Background

Best practice guidelines endorse self-management and exercise in chronic low back pain (CLBP) management. The majority of existing self-management interventions (SMIs) do not include exercise components, and the effect of SMIs with exercises on CLBP and disability remains unclear.

Objectives

To systematically review the evidence for the effect of SMIs with an exercise component added, on pain and disability in people with CLBP.

Design

Systematic review with meta-analysis.

Method

An electronic search of randomized controlled trials (RCTs) with SMIs with exercises was performed in 5 databases. Standardized Mean Difference (SMD) and 95% confidence interval (CI) were calculated using a random-effects model for meta-analysis at short-term, intermediate, and long-term follow-up points. The level of evidence was synthesized using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach.

Results

09 RCTs were included in the review and the GRADE quality assessment revealed low-quality evidence for all meta-analyses across 3 follow-up points. Effect sizes (ESs) for pain were -0.28, -0.36 and -0.21 for short-term, intermediate, and long-term respectively, and -0.30, -0.25 and -0.20 for short-term, intermediate, and long-term for disability, respectively. 6 out of 10 studies included tailored exercise programmes and exercise components differed widely in their content and delivery.

Conclusions

There is low-quality evidence that SMIs with exercises added have moderately positive effects on pain and disability in patients with CLBP compared to control interventions involving usual care typically consisting of access to medication, exercise, advice, education, and manual therapy.

中文翻译：

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添加运动成分的腰痛自我管理干预有什么效果？荟萃分析的系统评价

背景

最佳实践指南支持慢性腰痛 (CLBP) 管理中的自我管理和锻炼。大多数现有的自我管理干预 (SMI) 不包括运动成分，并且 SMI 与运动对 CLBP 和残疾的影响尚不清楚。

目标

系统地审查添加运动成分的 SMI 对 CLBP 患者的疼痛和残疾影响的证据。

设计

系统评价与荟萃分析。

方法

在 5 个数据库中对带有运动的 SMI 的随机对照试验 (RCT) 进行了电子搜索。使用随机效应模型在短期、中期和长期随访点进行荟萃分析计算标准化平均差异 (SMD) 和 95% 置信区间 (CI)。使用推荐分级评估、制定和评估 (GRADE) 方法综合了证据水平。

结果

09 评价中纳入了 RCT，GRADE 质量评估显示所有 3 个随访点的荟萃分析证据质量低。疼痛的短期、中期和长期效应值 (ES) 分别为 -0.28、-0.36 和 -0.21，短期、中期和长期的疼痛效应值 (ES) 分别为 -0.30、-0.25 和 -0.20。分别为残疾。10 项研究中有 6 项包括量身定制的锻炼计划，而锻炼内容在内容和交付方面差异很大。

结论

有低质量的证据表明，与涉及通常包括获得药物、运动、建议、教育和手动治疗的常规护理的对照干预相比，添加运动的 SMI 对 CLBP 患者的疼痛和残疾具有适度的积极影响。