Lemieux James, Abdollah Vahid, Powelske Brandyn, Kawchuk Greg
Department of Physical Therapy, Faculty of Rehabilitation Medicine, University of Alberta, Edmonton, AB, Canada.
PLoS One. 2020 Dec 30;15(12):e0244588. doi: 10.1371/journal.pone.0244588. eCollection 2020.
Low back pain (LBP) is the leading cause of disability worldwide with a substantial financial burden on individuals and health care systems. To address this, clinical practice guidelines often recommend non-pharmacological, non-invasive management approaches. One management approach that has been recommended and widely implemented for chronic LBP is group-based exercise programs, however, their clinical value compared with other non-pharmacological interventions has not been investigated systematically.
To compare the effectiveness of group-based exercise with other non-pharmacological interventions in people with chronic LBP.
Four electronic databases were searched by two independent reviewers. Only randomized controlled trials that compared group-based exercise with other non-pharmacological interventions for chronic LBP were eligible. Study quality was assessed using the Cochrane Handbook for systematic reviews of Interventions by two independent reviewers.
Eleven studies were eligible. We identified strong evidence of no difference between group exercise and other non-pharmacologic interventions for disability level and pain scores 3-month post-intervention in people with chronic LBP. We could not find any strong or moderate evidence for or against the use of group-based exercise in the rehabilitation of people with chronic LBP for other time-points and health measurement outcomes. We found no statistically significant differences in disability and quality of life and pain between the group and individual non-pharmacological interventions that included exercise.
With this equivocal finding, group-based exercise may be a preferred choice given potential advantages in other domains not reviewed here such as motivation and cost. Further research in this area is needed to evaluate this possibility.
腰痛是全球导致残疾的主要原因，给个人和医疗保健系统带来了沉重的经济负担。为解决这一问题，临床实践指南通常推荐非药物、非侵入性的管理方法。一种已被推荐并广泛应用于慢性腰痛的管理方法是基于群体的运动项目，然而，与其他非药物干预措施相比，其临床价值尚未得到系统研究。
比较基于群体的运动与其他非药物干预措施对慢性腰痛患者的有效性。
由两名独立评审员检索四个电子数据库。只有将基于群体的运动与其他针对慢性腰痛的非药物干预措施进行比较的随机对照试验才符合要求。两名独立评审员使用《Cochrane干预措施系统评价手册》对研究质量进行评估。
11项研究符合要求。我们发现有力证据表明，对于慢性腰痛患者，在干预后3个月时，群体运动与其他非药物干预措施在残疾水平和疼痛评分方面没有差异。对于在慢性腰痛患者康复的其他时间点和健康测量结果中使用基于群体的运动，我们找不到任何支持或反对的有力或中等强度证据。我们发现，在包括运动的群体和个体非药物干预措施之间，残疾、生活质量和疼痛方面没有统计学上的显著差异。
鉴于这一不确定的结果，考虑到在本文未探讨的其他方面（如动机和成本）可能存在的优势，基于群体的运动可能是一个首选。需要在这一领域进行进一步研究以评估这种可能性。
