Systematic Review to Inform a World Health Organization (WHO) Clinical Practice Guideline: Benefits and Harms of Structured and Standardized Education or Advice for Chronic Primary low back pain in Adults

Danielle Southerst¹, Cesar A Hincapié^{2

3

4}, Hainan Yu¹, Leslie Verville¹, André Bussières^{5

6}, Douglas P Gross⁷, Paulo Pereira^{8

9}, Silvano Mior^{1

10}, Andrea C Tricco^{11

12

13}, Christine Cedraschi^{14

15}, Ginny Brunton^{1

16

17}, Margareta Nordin¹⁸, Jessica J Wong¹, Gaelan Connell¹, Heather M Shearer^{1

10

19}, Astrid DeSouza¹, Javier Muñoz Laguna^{20

21

22}, Joyce G B Lee¹⁰, Daphne To²³, Rahim Lalji^{20

21

22}, Kent Stuber^{10

24}, Martha Funabashi^{5

10}, Léonie Hofstetter^{20

21

22}, Danny Myrtos²³, Andrew Romanelli²³, Brett Guist²⁵, James J Young^{10

26

27}, Sophia da Silva-Oolup^{25

28}, Maja Stupar¹⁰, Dan Wang¹, Kent Murnaghan²⁹, Carol Cancelliere³⁰

Affiliations

¹ Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada.
² EBPI-UWZH Musculoskeletal Epidemiology Research Group, University of Zurich and Balgrist University Hospital, Zurich, Switzerland. cesar.hincapie@uzh.ch.
³ Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland. cesar.hincapie@uzh.ch.
⁴ University Spine Centre Zurich (UWZH), Balgrist University Hospital and University of Zurich, Zurich, Switzerland. cesar.hincapie@uzh.ch.
⁵ Département chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières (Québec), Canada.
⁶ School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Québec, Canada.
⁷ Department of Physical Therapy, University of Alberta, Edmonton, Canada.
⁸ Department of Neurosurgery, Centro Hospitalar Universitário São João, Porto, Portugal.
⁹ Faculty of Medicine, University of Porto, Porto, Portugal.
¹⁰ Department of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Canada.
¹¹ Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada.
¹² Epidemiology Division and Institute for Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
¹³ Queen's Collaboration for Health Care Quality Joanna Briggs Institute Centre of Excellence, Queen's University, Kingston, Canada.
¹⁴ Division of General Medical Rehabilitation, Geneva University and University Hospitals, Geneva, Switzerland.
¹⁵ Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Centre, Geneva University Hospitals, Geneva, Switzerland.
¹⁶ EPPI-Centre, UCL Institute of Education, University College London, England, United Kingdom.
¹⁷ Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
¹⁸ Departments of Orthopedic Surgery and Environmental Medicine, NYU Grossman School of Medicine, New York University, New York, United States.
¹⁹ Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.
²⁰ EBPI-UWZH Musculoskeletal Epidemiology Research Group, University of Zurich and Balgrist University Hospital, Zurich, Switzerland.
²¹ Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland.
²² University Spine Centre Zurich (UWZH), Balgrist University Hospital and University of Zurich, Zurich, Switzerland.
²³ Department of Clinical Education, Canadian Memorial Chiropractic College, Toronto, Canada.
²⁴ Parker University Research Center, Dallas, United States.
²⁵ Department of Undergraduate Education, Canadian Memorial Chiropractic College, Toronto, Canada.
²⁶ Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
²⁷ Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada.
²⁸ Department of Graduate Education, Canadian Memorial Chiropractic College, Toronto, Canada.
²⁹ Library and Information Services, Canadian Memorial Chiropractic College, Toronto, Canada.
³⁰ Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada. carolina.cancelliere@ontariotechu.ca.

PMID: 37991651
PMCID: PMC10684630
DOI: 10.1007/s10926-023-10120-8

Systematic Review to Inform a World Health Organization (WHO) Clinical Practice Guideline: Benefits and Harms of Structured and Standardized Education or Advice for Chronic Primary low back pain in Adults

Danielle Southerst et al. J Occup Rehabil. 2023 Dec.

. 2023 Dec;33(4):625-635.

doi: 10.1007/s10926-023-10120-8. Epub 2023 Nov 22.

Authors

Affiliations

¹ Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada.
² EBPI-UWZH Musculoskeletal Epidemiology Research Group, University of Zurich and Balgrist University Hospital, Zurich, Switzerland. cesar.hincapie@uzh.ch.
³ Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland. cesar.hincapie@uzh.ch.
⁴ University Spine Centre Zurich (UWZH), Balgrist University Hospital and University of Zurich, Zurich, Switzerland. cesar.hincapie@uzh.ch.
⁵ Département chiropratique, Université du Québec à Trois-Rivières, Trois-Rivières (Québec), Canada.
⁶ School of Physical and Occupational Therapy, Faculty of Medicine and Health Sciences, McGill University, Québec, Canada.
⁷ Department of Physical Therapy, University of Alberta, Edmonton, Canada.
⁸ Department of Neurosurgery, Centro Hospitalar Universitário São João, Porto, Portugal.
⁹ Faculty of Medicine, University of Porto, Porto, Portugal.
¹⁰ Department of Research and Innovation, Canadian Memorial Chiropractic College, Toronto, Canada.
¹¹ Li Ka Shing Knowledge Institute, St. Michael's Hospital, Unity Health Toronto, Toronto, Canada.
¹² Epidemiology Division and Institute for Health Policy, Management, and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Canada.
¹³ Queen's Collaboration for Health Care Quality Joanna Briggs Institute Centre of Excellence, Queen's University, Kingston, Canada.
¹⁴ Division of General Medical Rehabilitation, Geneva University and University Hospitals, Geneva, Switzerland.
¹⁵ Division of Clinical Pharmacology and Toxicology, Multidisciplinary Pain Centre, Geneva University Hospitals, Geneva, Switzerland.
¹⁶ EPPI-Centre, UCL Institute of Education, University College London, England, United Kingdom.
¹⁷ Department of Health Research Methods, Evidence and Impact, Faculty of Health Sciences, McMaster University, Hamilton, Canada.
¹⁸ Departments of Orthopedic Surgery and Environmental Medicine, NYU Grossman School of Medicine, New York University, New York, United States.
¹⁹ Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, Canada.
²⁰ EBPI-UWZH Musculoskeletal Epidemiology Research Group, University of Zurich and Balgrist University Hospital, Zurich, Switzerland.
²¹ Epidemiology, Biostatistics and Prevention Institute (EBPI), University of Zurich, Zurich, Switzerland.
²² University Spine Centre Zurich (UWZH), Balgrist University Hospital and University of Zurich, Zurich, Switzerland.
²³ Department of Clinical Education, Canadian Memorial Chiropractic College, Toronto, Canada.
²⁴ Parker University Research Center, Dallas, United States.
²⁵ Department of Undergraduate Education, Canadian Memorial Chiropractic College, Toronto, Canada.
²⁶ Center for Muscle and Joint Health, Department of Sports Science and Clinical Biomechanics, University of Southern Denmark, Odense, Denmark.
²⁷ Schroeder Arthritis Institute, Krembil Research Institute, University Health Network, Toronto, Canada.
²⁸ Department of Graduate Education, Canadian Memorial Chiropractic College, Toronto, Canada.
²⁹ Library and Information Services, Canadian Memorial Chiropractic College, Toronto, Canada.
³⁰ Institute for Disability and Rehabilitation Research and Faculty of Health Sciences, Ontario Tech University, Oshawa, Canada. carolina.cancelliere@ontariotechu.ca.

PMID: 37991651
PMCID: PMC10684630
DOI: 10.1007/s10926-023-10120-8

Abstract

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

Methods: Electronic databases were searched for randomized controlled trials (RCTs) assessing education/advice compared with placebo/sham, usual care, or no intervention (including comparison interventions where the attributable effect of education/advice could be isolated). We conducted meta-analyses and graded the certainty of evidence.

Results: We screened 2514 citations and 86 full text RCTs and included 15 RCTs. Most outcomes were assessed 3 to 6 months post-intervention. Compared with no intervention, education/advice improved pain (10 RCTs, MD = -1.1, 95% CI -1.63 to -0.56), function (10 RCTs, SMD = -0.51, 95% CI -0.89 to -0.12), physical health-related quality of life (HRQoL) (2 RCTs, MD = 24.27, 95% CI 12.93 to 35.61), fear avoidance (5 RCTs, SMD = -1.4, 95% CI -2.51 to -0.29), depression (1 RCT; MD = 2.10, 95% CI 1.05 to 3.15), and self-efficacy (1 RCT; MD = 4.4, 95% CI 2.77 to 6.03). Education/advice conferred less benefit than sham Kinesio taping for improving fear avoidance regarding physical activity (1 RCT, MD = 5.41, 95% CI 0.28 to 10.54). Compared with usual care, education/advice improved pain (1 RCT, MD = -2.10, 95% CI -3.13 to -1.07) and function (1 RCT, MD = -7.80, 95% CI -14.28 to -1.32). There was little or no difference between education/advice and comparisons for other outcomes. For all outcomes, the certainty of evidence was very low.

Conclusion: Education/advice in adults with CPLBP was associated with improvements in pain, function, HRQoL, and psychological outcomes, but with very low certainty.

Keywords: Advice; Education; Low back pain; Meta-analysis; Systematic review.

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Conflict of interest statement

All team members provided DOI forms to WHO for evaluation at inception. CC, LV, DS, HY, GC, JJW, HMS report funding from the Canadian Chiropractic Guideline Initiative. ACT is funded by a Tier 2 Canada Research Chair in Knowledge Synthesis. JJW is funded by a Banting Postdoctoral Fellowship from the Canadian Institutes of Health Research (CIHR). 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 the Canadian Chiropractic Association, Canadian Chiropractic Research Foundation, and Canadian Institute of Health Research outside of 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. JML reports a grant from the European Cooperation in Science and Technology (COST) outside the submitted work. AB reports grants from the Canadian Chiropractic Association, Canadian Chiropractic Research Foundation, and Health Canada outside the submitted work. JJY is funded by an Arthritis Society Canada Postdoctoral Training Fellowship, Canadian Institutes of Health Research Fellowship, and grant from the Danish Foundation for Chiropractic Research and Post-graduate Education, all outside the submitted work.

Figures

**Fig. 1**
Flow diagram of literature search *1 trial was reported in 2 reports

**Fig. 2**
Education versus no intervention, and comparison interventions where the attributable effect of education/advice could be isolated for pain in the short term (closest to 3 months); scale range is 0 to 10

**Fig. 3**
Education versus no intervention, and comparison interventions where the attributable effect of education/advice effect could be isolated for function in the short term (closest to 3 months)

**Fig. 4**
Education versus no intervention, and comparison interventions where the attributable effect of education/advice could be isolated for fear avoidance in the short term (closest to 3 months)

See this image and copyright information in PMC

References

1. Oliveira CB, Maher CG, Pinto RZ, Traeger AC, Lin CC, Chenot JF, et al. Clinical practice guidelines for the management of non-specific low back pain in primary care: an updated overview. Eur Spine J. 2018;27(11):2791–803. doi: 10.1007/s00586-018-5673-2. - DOI - PubMed
1. Jones CM, Shaheed CA, Ferreira GE, Kharel P, Christine Lin CW, Maher CG. Advice and education provide small short-term improvements in pain and disability in people with non-specific spinal pain: a systematic review. J Physiother. 2021;67(4):263–70. doi: 10.1016/j.jphys.2021.08.014. - DOI - PubMed
1. Verville L, Hincapié CA, Southerst D, Yu H, Bussières A, Gross DP, et al. Systematic review to inform a World Health Organization (WHO) clinical practice guideline: benefits and harms of transcutaneous electrical nerve stimulation (TENS) for chronic primary low back pain in adults. J Occup Rehabil. 2023. 10.1007/s10926-023-10121-7. - PMC - PubMed
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Systematic Review to Inform a World Health Organization (WHO) Clinical Practice Guideline: Benefits and Harms of Structured and Standardized Education or Advice for Chronic Primary low back pain in Adults

Affiliations

Systematic Review to Inform a World Health Organization (WHO) Clinical Practice Guideline: Benefits and Harms of Structured and Standardized Education or Advice for Chronic Primary low back pain in Adults

Authors

Affiliations

Abstract

Conflict of interest statement

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References

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