Exercise therapy for chronic low back pain.

Area of Science:

• Orthopedics
• Rehabilitation Medicine
• Evidence-Based Practice

Background:

• Chronic low back pain is a leading global cause of disability, incurring substantial healthcare and productivity costs.
• Effective and evidence-based treatments are crucial for managing this widespread condition.

Purpose of the Study:

• To systematically review the impact of exercise treatment on pain and functional limitations in adults with chronic non-specific low back pain.
• To compare exercise interventions against no treatment, usual care, placebo, and other conservative treatments.

Main Methods:

• Systematic review and meta-analysis of randomized controlled trials (RCTs).
• Searched multiple databases including CENTRAL, MEDLINE, Embase, and clinical trials registries.
• Included 249 RCTs assessing exercise for chronic low back pain (duration >12 weeks).
• Assessed risk of bias using the Cochrane risk of bias tool and certainty of evidence with GRADE.

Main Results:

• Moderate-certainty evidence shows exercise significantly reduces pain compared to no treatment, usual care, or placebo (MD -15.2).
• Functional limitations showed moderate-certainty evidence of improvement, but did not meet the minimal clinically important difference threshold (MD -6.8).
• Exercise demonstrated improved pain and functional limitations compared to other conservative treatments, though effects were not always clinically significant.

Conclusions:

• Exercise offers moderate-certainty evidence for effectiveness in reducing pain for chronic low back pain patients.
• Functional limitations improvements were modest and did not consistently meet clinical significance thresholds.
• Exercise is likely more effective than education or electrotherapy but not superior to manual therapy for pain relief.