Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
Department of Community Health and Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada.
Br J Sports Med. 2020 Nov;54(21):1277-1278. doi: 10.1136/bjsports-2019-101205. Epub 2019 Nov 28.
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.
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.
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.
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.
腰痛是全球导致残疾的主要原因之一。运动疗法被广泛推荐用于治疗持续性非特异性腰痛。虽然有证据表明运动平均而言具有中等疗效，但仍不确定哪些人最能从运动中受益。
与 Cochrane 综述更新并行，我们向高质量的成人随机临床试验请求了个体参与者数据 (IPD)，这些试验的主要关注结局是疼痛和功能限制，以及总体恢复情况。我们汇编了一个主数据集，包括基线参与者特征、运动和对照特征以及短期、中期和长期随访的结局。我们进行了描述性分析，并使用多水平混合效应回归进行了 IPD 荟萃分析，分析了总体治疗效果和预设的潜在治疗效果修饰剂。
我们收到了 27 项试验 (3514 名参与者) 的 IPD。与不治疗/常规护理相比，与不治疗/常规护理相比，运动疗法平均可减轻疼痛（每 100 名患者的平均效应/95%置信区间为-10.7（-14.1 至-7.4）），这与临床上重要的 20%最小获益效应相符。运动疗法在短期随访时可使功能限制得到临床显著的 23%改善（每 100 名患者的平均效应/95%置信区间为-10.2（-13.2 至-7.3））。工作中没有繁重的体力需求和低背痛药物治疗是潜在的治疗效果修饰剂——与非运动对照相比，这些修饰剂与更好的运动结果相关。较低的身体质量指数与运动治疗相比，与不治疗/常规护理相比，结果也更好。本研究受到参与者特征的不一致可用性和测量的限制。
本研究提供了可能有用的信息，有助于治疗患者并设计更好地匹配特定亚组的运动干预研究。
