Hayden, JA, Wilson, MN, Stewart, S, Cartwright, JL, Smith, AO, Riley, RD ORCID: https://orcid.org/0000-0001-8699-0735, van Tulder, M, Bendix, T, Cecchi, F, Costa, LOP, Dufour, N, Ferreira, ML, Foster, NE ORCID: https://orcid.org/0000-0003-4429-9756, Gudavalli, MR, Hartvigsen, J, Helmhout, P, Kool, J, Koumantakis, GA, Kovacs, FM, Kuukkanen, T, Long, A, Macedo, LG, Machado, LAC, Maher, CG, Mehling, W, Morone, G, Peterson, T, Rasmussen-Barr, E, Ryan, CG, Sjögren, T, Smeets, R, Staal, JB, Unsgaard-Tøndel, M, Wajswelner, H and Yeung, EW (2019) Exercise treatment effect modifiers in persistent low back pain: an individual participant data meta-analysis of 3514 participants from 27 randomised controlled trials. British Journal of Sports Medicine, 15 (21).

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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.

Item Type: Article
Additional Information: This is the accepted author manuscript (AAM). The final published version (version of record) is available online via BMJ Publishing Group at http://doi.org/10.1136/bjsports-2019-101205 - please refer to any applicable terms of use of the publisher.
Uncontrolled Keywords: exercise rehabilitation, intervention effectiveness, lower back, meta-analysis
Subjects: R Medicine > RC Internal medicine > RC925 Diseases of the musculoskeletal system
Divisions: Faculty of Medicine and Health Sciences > Primary Care Health Sciences
Related URLs:
Depositing User: Symplectic
Date Deposited: 13 Dec 2019 14:05
Last Modified: 22 Dec 2020 15:11
URI: https://eprints.keele.ac.uk/id/eprint/7368

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