TY - JOUR
T1 - Exercise treatment effect modifiers in persistent low back pain
T2 - An individual participant data meta-analysis of 3514 participants from 27 randomised controlled trials
AU - Hayden, Jill A.
AU - Wilson, Maria N.
AU - Stewart, Samuel
AU - Cartwright, Jennifer L.
AU - Smith, Andrea O.
AU - Riley, Richard D.
AU - Van Tulder, Maurits
AU - Bendix, Tom
AU - Cecchi, Francesca
AU - Costa, Leonardo O.P.
AU - Dufour, Ninna
AU - Ferreira, Manuela L.
AU - Foster, Nadine E.
AU - Gudavalli, Maruti R.
AU - Hartvigsen, Jan
AU - Helmhout, Pieter
AU - Kool, Jan
AU - Koumantakis, George A.
AU - Kovacs, Francisco M.
AU - Kuukkanen, Tiina
AU - Long, Audrey
AU - Macedo, Luciana G.
AU - Machado, Luciana A.C.
AU - Maher, Chris G.
AU - Mehling, Wolf
AU - Morone, Giovanni
AU - Peterson, Tom
AU - Rasmussen-Barr, Eva
AU - Ryan, Cormac G.
AU - Sjögren, Tuulikki
AU - Smeets, Rob
AU - Staal, J. Bart
AU - Unsgaard-Tøndel, Monica
AU - Wajswelner, Henry
AU - Yeung, Ella W.
AU - Chronic Low Back Pain IPD Meta-Analysis Group, on behalf of
PY - 2019/11/1
Y1 - 2019/11/1
N2 - Background: Low back pain is one of the leading causes of disability worldwide. Exercise therapy is widely recommended to treat persistent non-specific low back pain. While evidence suggests exercise is, on average, moderately effective, there remains uncertainty about which individuals might benefit the most from exercise. Methods: In parallel with a Cochrane review update, we requested individual participant data (IPD) from high-quality randomised clinical trials of adults with our two primary outcomes of interest, pain and functional limitations, and calculated global recovery. We compiled a master data set including baseline participant characteristics, exercise and comparison characteristics, and outcomes at short-term, moderate-term and long-term follow-up. We conducted descriptive analyses and one-stage IPD meta-analysis using multilevel mixed-effects regression of the overall treatment effect and prespecified potential treatment effect modifiers. Results: We received IPD for 27 trials (3514 participants). For studies included in this analysis, compared with no treatment/usual care, exercise therapy on average reduced pain (mean effect/100 (95% CI) -10.7 (-14.1 to -7.4)), a result compatible with a clinically important 20% smallest worthwhile effect. Exercise therapy reduced functional limitations with a clinically important 23% improvement (mean effect/100 (95% CI) -10.2 (-13.2 to -7.3)) at short-term follow-up. Not having heavy physical demands at work and medication use for low back pain were potential treatment effect modifiers - these were associated with superior exercise outcomes relative to non-exercise comparisons. Lower body mass index was also associated with better outcomes in exercise compared with no treatment/usual care. This study was limited by inconsistent availability and measurement of participant characteristics. Conclusions: This study provides potentially useful information to help treat patients and design future studies of exercise interventions that are better matched to specific subgroups. Protocol publication: https://doi.org/10.1186/2046-4053-1-64.
AB - Background: Low back pain is one of the leading causes of disability worldwide. Exercise therapy is widely recommended to treat persistent non-specific low back pain. While evidence suggests exercise is, on average, moderately effective, there remains uncertainty about which individuals might benefit the most from exercise. Methods: In parallel with a Cochrane review update, we requested individual participant data (IPD) from high-quality randomised clinical trials of adults with our two primary outcomes of interest, pain and functional limitations, and calculated global recovery. We compiled a master data set including baseline participant characteristics, exercise and comparison characteristics, and outcomes at short-term, moderate-term and long-term follow-up. We conducted descriptive analyses and one-stage IPD meta-analysis using multilevel mixed-effects regression of the overall treatment effect and prespecified potential treatment effect modifiers. Results: We received IPD for 27 trials (3514 participants). For studies included in this analysis, compared with no treatment/usual care, exercise therapy on average reduced pain (mean effect/100 (95% CI) -10.7 (-14.1 to -7.4)), a result compatible with a clinically important 20% smallest worthwhile effect. Exercise therapy reduced functional limitations with a clinically important 23% improvement (mean effect/100 (95% CI) -10.2 (-13.2 to -7.3)) at short-term follow-up. Not having heavy physical demands at work and medication use for low back pain were potential treatment effect modifiers - these were associated with superior exercise outcomes relative to non-exercise comparisons. Lower body mass index was also associated with better outcomes in exercise compared with no treatment/usual care. This study was limited by inconsistent availability and measurement of participant characteristics. Conclusions: This study provides potentially useful information to help treat patients and design future studies of exercise interventions that are better matched to specific subgroups. Protocol publication: https://doi.org/10.1186/2046-4053-1-64.
KW - exercise rehabilitation
KW - intervention effectiveness
KW - lower back
KW - meta-analysis
UR - http://www.scopus.com/inward/record.url?scp=85075839486&partnerID=8YFLogxK
UR - http://www.scopus.com/inward/citedby.url?scp=85075839486&partnerID=8YFLogxK
U2 - 10.1136/bjsports-2019-101205
DO - 10.1136/bjsports-2019-101205
M3 - Review article
AN - SCOPUS:85075839486
JO - British Journal of Sports Medicine
JF - British Journal of Sports Medicine
SN - 0306-3674
ER -