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Exercise therapy compared with sham/placebo and no treatment may have no clinically relevant effect on pain or functional status in the short term in people with acute non-specific LBP, but the evidence is very uncertain. Owing to insufficient reporting of adverse events, we were unable to reach any conclusions on the safety or harms related to exercise therapy.
Exercise therapy compared to no treatment may have no clinically relevant effect on pain or functional status in the short term in people with acute non-specific LBP, but the evidence is very uncertain. We downgraded the certainty of the evidence to very low for inconsistency, risk of bias concerns, and imprecision (few participants).
The cost-utility estimates are rather uncertain, indicating that more economic evaluations are needed. REGISTRATION: PROSPERO, CRD42017059025.
Larger, well-designed trials are needed to confirm these findings and optimize stimulation parameters. SYSTEMATIC REVIEW REGISTRATION: https://www.crd.york.ac.uk/PROSPERO/view/CRD420251151315, identifier CRD420251151315.
We also found exercise to have improved pain (low-certainty evidence) and functional limitations outcomes (moderate-certainty evidence) compared to other conservative treatments; however, these effects were small and not clinically important when considering all comparisons together. Subgroup analysis suggested that exercise treatment is probably more effective than advice or education alone, or electrotherapy, but with no differences observed for manual therapy treatments.
CONCLUSION: The results demonstrate very low confidence in the results of most systematic reviews of exercise in chronic non-specific low back pain. Clinicians are more likely to deliver the most efficacious interventions to patients by critically appraising systematic reviews using AMSTAR 2 before making their decisions.
The graded activity was more beneficial than supervised group-based exercise therapy only during the follow-up. Clinicaltrials.gov (NCT04023162; registration date: 17/07/2019).
This systematic review found that manual therapy as an adjunct to exercise provides increased improvements in short-term pain, function and disability outcomes than exercise alone in the management of LBP. The addition of manual therapy is recommended for at least short-term pain and disability relief in LBP patients.
However, the laser-guided exercise therapy program showed greater improvements in ESD. Analysis of a new approach for the quantification of data obtained from postural control assessment relying on widely used devices (accelerometers and pressure platforms).
Notably, while the combined intervention group (ET + CFT) showed greater improvements across most outcomes, it was significantly different from the exercise-only group only on the Kinesiophobia scale. These findings suggest that cognitive functional therapy may enhance the effectiveness of exercise therapy by addressing psychological factors, such as fear of movement, that contribute to pain and disability in CNLBP.
However, psychological factors influenced outcomes differently depending on the treatment, with catastrophizing increasing pain only in the kinesiotape group. Thus, kinesiotaping may offer a protective effect by modulating psychological influences in chronic lower back pain.Trial registration NCT05544890.
In the sensitivity analyses, the SWE varied with different levels of certainty calibration; from 0% without certainty calibration to 60% with more extreme certainty calibration. This patient-informed threshold of clinical importance could guide the interpretation of findings from randomised trials and meta-analyses of exercise therapy compared to no exercise.
: This systematic review highlights the complex, context-dependent interplay of factors impacting adherence to ET in individuals with nsCLBP. Overall, these findings underscore the need for personalised, context-sensitive interventions that address the broad spectrum of factors, while future research should focus on validated adherence assessment tools.
Further research on comparisons between different interventions and on other core LBP outcomes may inform decision-making. OSF osf.io/3erjx/.
CONCLUSION: Manual therapy combined with therapeutic exercise does not appear to provide substantial additional short-term improvements in pain intensity when compared to exercise alone. However, significant benefits were identified for functional disability in both short- and long-term outcomes PROSPERO REGISTRATION: CRD42023413778.
Equipment-based Pilates and soft tissue manipulation showed favorable signals supported by moderate-confidence evidence. However, the findings do not support a definitive hierarchy of efficacy or categorical superiority of therapeutic exercise over manual therapy.
There is low-to-moderate certainty that exercise therapy and leisure-time PA are beneficial for improving pain and preventing the recurrence of LBP. However, evidence on the potential harms of these interventions is limited, and adverse events related to exercise and PA remain under-investigated.
Yoga had the same effect on pain and disability as any other exercise or physical therapy. Yoga might not improve the physical and mental quality of life based on the result of a merging.
The cost-utility analysis showed that Pilates three times a week was the preferred option. TRIAL REGISTRATION NUMBER: NCT02241538, Completed.
There was no significant difference for any of the secondary outcomes. However, our study lacked power.
