Hayden, JA, Wilson, MN, Stewart, S, Cartwright, JL, Smith, AO, Riley, RD, van Tulder, M, Bendix, T, Cecchi, F, Costa, LOP, Dufour, N, Ferreira, ML, Foster, NE, 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). ISSN 1473-0480

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IPD-Exercise-LBP-Manuscript-BJSM-Revision-September-20-FINALk2 accepted.docx - Accepted Version
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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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