Wood, L, Foster, NE ORCID: https://orcid.org/0000-0003-4429-9756, Lewis, AM and Bishop, A ORCID: https://orcid.org/0000-0002-9810-7994 (2020) Exercise interventions for persistent non-specific low back pain – does matching outcomes to treatment targets make a difference? A systematic review and meta-analysis. Journal of Pain. (In Press)

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Abstract

Exercise is a core treatment for persistent non-specific low back pain (NSLBP), but results from randomised controlled trials (RCTs) of exercise typically show only small to moderate standardised mean differences (SMDs) compared to non-exercise controls. The choice of primary outcome, and relationship to the specific targets of exercise may influence this. This systematic review aimed to explore whether primary outcomes match the exercise treatment targets used in NSLBP RCTs and the potential impact of matching on SMDs. Included RCTs were conducted with patients with persistent NSLBP, compared exercise to no exercise, with sample sizes >60 per arm. Screening, data extraction and risk of bias assessment were independently undertaken by paired reviewers. Of 19272 initial titles, 27 RCTs were included with 31 treatment targets and 6 primary outcome domains identified. Only 25% of included RCTs had primary outcomes that matched the treatment targets. SMDs of exercise versus comparison arms were observed to be larger in the matched (SMD 0.54 (95% CI 0.23 to 0.85), p=0.0006) compared to the unmatched category (SMD 0.22 (95% CI 0.01, 0.44) p=0.04) but this difference was not statistically significant (p=0.10). These exploratory findings may have implications for future teams developing RCTs of exercise for NSLBP and warrant further investigation in larger datasets.

Item Type: Article
Additional Information: This is the accepted author manuscript (AAM). The final published version (version of record) is available online via Elsevier at https://www.journals.elsevier.com/the-journal-of-pain - please refer to any applicable terms of use of the publisher.
Uncontrolled Keywords: Treatment targets, outcomes, exercise, low back pain, systematic review
Subjects: R Medicine > RC Internal medicine > RC925 Diseases of the musculoskeletal system
Divisions: Faculty of Medicine and Health Sciences > School of Primary, Community and Social Care
Depositing User: Symplectic
Date Deposited: 19 Jun 2020 10:36
Last Modified: 19 Jun 2020 10:43
URI: https://eprints.keele.ac.uk/id/eprint/8196

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