Department of General Practice, Erasmus Medical Center, Rotterdam, the Netherlands.
Best Pract Res Clin Rheumatol. 2010 Apr;24(2):193-204. doi: 10.1016/j.berh.2010.01.002.
Exercise therapy is the most widely used type of conservative treatment for low back pain. Systematic reviews have shown that exercise therapy is effective for chronic but not for acute low back pain. During the past 5 years, many additional trials have been published on chronic low back pain. This articles aims to give an overview on the effectiveness of exercise therapy in patients with low back pain. For this overview, existing Cochrane reviews for the individual interventions were screened for studies fulfilling the inclusion criteria, and the search strategy outlined by the Cochrane Back Review Group (CBRG) was followed. Studies were included if they fulfilled the following criteria: (1) randomised controlled trials,(2) adult (> or =18 years) population with chronic (> or =12 weeks) nonspecific low back pain and (3) evaluation of at least one of the main clinically relevant outcome measures (pain, functional status, perceived recovery or return to work). Two reviewers independently selected studies and extracted data on study characteristics, risk of bias and outcomes at short-term, intermediate and long-term follow-up. The GRADE approach (GRADE, Grading of Recommendations Assessment, Development and Evaluation) was used to determine the quality of evidence. In total, 37 randomised controlled trials met the inclusion criteria and were included in this overview. Compared to usual care, exercise therapy improved post-treatment pain intensity and disability, and long-term function. The authors conclude that evidence from randomised controlled trials demonstrated that exercise therapy is effective at reducing pain and function in the treatment of chronic low back pain. There is no evidence that one particular type of exercise therapy is clearly more effective than others. However, effects are small and it remains unclear which subgroups of patients benefit most from a specific type of treatment.
运动疗法是治疗腰痛最广泛使用的保守治疗方法。系统评价表明，运动疗法对慢性腰痛有效，但对急性腰痛无效。在过去的 5 年中，已经发表了许多关于慢性腰痛的额外试验。本文旨在概述运动疗法对腰痛患者的有效性。为此，对个别干预措施的现有 Cochrane 综述进行了筛选，以寻找符合纳入标准的研究，并遵循 Cochrane 腰痛综述组（CBRG）概述的搜索策略。如果研究符合以下标准，则将其纳入：（1）随机对照试验；（2）患有慢性（≥12 周）非特异性腰痛的成年（≥18 岁）人群；（3）评估至少一项主要临床相关结局指标（疼痛、功能状态、感知恢复或重返工作）。两位审查员独立选择研究，并提取研究特征、偏倚风险和短期、中期和长期随访结局的数据。使用 GRADE 方法（GRADE，推荐评估、制定和评估分级）来确定证据质量。共有 37 项随机对照试验符合纳入标准，并被纳入本综述。与常规护理相比，运动疗法可改善治疗后疼痛强度和残疾程度，以及长期功能。作者得出结论，随机对照试验的证据表明，运动疗法在治疗慢性腰痛时可有效减轻疼痛和功能障碍。没有证据表明某种特定类型的运动疗法比其他类型更有效。然而，效果较小，仍然不清楚哪些特定类型的治疗最能使哪些患者受益。
