Exercise therapy for treatment of non-specific low back pain - PubMed (original) (raw)

Review

Exercise therapy for treatment of non-specific low back pain

J A Hayden et al. Cochrane Database Syst Rev. 2005.

Abstract

Background: Exercise therapy is widely used as an intervention in low-back pain.

Objectives: To evaluate the effectiveness of exercise therapy in adult non-specific acute, subacute and chronic low-back pain versus no treatment and other conservative treatments.

Search strategy: The Cochrane Central Register of Controlled Trials (Issue 3, 2004), MEDLINE, EMBASE, PsychInfo, CINAHL databases to October 2004; citation searches and bibliographic reviews of previous systematic reviews.

Selection criteria: Randomized controlled trials evaluating exercise therapy for adult non-specific low-back pain and measuring pain, function, return-to-work/absenteeism, and/or global improvement outcomes.

Data collection and analysis: Two reviewers independently selected studies and extracted data on study characteristics, quality, and outcomes at short, intermediate, and long-term follow-up.

Main results: Sixty-one randomized controlled trials (6390 participants) met inclusion criteria: acute (11), subacute (6) and chronic (43) low-back pain (1 unclear). Evidence was found of effectiveness in chronic populations relative to comparisons at all follow-up periods; pooled mean improvement was 7.3 points (95% CI, 3.7 to 10.9) for pain (out of 100), 2.5 points (1.0 to 3.9) for function (out of 100) at earliest follow-up. In studies investigating patients (i.e. presenting to healthcare providers) mean improvement was 13.3 points (5.5 to 21.1) for pain, 6.9 (2.2 to 11.7) for function, representing significantly greater improvement over studies where participants included those recruited from a general population (e.g. with advertisements). There is some evidence of effectiveness of graded-activity exercise program in subacute low-back pain in occupational settings, though the evidence for other types of exercise therapy in other populations is inconsistent. There was evidence of equal effectiveness relative to comparisons in acute populations [pain: 0.03 points (95% CI, -1.3 to 1.4)].

Limitations: This review largely reflects limitations of the literature, including low quality studies with heterogeneous outcome measures, inconsistent and poor reporting, and possibility of publication bias.

Authors' conclusions: Exercise therapy appears to be slightly effective at decreasing pain and improving function in adults with chronic low-back pain, particularly in healthcare populations. In subacute low-back pain there is some evidence that a graded activity program improves absenteeism outcomes, though evidence for other types of exercise is unclear. In acute low-back pain, exercise therapy is as effective as either no treatment or other conservative treatments.

PubMed Disclaimer

Conflict of interest statement

Antti Malmivaara is the first author of one of the trials included in this review. Methodological quality assessment and data extraction of this trial was done by two other reviewers (Bart Koes and Maurits van Tulder).

Figures

1

1

2

2

1.1

1.1. Analysis

Comparison 1 Chronic populations, Outcome 1 Function measure (/100): Earliest follow‐up.

1.2

1.2. Analysis

Comparison 1 Chronic populations, Outcome 2 Function measure (/100): Short‐term follow‐up (˜6 weeks post‐randomization).

1.3

1.3. Analysis

Comparison 1 Chronic populations, Outcome 3 Function measure (/100): Intermediate follow‐up (˜6 months post‐randomization).

1.4

1.4. Analysis

Comparison 1 Chronic populations, Outcome 4 Function measure (/100): Long‐term follow‐up (˜12 months post‐randomization).

1.5

1.5. Analysis

Comparison 1 Chronic populations, Outcome 5 Pain measure (/100): Earliest follow‐up.

1.6

1.6. Analysis

Comparison 1 Chronic populations, Outcome 6 Pain measure (/100): Short‐term follow‐up (˜6 weeks post‐randomization).

1.7

1.7. Analysis

Comparison 1 Chronic populations, Outcome 7 Pain measure (/100): Intermediate follow‐up (˜6 months post‐randomization).

1.8

1.8. Analysis

Comparison 1 Chronic populations, Outcome 8 Pain measure (/100): Long‐term follow‐up (˜12 months post‐randomization).

2.1

2.1. Analysis

Comparison 2 Subacute populations, Outcome 1 Function measure (/100): Earliest follow‐up.

2.2

2.2. Analysis

Comparison 2 Subacute populations, Outcome 2 Function measure (/100): Short‐term follow‐up (˜6 weeks post‐randomization).

2.3

2.3. Analysis

Comparison 2 Subacute populations, Outcome 3 Function measure (/100): Intermediate follow‐up (˜6 months post‐randomization).

2.4

2.4. Analysis

Comparison 2 Subacute populations, Outcome 4 Function measure (/100): Long‐term follow‐up (˜12 months post‐randomization).

2.5

2.5. Analysis

Comparison 2 Subacute populations, Outcome 5 Pain measure (/100): Earliest follow‐up.

2.6

2.6. Analysis

Comparison 2 Subacute populations, Outcome 6 Pain measure (/100): Short‐term follow‐up (˜6 weeks post‐randomization).

2.7

2.7. Analysis

Comparison 2 Subacute populations, Outcome 7 Pain measure (/100): Intermediate follow‐up (˜6 months post‐randomization).

2.8

2.8. Analysis

Comparison 2 Subacute populations, Outcome 8 Pain measure (/100): Long‐term follow‐up (˜12 months post‐randomization).

3.1

3.1. Analysis

Comparison 3 Acute populations, Outcome 1 Pain measure (/100): Earliest follow‐up.

3.2

3.2. Analysis

Comparison 3 Acute populations, Outcome 2 Pain measure (/100): Short‐term follow‐up (˜6 weeks post‐randomization).

3.3

3.3. Analysis

Comparison 3 Acute populations, Outcome 3 Pain measure (/100): Intermediate follow‐up (˜6 months post‐randomization).

3.4

3.4. Analysis

Comparison 3 Acute populations, Outcome 4 Pain measure (/100): Long‐term follow‐up (˜12 months post‐randomization).

3.5

3.5. Analysis

Comparison 3 Acute populations, Outcome 5 Function measure (/100): Earliest follow‐up.

3.6

3.6. Analysis

Comparison 3 Acute populations, Outcome 6 Function measure (/100): Short‐term follow‐up (˜6 weeks post‐randomization).

3.7

3.7. Analysis

Comparison 3 Acute populations, Outcome 7 Function measure (/100): Intermediate follow‐up (˜6 months post‐randomization).

3.8

3.8. Analysis

Comparison 3 Acute populations, Outcome 8 Function measure (/100): Long‐term follow‐up (˜12 months post‐randomization).

4.1

4.1. Analysis

Comparison 4 POPULATION SOURCE: Chronic populations (Exploratory analysis), Outcome 1 Function measure (/100); Earliest follow‐up: Indirect comparisons.

4.2

4.2. Analysis

Comparison 4 POPULATION SOURCE: Chronic populations (Exploratory analysis), Outcome 2 Pain measure (/100); Earliest follow‐up: Indirect comparisons.

Update of

Comment in

Similar articles

Cited by

References

References to studies included in this review

Alexandre 2001 {published data only}
    1. Alexandre NM, Moraes MA, Correa Filho HR, Jorge SA. Evaluation of a program to reduce back pain in nursing personnel. Revista de Saude Publica 2001;35:356‐61. - PubMed
Aure 2003 {published data only}
    1. Aure O, Nilsen J, Vasseljen O. Manual therapy and exercise therapy in patients with chronic low back pain. A randomized, controlled trial with 1‐year follow‐up. Spine 2003;28(6):525‐532. - PubMed
Bendix_a 2000 {published data only}
    1. Bendix T, Bendix A, Labriola M, Haestrup C, Ebbehoj N. Functional restoration versus outpatient physical training in chronic low back pain: a randomized comparative study. Spine 2000;25:2494‐500. - PubMed
Bendix_b 1995 {published data only}
    1. Bendix AF, Bendix T, Labriola M, Boekgaard P. Functional restoration for chronic low back pain: Two‐year follow‐up of two randomized clinical trials. Spine 1998;23:717‐25. - PubMed
    1. Bendix AF, Bendix T, Lund C, Kirkbak S, Ostenfeld S, Kirking BC. Comparison of three intensive programs for chronic low back pain patients: a prospective, randomized, observer‐blinded study with one‐year follow‐up. Scand J Rehab Med 1997;29:81‐9. - PubMed
    1. Bendix AF, Bendix T, Ostenfeld S, Bush E, Andersen A. Active treatment programs for patients with chronic low back pain: a prospective randomized, observer‐blinded study. Eur Spine J 1995;4:148‐52. - PubMed
Bentsen 1997 {published data only}
    1. Bentsen H, Lindgärde F, Manthorpe R. The effect of dynamic strength back exercise and/or a home training program in 57‐year old women with chronic low back pain: results of a prospective randomized study with a 3‐year follow‐up period. Spine 1997;22:1494‐500. - PubMed
Bronfort 1996 {published data only}
    1. Bronfort G, Goldsmith CH, Nelson C, Boline PD, Anderson AV. Trunk exercise combined with spinal manipulative or NSAID therapy for chronic low back pain: a randomized, observer‐blinded clinical trial. J Manipulative Physiol Ther 1996;19:570‐82. - PubMed
Buswell 1982 {published data only}
    1. Buswell J. Low back pain: a comparison of two treatment programmes. NZ J Physiotherapy 1982;10:13‐7.
Calmels 2004 {published data only}
    1. Calmels P, Jacob JF, Fayolle‐Minon I, Charles C, Bouchet JP, Rimaud D, Thomas T. [Use of isokinetic techniques vs standard physiotherapy in patients with chronic low back pain. Preliminary results] [French]. Annales de Readaptation et de Medecine Physique 2004;47:20‐7. - PubMed
Cherkin 1998 {published data only}
    1. Cherkin DC, Deyo RA, Battie M, Street J, Barlow W. A comparison of physical therapy, chiropractic manipulation, and provision of an educational booklet for the treatment of patients with low back pain. N Engl J Med 1998;339:1021‐9. - PubMed
Chok 1999 {published data only}
    1. Chok B, Lee R, Latimer J, Seang BT. Endurance training of the trunk extensor muscles in people with subacute low back pain. Phys Ther 1999;79:1032‐42. - PubMed
Dalichau 2000 {published data only}
    1. Dalichau S, Scheele K. [Effects of elastic lumbar belts on the effect of a muscle training program for patients with chronic back pain]. [German]. Zeitschrift fur Orthopadie und Ihre Grenzgebiete 2000;138:8‐16. - PubMed
Davies 1979 {published data only}
    1. Davies JR, Gibson T, Tester L. The value of exercises in the treatment of low back pain. Rheumatol Rehabil 1979;18:243‐7. - PubMed
Delitto 1993 {published data only}
    1. Delitto A, Cibulka MT, Erhard RE, Bowling RW, Tenhula JA. Evidence for use of an extension‐mobilization category in acute low back syndrome: a prescriptive validation pilot study. Phys Ther 1993;73:216‐28. - PubMed
Descarreaux 2002 {published data only}
    1. Descarreaux M, Normand MC, Laurencelle L, Dugas C. Evaluation of a specific home exercise program for low back pain.. J Manipulative Physiol Ther 2002;25(8):497‐503. - PubMed
Deyo 1990 {published data only}
    1. Deyo RA, Walsh NE, Martin DC, Schoenfeld LS, Ramamurthy S. A controlled trial of transcutaneous electrical nerve stimulation (TENS) and exercise for chronic low back pain. N Engl J Med 1990;322:1627‐34. - PubMed
Elnaggar 1991 {published data only}
    1. Elnaggar IM, Nordin M, Sheikhzadeh A, Parnianpour M, Kahanovitz N. Effects of spinal flexion and extension exercises on low‐back pain and spinal mobility in chronic mechanical low‐back pain patients. Spine 1991;16:967‐72. - PubMed
Faas 1993 {published data only}
    1. Faas A, Chavannes AW, Eijk JThM, Gubbels JW. A randomized placebo‐controlled trial of exercise therapy in patients with acute low back pain. Spine 1993;18:1388‐95. - PubMed
    1. Faas A, Eijk JThM, Chavannes AW, Gubbels JW. A randomized trial of exercise therapy in patients with acute low back pain. Spine 1995;20:941‐7. - PubMed
Farrell 1982 {published data only}
    1. Farrell JP, Twomey LT. Acute low back pain: comparison of two conservative treatment approaches. Med J Aus 1982;1:160‐4. - PubMed
Frost 1995 {published data only}
    1. Frost H, Klaber Moffett JA, Moser JS, Fairbank JCT. Randomised controlled trial for evaluation of fitness programme for patients with chronic low back pain. Br Med J 1995;310:151‐4. - PMC - PubMed
    1. Frost H, Lamb SE, Klaber Moffett JA, Fairbank JCT, Moser JS. A fitness programme for patients with chronic low back pain: 2‐year follow‐up of a randomised controlled trial. Pain 1998;75:273‐9. - PubMed
Frost 2004 {published data only}
    1. Frost H, Lamb SE, Doll HA, Taffe Carver P, Stewart‐Brown S. Randomized controlled trial of physiotherapy compared with advice for low back pain. BMJ 2004;329:708‐11. - PMC - PubMed
Galantino 2004 {published data only}
    1. Galantino ML, Bzdewka TM, Eissler‐Russo JL, Holbrook ML, Mogck EP, Geigle P, et al. The impact of modified hatha yoga on chronic low back pain: A pilot study. Alternative Therapies in Health & Medicine 2004;10:56‐9. - PubMed
Gilbert 1985 {published data only}
    1. Evans C, Gilbert JR, Taylor DW, Hildebrand A. A randomized controlled trial of flexion exercises, education, and bed rest for patients with acute low back pain. Physiother Can 1987;39:96‐101.
    1. Gilbert JR, Taylor DW, Hildebrand A, Evans C. Clinical practice of common treatments for low‐back pain. Br Med J 1985;291:789‐92. - PMC - PubMed
Gur 2003 {published data only}
    1. Gur A, Karakoc M, Cevik R, Nas K, Sarac AJ, Karakoc M. Efficacy of low power laser therapy and exercise on pain and functions in chronic low back pain. Lasers in Surgery & Medicine 2003;32:233‐8. - PubMed
Hansen 1993 {published data only}
    1. Hansen FR, Bendix T, Skov P, Jensen CV, Kristensen JH, Krohn L, et al. Intensive, dynamic back‐muscle exercises, conventional physiotherapy, or placebo‐control treatment of low back pain. Spine 1993;18:98‐107. - PubMed
Hemmila 1997 {published data only}
    1. Hemmila H, Keinanen‐Kiukaanniemi SM, Levoska S, Puska P. Long‐term effectiveness of bone‐setting, light exercise therapy, and physiotherapy for prolonged back pain: A randomized controlled trial. J Manip Phys Therapeutics 2002;25:99‐104. - PubMed
    1. Hemmilä HM, Keinanen‐Kiukaanniemi SM, Levoska S, Puska P. Does folk medicine work? A randomized clinical trial on patients with prolonged back pain. Arch Phys Med Rehabil 1997;78:571‐7. - PubMed
Hides 1996 {published data only}
    1. Hides JA, Jull GA, Richardson CA. Long‐term effects of specific stabilizing exercises for first‐episode low back pain. Spine 2001;26:E243‐8. - PubMed
    1. Hides JA, Richardson CA, Jull GA. Multifidus muscle recovery is not automatic after resolution of acute first‐episode low back pain. Spine 1996;21:2763‐9. - PubMed
Hildebrandt 2000 {published data only}
    1. Hildebrandt VH, Proper KI, Berg R, Douwes M, Heuvel SG, Buuren S. [Cesar therapy is temporarily more effective in patients with chronic low back pain than the standard treatment by family practitioner: randomized, controlled and blinded clinical trial with 1 year follow‐up]. [Dutch]. Nederlands Tijdschrift voor Geneeskunde 2000;144:2258‐64. - PubMed
Johanssen 1995 {published data only}
    1. Johanssen F, Remvig L, Kryger P, Beck P, Warming S, Lybeck K, et al. Exercises for chronic low back pain: a clinical trial. J Orthop Sports Phys Ther 1995;22:52‐9. - PubMed
Jousset 2004 {published data only}
    1. Jousset N, Fanello S, Bontoux L, Dubus V, Billabert C, Vielle B, et al. Effects of functional restoration versus 3 hours per week physical therapy: a randomized controlled study. Spine 2004;29:487‐93. - PubMed
Kankaanpaa 1999 {published data only}
    1. Kankaanpaa M, Taimela S, Airaksinen O, Hanninen O. The efficacy of active rehabilitation in chronic low back pain. Effect on pain intensity, self‐experienced disability, and lumbar fatigability. Spine 1999;24:1034‐42. - PubMed
Kendall 1968 {published data only}
    1. Kendall PH, Jenkins JM. Exercises for backache: a double‐blind controlled trial. Physiother 1968;54:154‐7.
Kuukkanen 2000 {published data only}
    1. Kuukkanen TM, Malkia EA. An experimental controlled study on postural sway and therapeutic exercise in subjects with low back pain. Clinical Rehabilitation 2000;14:192‐202. - PubMed
Lidström 1970 {published data only}
    1. Lidström A, Zachrisson M. Physical therapy on low back pain and sciatica. Scand J Rehabil Med 1970;2:37‐42. - PubMed
Lie 1999 {published data only}
    1. Lie H, Frey S. [Mobilizing or stabilizing exercise in degenerative disk disease in the lumbar region?]. [Norwegian]. Tidsskrift for Den Norske Laegeforening 1999;119:2051‐3. - PubMed
Lindstrom 1992 {published data only}
    1. Lindström I. A successful intervention program for patients with subacute low back pain. (Academic Thesis). Göteborg: Göteborg University, 1994.
    1. Lindström I, Öhlund C, Eek C, Wallin L, Peterson LE, Fordyce WE, et al. The effect of graded activity on patients with subacute low back pain: a randomized prospective clinical study with an operant‐conditioning behavioural approach. Physical Therapy 1992a;72:279‐93. - PubMed
    1. Lindström I, Öhlund C, Eek C, Wallin L, Peterson LE, Nachemson A. Mobility, strength, and fitness after a graded activity program for patients with subacute low back pain. A randomized prospective clinical study with a behavioural therapy approach. Spine 1992b;17:641‐52. - PubMed
Ljunggren 1997 {published data only}
    1. Ljunggren AE, Weber H, Kogstad O, Thom E, Kirkesola G. Effect of exercise on sick leave due to low back pain: a randomized, comparative, long‐term study. Spine 1997;22:1610‐7. - PubMed
Malmivaara 1995 {published data only}
    1. Malmivaara A, Häkkinen U, Aro T, Heinrichs ML, Koskenniemi L, Kuosma E, et al. The treatment of acute low back pain ‐ bed rest, exercises or ordinary activity?. N Engl J Med 1995;332:351‐5. - PubMed
Manniche 1988 {published data only}
    1. Manniche C, Hesselsoe G, Bentzen L, Christensen I, Lundberg E. Clinical trial of intensive muscle training for chronic low back pain. Lancet 1988;ii:1473‐6. - PubMed
    1. Manniche C, Lundberg E, Christensen I, Bentzen L, Hesselsoe G. Intensive dynamic back exercises for chronic low back pain: a clinical trial. Pain 1991;47:53‐63. - PubMed
Mannion 1999 {published data only}
    1. Mannion AF, Muntener M, Taimela S, Dvorak J. A randomized clinical trial of three active therapies for chronic low back pain. Spine 1999;24:2435‐48. - PubMed
    1. Mannion AF, Muntener M, Taimela S, Dvorak J. Comparison of three active therapies for chronic low back pain: results of a randomized clinical trial with one‐year follow‐up. Rheum 2001;40:772‐8. - PubMed
    1. Mannion AF, Taimela S, Muntener M, Dvorak J. Active therapy for chronic low back pain part 1. Effects on back muscle activation, fatigability, and strength. Spine 2001;26:897‐908. - PubMed
Moffett 1999 {published data only}
    1. Moffett JK, Torgerson D, Bell‐Syer S, Jackson D, Llewlyn‐Phillips H, Farrin A, et al. Randomised controlled trial of exercise for low back pain: clinical outcomes, costs, and preferences. BMJ 1999;319:279‐83. - PMC - PubMed
Moseley 2002 {published data only}
    1. Moseley L. Combined physiotherapy and education is efficacious for chronic low back pain. Aust J Physiother 2002;48:297‐302. - PubMed
Niemisto 2003 {published data only}
    1. Niemisto L, Lahtinen‐Suopanki T, Rissanen P, Lindgren K‐A, Sarna S, Hurri H. A randomized trial of combined manipulation, stabilizing exercises, and physician consultation compared to physician consultation alone for chronic low back pain. Spine 2003;28:2185‐91. - PubMed
Petersen 2002 {published data only}
    1. Petersen T, Kryger P, Ekdahl C, Olsen S, Jacobsen S. The effect of McKenzie therapy as compared with that of intensive strengthening training for the treatment of patients with subacute or chronic low back pain: A randomized controlled trial.. Spine 2002;27:1702‐9. - PubMed
Preyde 2000 {published data only}
    1. Preyde M. Effectiveness of massage therapy for subacute low‐back pain: A randomized controlled trial. Can Med Assoc J 2000;162:1815‐20. - PMC - PubMed
Rasmussen‐Barr 2003 {published data only}
    1. Rasmussen‐Barr E, Nilsson‐Wikmar L, Arvidsson I. Stabilizing training compared with manual treatment in sub‐acute and chronic low‐back pain. Manual Therapy 2003;8:233‐41. - PubMed
Risch 1993 {published data only}
    1. Risch SV, Norvell NK, Pollock ML, Risch ED, Langer H, Fulton M, et al. Lumbar strengthening in chronic low back pain patients: physiologic and psychological benefits. Spine 1993;18:232‐8. - PubMed
Rittweger 2002 {published data only}
    1. Rittweger J, Just K, Kautzsch K, Reeg P, Felsenberg D. Treatment of chronic lower back pain with lumbar extension and whole‐body vibration exercise: a randomized controlled trial. Spine 2002;27:1829‐34. - PubMed
Seferlis 1998 {published data only}
    1. Seferlis T, Nemeth G, Carlsson AM, Gillström P. Conservative treatment in patients sick‐listed for acute low‐back pain: a prospective randomised study with 12 months' follow‐up. Eur Spine J 1998;7(6):461‐70. - PMC - PubMed
Soukup 1999 {published data only}
    1. Glomsrod B, Lonn JH, Soukup MG, Bo K, Larsen S. 'Active back school', prophylactic management for low back pain: Three‐year follow‐up of a randomized, controlled trial. J Rehab Med 2001;33:26‐30. - PubMed
    1. Lonn JH, Glomsrod B, Soukup MG, Bo K, Larsen S. Active back school: Prophylactic management for low back pain. A randomized controlled, 1‐year follow‐up study. Spine 1999;24:865‐71. - PubMed
    1. Soukup M, Lonn J, Glomsrod B, Bo K, Larsen S. Exercises and education as secondary prevention for recurrent low back pain. Phys Res Int 2001;6:27‐39. - PubMed
    1. Soukup MG, Glomsrod B, Lonn JH, Bo K, Larsen S, Fordyce WE. The effect of a Mensendieck exercise program as secondary prophylaxis for recurrent low back pain: A randomized, controlled trial with 12‐month follow‐up. Spine 1999;24:1585‐92. - PubMed
Staal 2004 {published data only}
    1. Staal JB, Hlobil H, Twisk JW, Smid T, Koke AJ, Mechelen W. Graded activity for low back pain in occupational health care: a randomized, controlled trial.[see comment]. Ann Intern Med 2004;140:77‐84. - PubMed
Stankovic 1990 {published data only}
    1. Stankovic R, Johnell O. Conservative treatment of acute low back pain: a prospective randomized trial. Spine 1990;15:120‐3. - PubMed
    1. Stankovic R, Johnell O. Conservative treatment of acute low‐back pain: a 5‐year follow‐up study of two methods of treatment. Spine 1995;20:469‐72. - PubMed
Storheim 2003 {published data only}
    1. Storheim K, Brox JI, Holm I, Koller AK, Bo K. Intensive group training versus cognitive intervention in sub‐acute low back pain: short‐term results of a single‐blind randomized controlled trial. J Rehabil Med 2003;35:132‐40. - PubMed
Torstensen 1998 {published data only}
    1. Torstensen TA, Ljunggren AE, Meen HD, Odland E, Mowinckel P, Geijerstam S. Efficiency and costs of medical exercise therapy, conventional physiotherapy, and self‐exercise in patients with chronic low back pain: a pragmatic, randomized, single‐blinded, controlled trial with 1‐year follow‐up. Spine 1998;23:2616‐24. - PubMed
Tritilanunt 2001 {published data only}
    1. Tritilanunt T, Wajanavisit W. The efficacy of an aerobic exercise and health education program for treatment of chronic low back pain. J Med Assoc Thailand 2001;84:S528‐33. - PubMed
Turner 1990 {published data only}
    1. Turner JA, Clancy S, McQuade KJ, Cardenas DD. Effectiveness of behavioral therapy for chronic low back pain: a component analysis. J Consult Clin Psychol 1990;58:573‐9. - PubMed
Underwood 1998 {published data only}
    1. Underwood MR, Morgan J. The use of a back class teaching extension exercises in the treatment of acute low back pain in primary care. Fam Pract 1998;15:9‐15. - PubMed
Waterworth 1985 {published data only}
    1. Waterworth RF, Hunter IA. An open study of diflunisal, conservative and manipulative therapy in the management of acute mechanical low back pain. N Z Med J 1985;95:372‐5. - PubMed
Yelland 2004 {published data only}
    1. Yelland MJ, Glasziou PP, Bogduk N, Schluter PJ, McKernon M. Prolotherapy injections, saline injections, and exercises for chronic low‐back pain: a randomized trial. Spine 2004;29:9‐16. - PubMed
Yeung 2003 {published data only}
    1. Yeung CK, Leung MC, Chow DH. The use of electro‐acupuncture in conjunction with exercise for the treatment of chronic low‐back pain. J Alternative & Complementary Medicine 2003;9:479‐90. - PubMed
Yozbatiran 2004 {published data only}
    1. Yozbatiran N, Yildirim Y, Parlak B. Effects of fitness and aquafitness exercises on physical fitness in patients with chronic low back pain. The Pain Clinic 2004;16:35‐42.
Zylbergold 1981 {published data only}
    1. Zylbergold RS, Piper MC. Lumbar disc disease: comparative analysis of physical therapy treatments. Arch Phys Med Rehabil 1981;62:176‐9. - PubMed

References to studies excluded from this review

Coxhead 1981 {published data only}
    1. Coxhead CE, Inskip H, Meade TW, North WRS, Troup JDG. Multicentre trial of physiotherapy in the management of sciatic symptoms. Lancet 1981;i:1065‐8. - PubMed
Danielsen 2000 {published data only}
    1. Danielsen JM, Johnsen R, Kibsgaard SK, Hellevik E. Early aggressive exercise for postoperative rehabilitation after discectomy. Spine 2000;25:1015‐20. - PubMed
Danneels 2001 {published data only}
    1. Danneels LA, Cools AM, Vanderstraeten GG, Cambier DC, Witvrouw EE, Bourgois J, et al. The effects of three different training modalities on the cross‐sectional area of the paravertebral muscles. Scand J Med Sci Sports 2001;11:335‐41. - PubMed
    1. Danneels LA, Vanderstraeten GG, Cambier DC, Witvrouw EE, Bourgois J, Dankaerts W, et al. Effects of three different training modalities on the cross sectional area of the lumbar multifidus muscle in patients with chronic low back pain. Br J Sports Med 2001;35:186‐91. - PMC - PubMed
Friedrich 1998 {published data only}
    1. Friedrich M, Gittler G, Halberstadt Y, Cermak T, Heiller I. Combined exercise and motivation program: Effect on the compliance and level of disability of patients with chronic low back pain: A randomized controlled trial. Arch Phys Med Rehab 1998;79:475‐87. - PubMed
Ghoname 1999 {published data only}
    1. Ghoname EA, Craig WF, White PF, Ahmed HE, Hamza MA, Henderson BN, et al. Percutaneous electrical nerve stimulation for low back pain: a randomized crossover study. [see comments.] [erratum appears in JAMA 1999 May 19;281(19):1795.]. JAMA 1999;281:818‐23. - PubMed
Hagen 2000 {published data only}
    1. Hagen EM, Eriksen HR, Ursin H. Does early intervention with a light mobilization program reduce long‐term sick leave for low back pain?. Spine 2000;25:1973‐6. - PubMed
Helewa 1999 {published data only}
    1. Helewa A, Goldsmith CH, Lee P, Smythe HA, Forwell L. Does strengthening the abdominal muscles prevent low back pain ‐ A randomized controlled trial. J Rheum 1999;26:1808‐15. - PubMed
Horneij 2001 {published data only}
    1. Horneij E, Hemborg B, Jensen I, Ekdahl C. No significant differences between intervention programmes on neck, shoulder and low back pain: a prospective randomized study among home‐care personnel. J Rehabil Med 2001;33:170‐6. - PubMed
Lang 2003 {published data only}
    1. Lang E, Liebig K, Kastner S, Neundorfer B, Heuschmann P. Multidisciplinary rehabilitation versus usual care for chronic low back pain in the community: effects on quality of life. Spine Journal 2003;3(4):270‐6. - PubMed
Little 2001 {published data only}
    1. Little P, Roberts L, Blowers H, Garwood J, Cantrell T, Langridge J, et al. Should we give detailed advice and information booklets to patients with back pain? A randomized controlled factorial trial of a self‐management booklet and doctor advice to take exercise for back pain. Spine 2001;26:2065‐72. - PubMed
Manniche 1993 {published data only}
    1. Manniche C, Asmussen K, Lauritsen B, Vinterberg H, Karbo H, Abildstrup S, et al. Intensive dynamic back exercises with or without hyperextension in chronic back pain after surgery for lumbar disc protrusion: a clinical trial. Spine 1993;18:560‐7. - PubMed
Martin 1980 {published data only}
    1. Martin PR, Rose MJ, Nichols PJR, Russell PL, Hughes JG. Physiotherapy exercises for low back pain: process and clinical outcome. Int Rehabil Med 1980;8:34‐8. - PubMed
Morton 1999 {published data only}
    1. Morton JE. Manipulation in the treatment of acute low back pain. J Man Manip Ther 1999;7:182‐9.
Muller 2001 {published data only}
    1. Muller K, Schwesig R, Leuchte S, Riede D. [Coordinative treatment and quality of life ‐ A randomised trial of nurses with back pain] German.. Gesundheitswesen 2001;63:609‐18. - PubMed
Nwuga 1982 {published data only}
    1. Nwuga VCB. Relative therapeutic efficacy of vertebral manipulation and conventional treatment in back pain management. Am J Phys Med 1982;61:273‐8. - PubMed
Nwuga 1985 {published data only}
    1. Nwuga G, Nwuga V. Relative therapeutic efficacy of the Williams and McKenzie protocols in back pain management. Physiother Pract 1985;1:99‐105.
O'Sullivan 1997 {published data only}
    1. O'Sullivan PB, Twomey LT, Allison GT. Evaluation of specific stabilising exercise in the treatment of chronic low back pain with radiologic diagnosis of spondylolysis or spondylolisthesis. Spine 1997;22:2959‐67. - PubMed
Sachs 1994 {published data only}
    1. Sachs BL, Ahmad SS, LaCroix M, Olimpio D, Heath R, David JA, et al. Objective assessment for exercise treatment on the B‐200 isostation as part of work tolerance rehabilitation: a random prospective blind evaluation with comparison control population. Spine 1994;19:49‐52. - PubMed
Scrimshaw 2001 {published data only}
    1. Scrimshaw SV, Maher CG. Randomized controlled trial of neural mobilization after spinal surgery. Spine 2001;26:2647‐52. - PubMed
Snook 1998 {published data only}
    1. Snook SH, Webster BS, McGorry RW, Fogleman MT, McCann B. The reduction of chronic nonspecific low back pain through the control of early morning lumbar flexion. A randomized controlled trial. Spine 1998;23:2601‐7. - PubMed
Spratt 1993 {published data only}
    1. Spratt KF, Weinstein JN, Lehmann TR, Woody J, Sayre H. Efficacy of flexion and extension treatments incorporating braces for low back pain patients with retrodisplacement, spondylolisthesis, or normal sagittal translation. Spine 1993;18:1839‐49. - PubMed
Strand 2001 {published data only}
    1. Strand LI, Ljunggren AE, Haldorsen EMH, Esphehaug B. The impact of physical function and pain on work status at 1‐year follow‐up in patients with back pain. Spine 2001;26:800‐8. - PubMed
White 1966 {published data only}
    1. White AWM. Low back pain in men receiving workmen's compensation. Can Med Assoc J 1966;95:50‐56. - PMC - PubMed

References to studies awaiting assessment

Erhard 1994 {published data only}
    1. Erhard RE, Delitto A, Cibulka MT. Relative effectiveness of an extension program and a combined program of manipulation and flexion and extension exercises in patients with acute low back syndrome. Phys Ther 1994;74(12):1093‐100. - PubMed
Gillan 1998 {published data only}
    1. Gillan MG, Ross JC, McLean IP, Porter RW. The natural history of trunk list, its associated disability and the influence of McKenzie management. Eur Spine J 1998;7:480‐3. - PMC - PubMed
Kladny 2003 {published data only}
    1. Kladny B, Fischer FC, Haase I. [Evaluation of specific stablizing exercise in the treatment of low back pain and lumbar disk disease in outpatient rehabilitation][German]. Zeitschrift fur Orthopadie und Ihre Grenzgbiete 2003;141:401‐5. - PubMed

Additional references

Abenhaim 2000
    1. Abenheim L, Rossignol M, Valat J, Nordin M, Avouac B, Blotman F, et al. The role of activity in the therapeutic management of back pain: Report of the International Paris Task Force on back pain. Spine 2000;25:1S‐33S. - PubMed
Begg 1996
    1. Begg C, Cho M, Eastwood S. Improving the quality of reporting of randomized controlled trials: the CONSORT statement. JAMA 1996;276:637‐9. - PubMed
Bombardier 2001
    1. Bombardier C, Hayden JA, Beaton DE. Minimally clinically important difference: Low back pain outcome measures. J Rheumatol 2001;28:431‐8. - PubMed
DerSimonian 1986
    1. DerSimonian R, Laird N. Meta‐analysis in clinical trials. Controlled Clinical Trials 1986;7:177‐88. - PubMed
Deyo 1998
    1. Deyo RA, Battie M, Beurskens AJ, Bombardier C, Croft P, Koes B, et al. Outcome measures for low back pain research: A proposal for standardized use. Spine 1998;23:2003‐13. - PubMed
Egger 1997
    1. Egger M, Zellweger‐Zähner T, Schneider M, Junker C, Lengeler C, Antes G. Language bias in randomised controlled trials published in English and German. Lancet 1997;350:326‐9. - PubMed
Ernst 2003
    1. Ernst E, Canter PH. The Alexander technique: a systematic review of controlled clinical trials. Forschende Komplementarmedizin und Klassische Naturheilkunde 2003;10:325‐9. - PubMed
Higgins 2002
    1. Higgins JP, Thompson SG. Quantifying heterogeneity in a meta‐analysis. Statistics in Medicine 2002;21(11):1539‐58. - PubMed
Hilde 1998
    1. Hilde G, Bo K. Effect of exercise in the treatment of chronic low back pain: a systematic review emphasizing type and dose of exercise. Physical Therapy Reviews 1998;3:107‐17.
Jadad 1996
    1. Jadad AR, Moore A, Carroll D, Jenkinson C, Reynolds JM, Gavaghan DJ, et al. Assessing the quality of reports of randomized clinical trials: Is blinding necessary?. Controlled Clinical Trials 1996;17(1):1‐12. - PubMed
Kool 2004
    1. Kool J, Bie R, Oesch P, Knusel O, Brandt P, Bachmann S. Exercise reduces sick leave in patients with non‐acute non‐specific low back pain: a meta‐analysis. Journal of Rehabilitation Medicine 2004;36:49‐62. - PubMed
Kopec 2000
    1. Kopec JA. Measuring functional outcomes in persons with back pain: A review of back‐specific questionnaires. Spine 2000;25:3110‐4. - PubMed
Liddle 2004
    1. Liddle SD, Baxter GD, Gracey JH. Exercise and chronic low back pain: what works?. Pain 2004;107:176‐90. - PubMed
Pengel 2002
    1. Pengel HM, Maher CG, Refshauge KM. Systematic review of conservative interventions for subacute low back pain. Clin Rehabil 2002;16:811‐20. - PubMed
Salaffi 2004
    1. Salaffi F, Stancati A, Silvestri CA, Ciapetti A, Grassi W. Minimally clinically important changes in chronic musculoskeletal pain intensity measured on a numerical rating scale. European Journal of Pain 2004;8:283‐91. - PubMed
Song 2003
    1. Song F, Altman DG, Glenny AM, Deeks JJ. Validity of indirect comparison for estimating efficacy of competing interventions: empirical evidence from published meta‐analyses. BMJ 2003;326:472. - PMC - PubMed
Tugwell 2001
    1. Tugwell P. Philadelphia panel evidence‐based clinical practice guidelines on selected rehabilitation interventions for low back pain. Physical Therapy 2001;81:1641‐74. - PubMed
van Tulder 2003
    1. Tulder MW, Furlan A, Bombardier C, Bouter L, the Editorial Board of the Cochrane Collaboration Back Review Group. Updated method guidelines for systematic reviews in the Cochrane Collaboration Back Review Group. Spine 2003;28:1290‐9. - PubMed
von Korff 2000
    1. Korff M, Jensen MP, Karoly P. Assessing global pain severity by self‐report in clinical health services research. Spine 2000;25:3140‐51. - PubMed
Waddell 1997
    1. Waddell G, Feder G, Lewis M. Systematic reviews of bed rest and advice to stay active for acute low back pain. Br J Gen Pract 1997;47:647‐52. - PMC - PubMed

References to other published versions of this review

Hayden 2005a
    1. Hayden JA, Tulder MW, Malmivaara AV, Koes BW. Meta‐analysis: Exercise Therapy for Nonspecific Low Back Pain. Annals of Internal Medicine 2005;142:765‐75. - PubMed
Hayden 2005b
    1. Hayden JA, Tulder MW, Tomlinson G. Systematic Review: Strategies for Using Exercise Therapy to Improve Outcomes in Chronic Low Back Pain. Annals of Internal Medicine 2005;142:776‐85. - PubMed
van Tulder 2000a
    1. Tulder MW, Malmivaara A, Esmail R, Koes BW. Exercise therapy for low‐back pain. Cochrane Database of Systematic Reviews 2000, Issue 2. [Art. No.: CD000335. DOI: 10.1002/14651858.CD000335.] - PubMed
van Tulder 2000b
    1. Tulder MW, Malmivaara A, Esmail R, Koes BW. Exercise therapy for low back pain: A systematic review within the framework of the Cochrane Collaboration Back Review Group. Spine 2000;25(21):2784‐96. - PubMed

Publication types

MeSH terms

LinkOut - more resources