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. 2023 Dec;33(4):636-650.
doi: 10.1007/s10926-023-10124-4. Epub 2023 Nov 22.

Systematic Review to Inform a World Health Organization (WHO) Clinical Practice Guideline: Benefits and Harms of Structured Exercise Programs for Chronic Primary Low Back Pain in Adults

Leslie Verville  1 , Rachel Ogilvie  2 , Cesar A Hincapié  3   4   5 , Danielle Southerst  1 , Hainan Yu  1 , André Bussières  6   7 , Douglas P Gross  8 , Paulo Pereira  9 , Silvano Mior  1   10 , Andrea C Tricco  11   12   13 , Christine Cedraschi  14   15 , Ginny Brunton  1   16   17 , Margareta Nordin  18 , Gaelan Connell  1 , Jessica J Wong  1 , Heather M Shearer  1   10   19 , Joyce G B Lee  10 , Dan Wang  1 , Jill A Hayden  2 , Carol Cancelliere  20
Affiliations

Systematic Review to Inform a World Health Organization (WHO) Clinical Practice Guideline: Benefits and Harms of Structured Exercise Programs for Chronic Primary Low Back Pain in Adults

Leslie Verville et al. J Occup Rehabil. 2023 Dec.

Abstract

Purpose: Evaluate benefits and harms of structured exercise programs for chronic primary low back pain (CPLBP) in adults to inform a World Health Organization (WHO) standard clinical guideline.

Methods: We searched for randomized controlled trials (RCTs) in electronic databases (inception to 17 May 2022). Eligible RCTs targeted structured exercise programs compared to placebo/sham, usual care, or no intervention (including comparison interventions where the attributable effect of exercise could be isolated). We extracted outcomes, appraised risk of bias, conducted meta-analyses where appropriate, and assessed certainty of evidence using GRADE.

Results: We screened 2503 records (after initial screening through Cochrane RCT Classifier and Cochrane Crowd) and 398 full text RCTs. Thirteen RCTs rated with overall low or unclear risk of bias were synthesized. Assessing individual exercise types (predominantly very low certainty evidence), pain reduction was associated with aerobic exercise and Pilates vs. no intervention, and motor control exercise vs. sham. Improved function was associated with mixed exercise vs. usual care, and Pilates vs. no intervention. Temporary increased minor pain was associated with mixed exercise vs. no intervention, and yoga vs. usual care. Little to no difference was found for other comparisons and outcomes. When pooling exercise types, exercise vs. no intervention probably reduces pain in adults (8 RCTs, SMD = - 0.33, 95% CI - 0.58 to - 0.08) and functional limitations in adults and older adults (8 RCTs, SMD = - 0.31, 95% CI - 0.57 to - 0.05) (moderate certainty evidence).

Conclusions: With moderate certainty, structured exercise programs probably reduce pain and functional limitations in adults and older people with CPLBP.

Keywords: Exercise; Low back pain; Meta-analysis; Rehabilitation; Systematic review.

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Conflict of interest statement

All team members provided DOI forms to WHO for evaluation at inception. CC (Carol Cancelliere), LV, DS, HY, GC, JJW, HMS report funding from the Canadian Chiropractic Guideline Initiative. JAH and RO report funding from the Canadian Institutes of Health Research to support the ‘exercise treatment for chronic low back pain’ Cochrane review. ACT is funded by a Tier 2 Canada Research Chair in Knowledge Synthesis. CAH reports grants to the University of Zurich from the Foundation for the Education of Chiropractors in Switzerland, the Swiss National Science Foundation (SNSF), and the European Centre for Chiropractic Research Excellence (ECCRE) outside the submitted work. SM reports grants from Canadian Chiropractic Association, Canadian Chiropractic Research Foundation, and Canadian Institute of Health Research outside of submitted work. AB reports grants from the Canadian Chiropractic Association, Canadian Chiropractic Research Foundation, and Health Canada outside the submitted work. JJW reports grants from the Canadian Institutes of Health Research (CIHR) and Canadian Chiropractic Research Foundation (paid to university), and travel reimbursement for research meetings from the Chiropractic Academy of Research Leadership outside the submitted work.

Figures

Fig. 1
Fig. 1
Flow diagram of literature search
Fig. 2
Fig. 2
Any exercise versus comparison interventions where the attributable effect of exercise could be isolated for pain in the immediate term (closest to 2 weeks)
Fig. 3
Fig. 3
Any exercise versus comparison interventions where the attributable effect of exercise could be isolated for pain in the immediate term (closest to 2 weeks)
See this image and copyright information in PMC

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