What is the effect of low back pain self-management interventions with exercise components added? A systematic review with meta-analysis

Background Best practice guidelines endorse self-management and exercise in chronic low back pain (CLBP) management. The majority of existing self-management interventions (SMIs) do not include exercise components, and the effect of SMIs with exercises on CLBP and disability remains unclear. Objectives To systematically review the evidence for the effect of SMIs with an exercise component added, on pain and disability in people with CLBP. Design Systematic review with meta-analysis. Method An electronic search of randomized controlled trials (RCTs) with SMIs with exercises was performed in 5 databases. Standardized Mean Difference (SMD) and 95% confidence interval (CI) were calculated using a random-effects model for meta-analysis at short-term, intermediate, and long-term follow-up points. The level of evidence was synthesized using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) approach. Results 09 RCTs were included in the review and the GRADE quality assessment revealed low-quality evidence for all meta-analyses across 3 follow-up points. Effect sizes (ESs) for pain were -0.28, -0.36 and -0.21 for short-term, intermediate, and long-term respectively, and -0.30, -0.25 and -0.20 for short-term, intermediate, and long-term for disability, respectively. 6 out of 10 studies included tailored exercise programmes and exercise components differed widely in their content and delivery. Conclusions There is low-quality evidence that SMIs with exercises added have moderately positive effects on pain and disability in patients with CLBP compared to control interventions involving usual care typically consisting of access to medication, exercise, advice, education, and manual therapy