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Exercise treatment effect modifiers in persistent low back pain: an individual participant data meta-analysis of 3514 participants from 27 randomised controlled trials.
- Hayden, Jill A;
- Wilson, Maria N;
- Stewart, Samuel;
- Cartwright, Jennifer L;
- Smith, Andrea O;
- Riley, Richard D;
- van Tulder, Maurits;
- Bendix, Tom;
- Cecchi, Francesca;
- Costa, Leonardo OP;
- Dufour, Ninna;
- Ferreira, Manuela L;
- Foster, Nadine E;
- Gudavalli, Maruti R;
- Hartvigsen, Jan;
- Helmhout, Pieter;
- Kool, Jan;
- Koumantakis, George A;
- Kovacs, Francisco M;
- Kuukkanen, Tiina;
- Long, Audrey;
- Macedo, Luciana G;
- Machado, Luciana AC;
- Maher, Chris G;
- Mehling, Wolf;
- Morone, Giovanni;
- Peterson, Tom;
- Rasmussen-Barr, Eva;
- Ryan, Cormac G;
- Sjögren, Tuulikki;
- Smeets, Rob;
- Staal, J Bart;
- Unsgaard-Tøndel, Monica;
- Wajswelner, Henry;
- Yeung, Ella W;
- Chronic Low Back Pain IPD Meta-Analysis Group
- et al.
Published Web Location
https://doi.org/10.1136/bjsports-2019-101205Abstract
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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