Exercises for prevention of recurrences of low-back pain

Background Back pain is a common disorder that has a tendency to recur. It is unclear if exercises, either as part of treatment or as a posttreatment programme, can reduce back pain recurrences. Objectives To investigate the effectiveness of exercises for preventing new episodes of low-back pain or low-back pain-associated disability. Search strategy We searched CENTRAL (The Cochrane Library 2009, issue 3), MEDLINE, EMBASE and CINAHL up to July 2009. Selection criteria Inclusion criteria were: participants who had experienced back pain before, an intervention that consisted of exercises without additional specific treatment and outcomes that measured recurrence of back pain or time to recurrence. Data collection and analysis Two review authors independently judged if references met the inclusion criteria. The same review authors independently extracted data and judged the risk of bias of the studies. Studies were divided into post-treatment intervention programmes and treatment studies. Study results were pooled with meta-analyses if participants, interventions, controls and outcomes were judged to be sufficiently homogenous. Main results We included 13 articles reporting on nine studies with nine interventions. Four studies with 407 participants evaluated post-treatment programmes and five studies with 1113 participants evaluated exercise as a treatment modality. Four studies had a low risk of bias, one study a high risk and the remainder an unclear risk of bias. We found moderate quality evidence that post-treatment exercises were more effective than no intervention for reducing the rate of recurrences at one year (Rate Ratio 0.50; 95% Confidence Interval 0.34 to 0.73). There was moderate quality evidence that the number of recurrences was significantly reduced in two studies (Mean Difference -0.35; 95% CI -0.60 to -0.10) at one-half to two years followup. There was very low quality evidence that the days on sick leave were reduced by post-treatment exercises (Mean Difference -4.37; 95% CI -7.74 to -0.99) at one-half to two years follow-up. We found conflicting evidence for the effectiveness of exercise treatment in reducing the number of recurrences or the recurrence rate. Authors' conclusions There is moderate quality evidence that post-treatment exercise programmes can prevent recurrences of back pain but conflicting evidence was found for treatment exercise. Studies into the validity of measurement of recurrences and the effectiveness of post-treatment exercise are needed.