The recent network meta-analysis by Owen and colleagues1 included 89 trials of exercise for chronic low back pain (LBP) and reported low quality evidence that Pilates, stabilisation, resistance and aerobic exercises are the most effective treatments for these patients. We were surprised by how few trials were included and even more surprised by how large the estimates of treatment effect were. For example, with Pilates the effect is reported to be 1.86 standardised mean difference (SMD) in the abstract and 2.32 SMD in online supplementary table 5. These estimates are about 3–4 times effect sizes normally reported for exercise interventions in LBP and so we took a closer look at the review to try to understand what had happened. That investigation revealed some important issues that we would like to share with readers. First, the review has missed a lot of relevant trials. The Cochrane review of exercise for chronic LBP that is currently underway has identified over 350 trials, whereas the Owen review included only 89. Even applying the restrictive selection criteria of the Owen …

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回信：“哪种特定的运动训练模式对治疗腰痛最有效？Owen 等人的网络荟萃分析

Owen 及其同事最近进行的网络荟萃分析 1 包括 89 项针对慢性腰痛 (LBP) 的运动试验，并报告了低质量的证据表明普拉提、稳定性、阻力和有氧运动是对这些患者最有效的治疗方法。我们对纳入的试验如此之少感到惊讶，对治疗效果的估计值如此之大更感到惊讶。例如，普拉提的效果在摘要中报告为 1.86 标准化平均差 (SMD)，在在线补充表 5 中为 2.32 SMD。这些估计值约为 LBP 运动干预通常报告的效果大小的 3-4 倍，因此我们仔细查看了评论，试图了解发生了什么。该调查揭示了一些我们想与读者分享的重要问题。第一的，审查漏掉了很多相关的试验。目前正在进行的慢性 LBP 运动的 Cochrane 综述已经确定了 350 多项试验，而 Owen 综述仅包括 89 项。即使应用 Owen 的限制性选择标准……