Effectiveness of physical therapy and exercise on pain and functional status in patients with chronic low back pain: a randomized-controlled trial

Prognostic Factors in Patients Undergoing Physiotherapy for Chronic Low Back Pain: A Level I Systematic Review

Background: Low back pain is common. For patients with mechanic or non-specific chronic LBP (cLBP), the current guidelines suggest conservative, nonpharmacologic treatment as a first-line treatment. Among the available strategies, physiotherapy represents a common option offered to patients presenting with cLBP. The present systematic review investigates the prognostic factors of patients with mechanic or non-specific cLBP undergoing physiotherapy. Methods: In September 2024, the following databases were accessed: PubMed, Web of Science, Google Scholar, and Embase. All the randomised controlled trials (RCTs) which evaluated the efficacy of a physiotherapy programme in patients with LBP were accessed. All studies evaluating non-specific or mechanical LBP were included. Data concerning the following PROMs were collected: the pain scale, Roland Morris Disability Questionnaire (RMQ), and Oswestry Disability Index (ODI). A multiple linear model regression analysis was conducted using the Pearson Product-Moment Correlation Coefficient. Results: Data from 2773 patients were retrieved. The mean length of symptoms before the treatment was 61.2 months. Conclusions: Age and BMI might exert a limited influence on the outcomes of the physiotherapeutic management of cLBP. Pain and disability at baseline might represent important predictors of health-related quality of life at the six-month follow-up. Further studies on a larger population with a longer follow-up are required to validate these results.

Evidence of Commonly Used Integrative Approaches with Pharmacotherapy for Chronic Pain Management

This review examines the integration of traditional pharmacological methods with alternative and complementary therapies in chronic pain management. It delves into neurostimulation techniques, highlighting their clinical outcomes and biological bases. Acupuncture's role in modulating pain pathways is explored, illustrating its balance of tradition and clinical application. The paper also covers the pain-relieving potential of herbal medicine, emphasizing natural products' significance in pain relief. Additionally, it discusses the psychological and rehabilitative dimensions of pain through psychosocial therapy and counseling. The conclusion underscores the importance of a multidisciplinary approach, integrating diverse therapies into conventional pain management to effectively treat chronic pain. This synthesis highlights the synergistic potential of combining traditional and innovative therapeutic modalities, offering a comprehensive guide for healthcare professionals in enhancing pain management practices.

Knowledge and Attitude Toward Sciatica Pain and Treatment Methods Among the Population of Qassim in Saudi Arabia: A Cross-Sectional Study

Background: Sciatica, a pain radiating along the sciatic nerve, can cause significant suffering and functional limitations. Understanding individual populations' knowledge and attitudes about sciatica pain is crucial for designing targeted interventions and enhancing healthcare delivery, especially in Saudi Arabia. This study aimed to evaluate the knowledge and attitude toward sciatica pain and treatment methods among the population of Al-Qassim in Saudi Arabia. Methods and materials:This online cross-sectional study was conducted in the Al-Qassim region, Saudi Arabia, using a self-administered questionnaire. The data was analyzed using SPSS software, with numeric data presented as mean ± SD and categorical variables as frequencies and percentages. Correlation analyses included the Chi-squared test and one-way ANOVA. Results: The study received 398 responses, from mostly female (n=305, 76.6%) and Saudi adults aged under 30 (n=248, 62.3%). Most participants sought treatment for sciatica pain from a specialist doctor (n=28, 56.0%) or a general doctor (n=10, 20.0%). Physical therapy was the most common self-treatment method (n=11, 32.4%), followed by painkillers and muscle relaxants (n=10, 29.4%). Knowledge and attitude toward sciatica were generally low (mean score: 3.54 ± 2.61 out of 9), with only 70 (17.6%) showing good knowledge. Most respondents recognized practices like spinal imaging, surgery as a last resort, and exercise/sitting habits as impacting sciatica outcomes. Traditional therapies like massage, cupping, acupuncture, and cautery were considered beneficial. Educational level significantly impacted knowledge scores, with higher mean scores among postgraduate education holders and bachelor's degree holders (mean scores: 4.06 ± 2.48 and 3.98 ± 2.53, respectively). Age, gender, occupation, nationality, and region showed no significant differences in mean knowledge scores. Attitude scores were similar across sociodemographic spectra, with younger respondents having slightly more positive attitudes.  Conclusion: The study showed poor knowledge, influenced by education levels, and neutral attitudes about sciatica among residents of Al-Qassim. Therefore, educational programs and engagement of healthcare stakeholders are recommended to raise awareness and improve knowledge and attitudes.

Physiotherapeutic and non-conventional approaches in patients with chronic low-back pain: a level I Bayesian network meta-analysis

Chronic low back pain (cLBP) is a major cause of disability and healthcare expenditure worldwide. Its prevalence is increasing globally from somatic and psychosocial factors. While non-pharmacological management, and in particular physiotherapy, has been recommended as a first-line treatment for cLBP, it is not clear what type of physiotherapeutic approach is the most effective in terms of pain reduction and function improvement. This analysis is rendered more difficult by the vast number of available therapies and a lack of a widely accepted classification that can effectively highlight the differences in the outcomes of different management options. This study was conducted according to the PRISMA guidelines. In January 2024, the following databases were accessed: PubMed, Web of Science, Google Scholar, and Embase. All the randomised controlled trials (RCTs) which compared the efficacy of physiotherapy programs in patients with cLBP were accessed. Studies reporting on non-specific or mechanical cLPB were included. Data concerning the Visual Analogic Scale (VAS) or numeric rating scale (NRS), Roland Morris Disability Questionnaire (RMQ) and Oswestry Disability Index (ODI). Data from 12,773 patients were collected. The mean symptom duration was 61.2 ± 51.0 months and the mean follow-up was 4.3 ± 5.9 months. The mean age was 44.5 ± 9.4 years. The mean BMI was 25.8 ± 2.9 kg/m2. The Adapted Physical Exercise group evidenced the lowest pain score, followed by Multidisciplinary and Adapted Training Exercise/Complementary Medicine. The Adapted Physical Exercise group evidenced the lowest RMQ score followed by Therapeutic Exercises and Multidisciplinary. The Multidisciplinary group evidenced the lowest ODI score, followed by Adapted Physical Exercise and Physical Agent modalities. Within the considered physiotherapeutic and non-conventional approaches to manage nonspecific and/or mechanic cLBP, adapted physical exercise, physical agent modalities, and a multidisciplinary approach might represent the most effective strategy to reduce pain and disability.

Effects of Pain Neuroscience Education and Physiotherapy on Chronic Low Back Pain, Fear of Movement and Functional Status: A Randomised Pilot Study

Background: Chronic non-specific low back pain is a non-harmous condition often found in the general population. It is one of the most significant disabilities and needs different treatment modalities. This study investigates the effects of pain neuroscience education and physiotherapy on pain intensity, fear of movement and functional status in a Lithuanian cohort with non-specific low back pain. Methods: The study was performed at the primary health care unit in Kaunas, Lithuania. The key inclusion criterion was persistent non-specific low back pain longer than three months and which affects daily life functions. Thirty participants (mean 33.47, SD 4.38 years age, 70% women) were randomised into two training groups with and without pain neuroscience education (for a total of 60 min of teaching). Physiotherapy was performed twice per week during 45 min/session for a period of 10 weeks with exercises which strengthen, stabilize, and stretch the spinal cord muscles. Outcomes included pain intensity, kinesiophobia and disability and these were measured by self-scored questionnaires (numeric rating scale, Tampa scale for kinesiophobia-11, Oswestry disability index and the Roland-Morris questionnaire, respectively). Results: The results indicate that both groups improved in the measured outcomes, with the only difference between them being a better improvement in kinesiophobia in the group receiving physiotherapy and pain neuroscience education. Conclusions: The results of this study confirm that a relatively short intervention of pain neuroscience education enhances the effects of physiotherapy and should be implemented in clinical practice.

Conservative Treatment in Adult Degenerative Scoliosis: a Prospective Cohort Study

Background: Adult degenerative scoliosis (ADS) is a coronal deviation of the spine greater than 10° resulting from the progressive degeneration of the vertebral elements in middle age, which is a three-dimensional deformity. In this study, the effect of conservative treatment methods on pain, disability, and quality of life of patients with ADS was evaluated. Methods:Thirty females with ADS were included in the present study. Demographic characteristics, Cobb angles, Visual Analog Scale (VAS), Short Form-36 (SF-36), Scoliosis Research Society-22 (SRS-22) and Roland Morris Disability Questionnaires (RMDQ) were noted. Fifteen sessions of physical therapy (hotpack, TENS and ultrasound) and exercises were administered to all patients. All assessment scales were used for evaluation at baseline as well as one month and three months after treatment. Results:Visual Analog Scale scores statistically differed between the first, second and third measurements (p<0,001). There was a significantly improvement in RMDQ between periods of time (p<0,001). While the second assessment was significantly lower than the first measure (p=0,001), there was no difference between the third and second measures (p=0,496). Similarly, quality of life assessments (SRS-22, SF-36) significantly differed between the first and second assessments and continued at the third assessment. Conclusion:Given the difficulties of surgical treatment and patients' comorbidities, conservative treatment methods are becoming important for ADS. Non-surgical treatments for ADS should be taken into consideration to improve pain, disability and quality of life outcomes.

Bidirectional Longitudinal Association between Back Pain and Loneliness in Later Life: Evidence from English Longitudinal Study of Ageing

BACKGROUND

This study examined the bidirectional and temporal-ordinal relationship between loneliness and back pain.

METHODS

Data from 7,730 participants in waves 6 (2012-2013), 7 (2014-2015), and 8 (2016-2017) of the national English Longitudinal Study of Ageing were analyzed. Back pain was graded on a scale of 0-10 (0, no discomfort; 10, unbearable pain). Loneliness was measured using the Revised University of California Los Angeles Loneliness Scale. A targeted minimum loss-based estimator was used to examine the bidirectional longitudinal associations between back pain and loneliness.

RESULTS

No loneliness in waves 6 and 7 (relative risk [RR]=0.76; 95% confidence interval [CI], 0.61-0.94), no loneliness in wave 6 but loneliness in wave 7 (RR=0.58; 95% CI, 0.50-0.68), and loneliness in wave 6 but not in wave 7 (RR=0.69; 95% CI, 0.57-0.86) were associated with significant risk reductions of back pain in wave 8 compared with the scenario of loneliness in waves 6 and 7. Mild back pain in wave 6 but moderate back pain (RR=0.55; 95% CI, 0.35-0.86) or severe back pain in wave 7 (RR=0.49; 95% CI, 0.34-0.72) showed a significant risk reduction of loneliness in wave 8 compared with severe back pain in waves 6 and 7.

CONCLUSION

Loneliness may be a risk factor for back pain, and back pain may be a risk factor for loneliness. The results of this study will inform the development of more effective interventions for loneliness and back pain.

Conservative Treatment in Adult Degenerative Scoliosis: a Prospective Cohort Study

Background: Adult degenerative scoliosis (ADS) is a coronal deviation of the spine greater than 10° resulting from the progressive degeneration of the vertebral elements in middle age, which is a three-dimensional deformity. In this study, the effect of conservative treatment methods on pain, disability, and quality of life of patients with ADS was evaluated. Methods:Thirty females with ADS were included in the present study. Demographic characteristics, Cobb angles, Visual Analog Scale (VAS), Short Form-36 (SF-36), Scoliosis Research Society-22 (SRS-22) and Roland Morris Disability Questionnaires (RMDQ) were noted. Fifteen sessions of physical therapy (hotpack, TENS and ultrasound) and exercises were administered to all patients. All assessment scales were used for evaluation at baseline as well as one month and three months after treatment. Results:Visual Analog Scale scores statistically differed between the first, second and third measurements (p<0,001). There was a significantly improvement in RMDQ between periods of time (p<0,001). While the second assessment was significantly lower than the first measure (p=0,001), there was no difference between the third and second measures (p=0,496). Similarly, quality of life assessments (SRS-22, SF-36) significantly differed between the first and second assessments and continued at the third assessment. Conclusion:Given the difficulties of surgical treatment and patients' comorbidities, conservative treatment methods are becoming important for ADS. Non-surgical treatments for ADS should be taken into consideration to improve pain, disability and quality of life outcomes.

Mézières Method as a practice of embodiment in patients with low back pain: a mixed study

INTRODUCTION

The objectives of this study were to determine the effects of the Mézières Method (MM) on pain and disability related to low back pain (LBP), compared to a program of heat, massage and exercise, and to understand the meaning of the bodily experience with the MM.

PATIENTS AND METHODS

Mixed methods convergent parallel design, combining an equivalent randomized clinical trial with a qualitative phenomenological approach. Sixty-one participants aged 18-65 years with chronic non-specific LBP lasting more than 3 months. Patients were randomized into two groups: the MM group (n = 29) and the comparison group (CG) who received heat, massage plus flexibility and strengthening exercises (n = 31). MM and CG participants underwent 10 one-hour physical therapy sessions over a 5-week period and were evaluated three times: pre-intervention, post-intervention and follow-up at 6 weeks after the end of treatment.

RESULTS

Both groups reported positive effects on LBP . MM group showed superior effects in pain relief in the short term (Cohen's D 0.80; p = 0.004). Participants interpreted the interaction with the MM as a teaching-learning process that allowed body awareness.

CONCLUSION

Both treatment were similarly beneficial but MM had superior effects on pain in the short term. MM is perceived by the participants as a teaching-learning process focused on body awareness that facilitate effective management of LBP.

The effect of a mobile health App on treatment adherence and revenue at physical health clinics: a retrospective record review

BACKGROUND

A significant proportion of patients do not adhere to their prescribed course of physical therapy or self-discharge themselves from care. Adhering to prescribed physical therapy, including attending physical therapy clinic appointments, contribute to patients achieving the goals of therapy including reducing pain and increasing functioning. Online platforms have been demonstrated to be effective means for managing clinical patients with musculoskeletal pain similar to managing them in person. Behavioral change techniques introduced through digital or online platforms can reduce nonadherence with prescribed physical therapy and improve patient outcomes. The literature also indicates that a phone-based App provided to patients that includes a reward incentive gamification to complement their care contributed to a greater number of kept appointments in a physical therapy clinic.

OBJECTIVE

The purpose of this study was to compare the rate of provider-discharge with self-discharge and the number of clinic visits among patients attending a physical health clinic who did and did not choose to adopt a phone-based App to complement their care. A secondary purpose was to compare the revenue generated by patients attending a physical health clinic who did and did not choose to adopt a phone-based App to complement their care.

METHODS

A retrospective analysis of all new outpatient medical records (n=5,328) from a multisite physical health practice were evaluated between January 2018 to December 2019. Patients in the sample self-selected into the 2018 Usual Care Group, the 2019 Usual Care Group and the 2019 Kanvas App Group who downloaded the Kanvas App. Kanvas is a customized private practice App, designed for patient engagement with their specific health care provider. This App included a gamification system that provided rewards to the patient for attending their scheduled clinic appointments. According to their medical record each patient was classified as completing prescribed therapy (Provider-Discharged) or not completing their prescribed therapy (Self-Discharged). Also, extracted from each patient's medical record were the total number of clinic visits each patient attended, the total charges for services and the total payments received by the clinic per patient.

RESULTS

Patients in the 2019 Kanvas App Group exhibited a higher rate of provider-discharge compared to the patients who did not adopt the App. This greater rate of provider-discharges among the patients who adopted the Kanvas App likely contributed to this group attending more clinic visits (13.21+12.09) than the other study groups who did not download the App (10.72+9.80 - 11.35+11.10). This greater number of clinic visits in turn contributed to the patients who adopted the App generating more clinic charges and payments.

CONCLUSIONS

Future investigators need to employ more rigorous methods to confirm these findings and healthcare providers need to weigh the anticipated benefits against the cost and staff involvement in managing the Kanvas App.

CLINICALTRIAL

Home Exercise Programs Are Infrequently Prescribed in Trials of Supervised Exercise for Individuals With Low Back Pain: A Scoping Review of 292 Randomized Controlled Trials

OBJECTIVES: To (1) determine how often home exercise programs (HEPs) are prescribed in supervised exercise trials for low back pain (LBP) and (2) describe characteristics of the HEP programs (design, purpose, dose, and adherence). DESIGN: Scoping review. LITERATURE SEARCH: PubMed, CINAHL, and Ovid MEDLINE were searched from January 1, 2010, to August 17, 2021. STUDY SELECTION CRITERIA: Randomized controlled trials that included adults with LBP who received exercise interventions. DATA SYNTHESIS: The presence or absence of a prescribed HEP and any details of the HEP including design, dose, and adherence were extracted and summarized. RESULTS: Of 2689 potentially relevant trials, 292 were eligible for inclusion. Ninety-four trials (32%) included a HEP. The most commonly prescribed home exercises were core stability, trunk strengthening, and motor control exercises. There was great variation in the frequency and duration with which HEPs were prescribed. Adherence to HEPs was measured in fewer than half of the trials, and the methods for measuring adherence were inconsistent. Adherence to HEPs ranged from 29% to 82% in the 21 trials that reported adherence. CONCLUSION: Home exercise programs are not regularly prescribed in supervised exercise trials for LBP. There was considerable variation in prescribing HEPs and monitoring exercise adherence in trials of exercise-based treatments for adults with LBP. There is no consistent method used to measure participants' adherence to HEPs, and adherence percentages vary widely. J Orthop Sports Phys Ther 2023;53(3):120-142. Epub: 16 January 2023. doi:10.2519/jospt.2023.11448.

Rehabilitation Strategies for a Patient With Traumatic Multiple Fractures: A Case Report

Le Fort fractures are a specific kind of facial bone fracture that develops after a blow to the face. Most of the fractures of the spine occur in the thoracolumbar region. The benefits of physiotherapy, which includes manual therapies and exercise regimens, for patients are becoming more and more clear. We are going to report the case of a 25-year-old male adult with a thoracolumbar fracture and a Le Fort fracture. We made an effort to develop a post-surgical physical therapy rehabilitation program. The patient's condition and general quality of life were successfully improved. We focused on the patient's primary symptoms, which were thoracolumbar discomfort, lower limb weakness, edema and pain on the left side of the face, trismus, and restricted mouth opening. We worked on the complaints mentioned by the patient and were successful in resolving them.

Comparison of the effects of conventional physiotherapy and proprioception exercises on pain and ankle proprioception in patients with lumbar radiculopathy

BACKGROUND

Lumbar radiculopathy is characterized by a significant amount of backache causing loss of workforce and is a significant health problem frequently seen in the general population.

OBJECTIVE

The purpose of this study was to compare the effects of conventional physiotherapy (CT) and proprioception exercises (PE) on ankle proprioception and lumbar pain between patients with lumbar radiculopathy and a healthy control group.

METHODS

In this randomized clinical trial, 89 patients referred to the Physical Medicine and Rehabilitation outpatient clinic were selected through convenience sampling. They were randomly assigned to three groups: CT (n= 27), PE (n= 31), CT&PE (n= 31). Thirty healthy volunteers were included in the study as the control group. Proprioception measurements were made with an isokinetic dynamometer at 10∘ dorsiflexion (DF), 11∘, and 25∘ plantarflexion (PF) angles. Lumbar pain was assessed by using the Numerical Pain Rating Scale (NPRS). The data were analyzed by IBM SPSS Statistics version 22.0 via the Kruskal-Wallis and Mann-Whitney U tests.

RESULTS

There was a statistically significant difference between the groups in terms of ankle proprioception and NPRS measurements in post-treatment evaluations (p< 0.05). Statistically significant differences were found between CT and PE groups and CT&PE and control groups. There was no statistically significant difference in comparing CT and PE groups and CT&PE and control groups within themselves (p> 0.05).

CONCLUSION

The combined use of CT and PE is an effective method that can be used in the clinic to reduce angular differences in ankle proprioception which is one of the primary factors of balance and coordination and lumbar pain.

Chronic low back pain changes the latissmus dorsi and gluteus maximus muscles activation pattern and upward scapular rotation: A cross-sectional study

BACKGROUND

Patients with chronic low back pain (LBP) have an impaired dynamic spinal stability, which may lead to arm injuries.

OBJECTIVES

To examine the latissimus dorsi and gluteus maximus muscles activation pattern and the upward scapular rotation in patients with chronic LBP.

METHODS

Sixty-one right-handed males were divided into two groups: chronic LBP group (n= 31) and healthy controls (n= 30). The electromyography (EMG) activities of the right and left latissimus dorsi and gluteus maximus were recorded. The upward scapular rotation in different shoulder positions (neutral, 45∘, 90∘, 135∘ abduction and end range) was measured in both groups.

RESULTS

The LBP group has a bilateral significant increased EMG of latissimus dorsi (p< 0.05) and significantly decreased EMG of gluteus maximus (p< 0.05) compared to the control group, without significant differences between the right and left sides (p> 0.05). There was a significant increase in upward scapular rotation in the LBP group relative to the control group in all shoulder abduction positions on both sides. The left side upward scapular rotation was more significant than the right (p< 0.05).

CONCLUSION

Chronic LBP increased the latissimus dorsi muscle activities and decreased the gluteus maximus activities. It furthermore increased the upward scapular rotation in different shoulder abduction positions.

Exercise therapy for chronic low back pain

BACKGROUND

Low back pain has been the leading cause of disability globally for at least the past three decades and results in enormous direct healthcare and lost productivity costs.

OBJECTIVES

The primary objective of this systematic review is to assess the impact of exercise treatment on pain and functional limitations in adults with chronic non-specific low back pain compared to no treatment, usual care, placebo and other conservative treatments.

SEARCH METHODS

We searched CENTRAL (which includes the Cochrane Back and Neck trials register), MEDLINE, Embase, CINAHL, PsycINFO, PEDro, SPORTDiscus, and trials registries (ClinicalTrials.gov and World Health Organization International Clinical Trials Registry Platform), and conducted citation searching of relevant systematic reviews to identify additional studies. The review includes data for trials identified in searches up to 27 April 2018. All eligible trials have been identified through searches to 7 December 2020, but have not yet been extracted; these trials will be integrated in the next update.

SELECTION CRITERIA

We included randomised controlled trials that assessed exercise treatment compared to no treatment, usual care, placebo or other conservative treatment on the outcomes of pain or functional limitations for a population of adult participants with chronic non-specific low back pain of more than 12 weeks' duration.

DATA COLLECTION AND ANALYSIS

Two authors screened and assessed studies independently, with consensus. We extracted outcome data using electronic databases; pain and functional limitations outcomes were re-scaled to 0 to 100 points for meta-analyses where 0 is no pain or functional limitations. We assessed risk of bias using the Cochrane risk of bias (RoB) tool and used GRADE to evaluate the overall certainty of the evidence. When required, we contacted study authors to obtain missing data. To interpret meta-analysis results, we considered a 15-point difference in pain and a 10-point difference in functional limitations outcomes to be clinically important for the primary comparison of exercise versus no treatment, usual care or placebo.

MAIN RESULTS

We included 249 trials of exercise treatment, including studies conducted in Europe (122 studies), Asia (38 studies), North America (33 studies), and the Middle East (24 studies). Sixty-one per cent of studies (151 trials) examined the effectiveness of two or more different types of exercise treatment, and 57% (142 trials) compared exercise treatment to a non-exercise comparison treatment. Study participants had a mean age of 43.7 years and, on average, 59% of study populations were female. Most of the trials were judged to be at risk of bias, including 79% at risk of performance bias due to difficulty blinding exercise treatments. We found moderate-certainty evidence that exercise treatment is more effective for treatment of chronic low back pain compared to no treatment, usual care or placebo comparisons for pain outcomes at earliest follow-up (MD -15.2, 95% CI -18.3 to -12.2), a clinically important difference. Certainty of evidence was downgraded mainly due to heterogeneity. For the same comparison, there was moderate-certainty evidence for functional limitations outcomes (MD -6.8 (95% CI -8.3 to -5.3); this finding did not meet our prespecified threshold for minimal clinically important difference. Certainty of evidence was downgraded mainly due to some evidence of publication bias.  Compared to all other investigated conservative treatments, exercise treatment was found to have improved pain (MD -9.1, 95% CI -12.6 to -5.6) and functional limitations outcomes (MD -4.1, 95% CI -6.0 to -2.2). These effects did not meet our prespecified threshold for clinically important difference. Subgroup analysis of pain outcomes suggested that exercise treatment is probably more effective than education alone (MD -12.2, 95% CI -19.4 to -5.0) or non-exercise physical therapy (MD -10.4, 95% CI -15.2 to -5.6), but with no differences observed for manual therapy (MD 1.0, 95% CI -3.1 to 5.1). In studies that reported adverse effects (86 studies), one or more adverse effects were reported in 37 of 112 exercise groups (33%) and 12 of 42 comparison groups (29%). Twelve included studies reported measuring adverse effects in a systematic way, with a median of 0.14 (IQR 0.01 to 0.57) per participant in the exercise groups (mostly minor harms, e.g. muscle soreness), and 0.12 (IQR 0.02 to 0.32) in comparison groups.

AUTHORS' CONCLUSIONS

We found moderate-certainty evidence that exercise is probably effective for treatment of chronic low back pain compared to no treatment, usual care or placebo for pain. The observed treatment effect for the exercise compared to no treatment, usual care or placebo comparisons is small for functional limitations, not meeting our threshold for minimal clinically important difference. We also found exercise to have improved pain (low-certainty evidence) and functional limitations outcomes (moderate-certainty evidence) compared to other conservative treatments; however, these effects were small and not clinically important when considering all comparisons together. Subgroup analysis suggested that exercise treatment is probably more effective than advice or education alone, or electrotherapy, but with no differences observed for manual therapy treatments.

Policy Facilitators Versus Structural Barriers: Integrative Therapy Telehealth Changes in the United States During the COVID-19 Pandemic

Introduction: Complementary and integrative therapies such as physical therapy (PT) and occupational therapy (OT) have been shown to improve functional outcomes and reduce opioid use. Due to the COVID-19 (or SARS-CoV-2 [severe acute respiratory syndrome coronavirus 2]) pandemic, these therapies are switching to telehealth and telemedicine practices, but access and utilization may be limited due to state policies and social vulnerability. Objective: The objective of this cross-sectional analysis was to evaluate the policy changes to telehealth provisions during the pandemic and the degree to which structural barriers could stymie the intended impact of these policies (e.g., PT/OT accessibility). Materials and Methods: Our analysis examined each states' telehealth policies in relation to PT/OT, ranked their telehealth readiness, identified relationships between existing policies and opioid prescription rates, and discussed how social determinants of health may be associated with telehealth availability and accessibility. Results: Approximately two of five states have both telehealth and telemedicine policies, whereas the majority of states had either a PT- or OT-specific policy in place. In addition, almost all states and the District of Columbia (90%) had general telehealth/medicine policy changes as a result of the pandemic. Discussion: Although such policy changes could reduce COVID-19-related barriers, the degree to which these policies can have a large and long-lasting impact may be contingent on structural barriers. Many states that lack broadband access and have high social vulnerability need more improvements to ensure the utilization of telehealth care, including PT and OT. Conclusion: Despite the policies expanding PT/OT telehealth capabilities, structural barriers may further exacerbate inequities in care accessibility.

The Effect of Auricular Acupressure for Chronic Low Back Pain in Elders: A Randomized Controlled Study

Chronic low back pain (CLBP) is a major problem throughout the world and getting worse because of population increase and aging. The cost of treatment increases as the population of people with CLBP increases. This study aimed to examine the effect of auricular acupressure (AA) on pain and disability in elders with chronic low back pain. The randomized, single-blinded, and placebo-controlled study was conducted on 51 elders with CLBP in South Korea from June 2019 to August 2019. The experimental group (n = 26) received AA on low back pain-related points, whereas the placebo control group (n = 25) received AA on points unrelated to low back pain. Participants received 6 weeks of AA in weekly cycles. Collected data were analyzed using IBM SPSS Statistics, version 25. Statistically significant differences between the 2 groups emerged in the visual analog scale (P < .001), pain threshold (P < .001), and Oswestry Disability Index (P < .001). This study showed that 6 weeks of AA improved CLBP and pain-related disability. Therefore, AA can be used as a noninvasive and self-managed alternative intervention for CLBP in older adults.

Pharmacological and non-pharmacological treatment approaches to chronic lumbar back pain

Low back pain is a common and important cause of disability. Chronic pain increases disability and cost. In this review, we discuss pharmacological and non-pharmacological treatment approaches for chronic low back pain in the light of current data and guidelines.

Association of complementary and integrative therapy use and symptoms among Turkish patients with familial Mediterranean fever

OBJECTIVE

This study explored the correlations between the use of complementary and integrative therapies (CITs) and symptoms among Turkish patients with familial Mediterranean fever (FMF).

METHODS

This is a cross-sectional and descriptive study. The study was conducted with 1119 FMF patients who were registered to the social networking site for Behcet's and the FMF Patients Association (Befemder) in Turkey, between January 2018 and February 2019. Data were collected using an online survey, for which a three-part questionnaire was created using a Google form. Descriptive statistics, chi-square test and logistic regression analysis were used to analyze the data.

RESULTS

It was determined that 53.2% of the individuals who participated in the research used various forms of CITs and that 32.8% used vitamin and mineral supplements (calcium, iron, and vitamin B12, C and D), 25.0% used nutritional supplements (fish oil and honey), and 24.6% used oral herbs (ginger, turmeric, green tea and rosemary) and mind-body methods (relaxation, respiration exercise and meditation). It was determined that the percentage of participants that used CITs was higher among women (odds ratio [OR] = 1.825; 95% confidence interval [CI] 1.421-2.344), those with joint pain (OR = 1.385; 95% CI 1.047-1.832), those with difficulty breathing (OR = 1.323; 95% CI 1.031-1.697), those with gastrointestinal symptoms (OR = 1.405; 95% CI 1.089-1.814) and those who had a family member with FMF (OR = 1.437; 95% CI 1.115-1.851).

CONCLUSION

More than half of the individuals used at least one type of CIT for symptom control.

Early Experience of a Multidisciplinary Group Pain Program with Cognitive Behavioural Strategies, Physiotherapy and Peer Support for Patients with Chronic Noncancer Pain

BACKGROUND

Chronic non-cancer pain affects about 20% of the population worldwide. The effect of medical treatment in isolation is often limited. A multidisciplinary approach has been strongly advocated to help manage patients' pain more effectively.

AIMS

The primary purpose was to reduce pain severity, pain interference on patients'daily activities and improve their levels of self-efficacy despite pain. The secondary aim was to evaluate the possible changes in patients' depression, anxiety, and stress symptoms after amultidisciplinary group pain program. The program content and structure were also evaluated.

DESIGN

This scholarly project used within-subject pre- and post-test design.

SETTINGS/SUBJECTS

Fifty-six patients were recruited from the project center pain clinic.

METHODS

An evidence-based eight-hour multidisciplinary group pain program was implemented. Data was collected before and 3 months after the program.

INTERVENTIONS

The program covered pain physiology, cognitive behavioural strategies, demonstration of various exercises, self-management skills, medication management, and peer support.

RESULTS

Three months postprogram, there was a statistically significant improvement in patients' pain severity (β = -0.9, 95% CI: -1.73 to -0.14, p = .023) and self-efficacy (β = 5.6, 95% CI: 0.85 to 10.41, p = .023). Pain interference on their daily activities was also significantly reduced (β = -2.0, 95% CI: -2.90 to -0.83, p = .001). Patients provided positive and encouraging feedback about the program.

CONCLUSION

Initial improvements in patients' ability to cope with pain and to perform daily activities were demonstrated following participation in the brief multidisciplinary group pain program. Future randomized controlled trials are needed to confirm that the results are due to patients' participation in the program.

Digital interventions for promoting exercise adherence in chronic musculoskeletal pain: a systematic review and meta-analysis

BACKGROUND

Chronic musculoskeletal disorders are the second largest contributor to disability globally. Exercise is typically recommended by physiotherapists to manage symptoms. However, adherence to the prescribed exercise programme is often poor. Adjunctive digital interventions offer potential to enhance exercise adherence.

OBJECTIVES

To review evidence on the effectiveness of digital interventions for improving exercise adherence in people with chronic musculoskeletal conditions. The study is reported in line with PRISMA guidance and was registered with PROSPERO (CRD42019124502).

DATA SOURCES

MEDLINE, Embase and PsycInfo were searched using a comprehensive search strategy. The reference lists of all included papers and relevant systematic reviews identified during the search were scanned for relevant articles.

STUDY APPRAISAL AND SYNTHESIS METHODS

Two researchers independently checked articles for inclusion and extracted data.

RESULTS

The search returned a total of 4257 results of which five trials were included in the review and two studies were included in a random effects meta-analysis. There was no statistically significant difference in exercise adherence (SMD: 0.23; 95% CI: -0.10, 0.57). Studies that were not suitable for inclusion in the meta-analysis reported similar results. Heterogeneity of effects was high and study quality ranged from low to moderate. All of the meta-analysed data related to osteoarthritis of the hip and/or knee.

CONCLUSION

We found no evidence that digital interventions enhance adherence to therapeutic exercise in patients with chronic musculoskeletal disorders. However, further, high quality research is required to draw definitive conclusions on their effectiveness and to identify key components that are associated with effectiveness.

SYSTEMATIC REVIEW REGISTRATION NUMBER

PROSPERO CRD42019124502.