SYSTEMATIC REVIEW AND SYNTHESIS OF HIGHER QUALITY EVIDENCE OF THE EFFECTIVENESS OF EXERCISE INTERVENTIONS FOR NON-SPECIFIC LOW BACK PAIN OF AT LEAST 6 WEEKS' DURATION

Systematic reviews and randomised controlled trials (RCTs) generally support the use of exercise interventions to reduce pain and improve function in patients with chronic nonspecific low back pain (LBP). However, many RCTs in the field of LBP include small numbers of subjects, have significant methodological limitations and use diverse exercise interventions. This review shows that the smaller RCTs often overestimate the true effectiveness or fail to detect true benefits. Also, statistically significant results from RCTs of low methodological quality might not be valid. This review showed that evidence from RCTs that are larger (>= 40 subjects in exercise group), score high on the adapted van Tulder methodological quality criteria (>= 5/10) and have used adequate statistical tests, support the use of exercise for patients with LBP of at least 6 weeks' duration, although the effect sizes tend to be smaller. This higher quality evidence particularly supports the use of strengthening exercises, (organised) aerobic exercises, general exercises, hydrotherapy and McKenzie exercises for back pain of at least 6 weeks' duration.