McLean RM, et al. Noninvasive treatments for acute, subacute, and chronic low back pain: a clinical practice guideline from the American College of Physicians. Ann Intern Med. 2017;166(7):514–530. - PubMed
    1. Stochkendahl MJ, Kjaer P, Hartvigsen J, et al. National clinical guidelines for non-surgical treatment of patients with recent onset low back pain or lumbar radiculopathy. Eur Spine J. 2018;27(1):60–75. - PubMed