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.
Exercise treatment effect modifiers in persistent low back pain: An individual participant data meta-analysis of 3514 participants from 27 randomised controlled trials / Hayden J.A.; Wilson M.N.; Stewart S.; Cartwright J.L.; Smith A.O.; Riley R.D.; Van Tulder M.; Bendix T.; Cecchi F.; Costa L.O.P.; Dufour N.; Ferreira M.L.; Foster N.E.; Gudavalli M.R.; Hartvigsen J.; Helmhout P.; Kool J.; Koumantakis G.A.; Kovacs F.M.; Kuukkanen T.; Long A.; Macedo L.G.; Machado L.A.C.; Maher C.G.; Mehling W.; Morone G.; Peterson T.; Rasmussen-Barr E.; Ryan C.G.; Sjogren T.; Smeets R.; Staal J.B.; Unsgaard-Tondel M.; Wajswelner H.; Yeung E.W.. - In: BRITISH JOURNAL OF SPORTS MEDICINE. - ISSN 0306-3674. - ELETTRONICO. - 54:(2020), pp. 1277-1278. [10.1136/bjsports-2019-101205]
Exercise treatment effect modifiers in persistent low back pain: An individual participant data meta-analysis of 3514 participants from 27 randomised controlled trials
Cecchi F.;
2020
Abstract
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.
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