Article type
Year
Abstract
Introduction: A large variety of therapeutic interventions is available for the treatment of chronic low back pain, but the efficacy of most of these interventions has not yet been proved beyond doubt.
Objective: To systematically evaluate the efficacy of the most common therapeutic interventions for chronic low back pain.
Methods: A systematic computerized literature search in the MEDLINE, EMBASE and PsycLIT databases was conducted, and studies were included in the review if the interventions were randomly allocated, if the results (exclusively or separately) concerned patients with chronic low back pain and if the article was published in English. A rating system was used to assess the strength of the evidence, based on the methodological quality of the randomized clinical trials, the relevance of the outcome measures and the consistency of the results.
Results: 80 Trials of 14 interventions were included in the review. The number of trials varied widely with regard to the interventions involved. In general, the methodological quality of the trials was poor; only 25% of the trials were considered to be of high quality. The most prevalent methodological problems concerned the size of the study population, the adequacy of compliance, the avoidance of co-interventions, the blinded effect measurements, the adequacy of the randomization procedure, the blinding of patients, and the description of drop-outs. Strong evidence was found for the effectiveness of spinal manipulation, back schools and exercise therapy, especially for short-term effects. The evidence in favour of other conservative types of treatment was only moderate or limited, or there was no evidence at all.
Discussion: The quality of the design, execution and reporting of randomized clinical trials should be improved in order to establish strong evidence for the efficacy of the various therapeutic interventions for chronic low back pain.
Objective: To systematically evaluate the efficacy of the most common therapeutic interventions for chronic low back pain.
Methods: A systematic computerized literature search in the MEDLINE, EMBASE and PsycLIT databases was conducted, and studies were included in the review if the interventions were randomly allocated, if the results (exclusively or separately) concerned patients with chronic low back pain and if the article was published in English. A rating system was used to assess the strength of the evidence, based on the methodological quality of the randomized clinical trials, the relevance of the outcome measures and the consistency of the results.
Results: 80 Trials of 14 interventions were included in the review. The number of trials varied widely with regard to the interventions involved. In general, the methodological quality of the trials was poor; only 25% of the trials were considered to be of high quality. The most prevalent methodological problems concerned the size of the study population, the adequacy of compliance, the avoidance of co-interventions, the blinded effect measurements, the adequacy of the randomization procedure, the blinding of patients, and the description of drop-outs. Strong evidence was found for the effectiveness of spinal manipulation, back schools and exercise therapy, especially for short-term effects. The evidence in favour of other conservative types of treatment was only moderate or limited, or there was no evidence at all.
Discussion: The quality of the design, execution and reporting of randomized clinical trials should be improved in order to establish strong evidence for the efficacy of the various therapeutic interventions for chronic low back pain.