Goethe-University Frankfurt, Institute of Sports Sciences, Department of Sports Medicine and Exercise Physiology, Frankfurt am Main; Department of Pain Medicine, Klinikum Landsberg am Lech, Landsberg am Lech, Germany.
TU Dresden- University Hospital Carl Gustav Carus, University Center of Orthopedics, Trauma and Plastic Surgery, Dresden, Germany.
J Pain. 2022 Nov;23(11):1856-1873. doi: 10.1016/j.jpain.2022.07.005. Epub 2022 Jul 29.
This systematic review, meta-analysis and meta-regression investigated the effects of individualized interventions, based on exercise alone or combined with psychological treatment, on pain intensity and disability in patients with chronic non-specific low-back-pain. Databases were searched up to January 31, 2022 to retrieve respective randomized controlled trials of individualized and/or personalized and/or stratified exercise interventions with or without psychological treatment compared to any control. Fifty-eight studies (n = 10084) were included. At short-term follow-up (12 weeks), low-certainty evidence for pain intensity (SMD -0.28 [95%CI -0.42 to -0.14]) and very low-certainty evidence for disability (-0.17 [-0.31 to -0.02]) indicates effects of individualized versus active exercises, and very low-certainty evidence for pain intensity (-0.40; [-0.58 to -0.22])), but not (low-certainty evidence) for disability (-0.18; [-0.22 to 0.01]) compared to passive controls. At long-term follow-up (1 year), moderate-certainty evidence for pain intensity (-0.14 [-0.22 to -0.07]) and disability (-0.20 [-0.30 to -0.10]) indicates effects versus passive controls. Sensitivity analyses indicates that the effects on pain, but not on disability (always short-term and versus active treatments) were robust. Pain reduction caused by individualized exercise treatments in combination with psychological interventions (in particular behavioral-cognitive therapies) (-0.28 [-0.42 to -0.14], low certainty) is of clinical importance. Certainty of evidence was downgraded mainly due to evidence of risk of bias, publication bias and inconsistency that could not be explained. Individualized exercise can treat pain and disability in chronic non-specific low-back-pain. The effects at short term are of clinical importance (relative differences versus active 38% and versus passive interventions 77%), especially in regard to the little extra effort to individualize exercise. Sub-group analysis suggests a combination of individualized exercise (especially motor-control based treatments) with behavioral therapy interventions to booster effects. PERSPECTIVE: The relative benefit of individualized exercise therapy on chronic low back pain compared to other active treatments is approximately 38% which is of clinical importance. Still, sustainability of effects (> 12 months) is doubtable. As individualization in exercise therapies is easy to implement, its use should be considered. PROSPERO REGISTRATION: CRD42021247331.
本系统评价、荟萃分析和荟萃回归研究了基于运动的个体化干预措施对慢性非特异性下腰痛患者疼痛强度和残疾的影响，这些干预措施单独或结合心理治疗。研究人员检索了截至 2022 年 1 月 31 日的数据库，以获取与任何对照组相比，个体化和/或个性化和/或分层运动干预措施（有或没有心理治疗）的随机对照试验。共纳入 58 项研究（n=10084）。在短期随访（12 周）时，低确定性证据表明疼痛强度（SMD -0.28 [95%CI -0.42 至 -0.14]）和残疾（非常低确定性证据 -0.17 [-0.31 至 -0.02]）存在影响，而与被动对照相比，疼痛强度（非常低确定性证据 -0.40 [0.58 至 -0.22]）但不是残疾（低确定性证据 -0.18 [0.22 至 0.01]）存在影响。在长期随访（1 年）时，中确定性证据表明疼痛强度（-0.14 [-0.22 至 -0.07]）和残疾（-0.20 [-0.30 至 -0.10]）存在影响。敏感性分析表明，疼痛的效果，但不是残疾（始终是短期的，与主动治疗相比）是稳健的。个体化运动治疗与心理干预（特别是行为认知疗法）相结合可降低疼痛（-0.28 [-0.42 至 -0.14]，低确定性），具有临床重要意义。证据的确定性主要因偏倚风险、发表偏倚和无法解释的不一致而降低。个体化运动可治疗慢性非特异性下腰痛的疼痛和残疾。短期效果具有临床重要意义（与主动治疗相比相对差异为 38%，与被动治疗相比为 77%），特别是考虑到个体化运动的额外努力很小。亚组分析表明，个体化运动（尤其是基于运动控制的治疗）与行为治疗干预相结合可以增强效果。观点：与其他主动治疗相比，个体化运动疗法对慢性腰痛的相对益处约为 38%，这具有临床意义。然而，效果的可持续性（>12 个月）值得怀疑。由于运动疗法中的个体化很容易实施，因此应考虑使用。PROSPERO 注册：CRD42021247331。
