DARE: Search Results
Document: 5
Low back pain: an evaluation of therapeutic interventions.
Evans G, Richards S.
Low back pain: an evaluation of therapeutic interventions.
Bristol: University of Bristol, Health Care Evaluation Unit,
1996,
p176
Record status
This record is a structured abstract written by CRD reviewers. The original
has met a set of quality criteria.
Author's objective
To evaluate diverse treatments and treatment approaches for acute and chronic
low back pain (LBP). Type of intervention
Treatment
Specific interventions included in the review
Therapies used in the management of acute LBP:
physiotherapy, back schools, educational packages, corsets, and the
complementary therapies of acupuncture, osteopathy and chiropractic.
Therapies used in the management of chronic LBP:
spinal manipulations, physiotherapy, physical reconditioning, specific
cognitives, back school, behavioural interventions, pain management clinics,
acupuncture, transcutaneous electrical nerve stimulation, facet joint
injections of steroids, laser therapy, injections of collagen proliferant
substances into spinal soft tissues, family therapies, antidepressant
medication.
Participants included in the review
Patients with acute or chronic low back pain (LBP).
Outcomes assessed in the review
Physical performance; functional status; pain measures; psychological status;
and multidimensional health status profiles.
Study designs of evaluations included in the review
Randomised controlled trials (RCTs) and non-random controlled studies (where
no RCT's existed).
What sources were searched to identify primary studies?
The literature search strategy was developed using key words and search
headings for Embase (1986-94), Amed (1988-93), PsycLit (1980-95), and
Silverplatter Medline (1986-95). Search terms are given for each database.
Criteria on which the validity (or quality) of studies was assessed
The quality of information was assessed on the basis of: case definition and
selection criteria, selection of control groups, interventions compared,
rigour of randomisation, attrition rates, numbers participating in the trial,
appropriateness of outcome measures, characteristics of the sample population,
appropriateness of statistical analysis, validity of conclusions.
How were the judgements of validity (or quality) made?
Not stated
How were decisions on the relevence of primary studies made?
Not stated
How was the data extracted from primary studies?
Not stated
Number of studies included
Acute LBP:
10 RCTs of manual therapy vs placebo (n=1527);
9 RCTs of manual therapy vs physiotherapy (n=1458);
4 RCTs of manual therapy vs other treatments (n=606);
2 RCTs of mechanical therapy (n=359);
8 RCTs of exercise programmes (n=1476);
2 RCTs of back school (n=379);
1 RCTs of bed rest (n=192).
Chronic LBP:
15 RCTs of manual & conventional physiotherapy (n=2841);
9 RCTs of physical exercise (n=1952);
8 RCTs of back school (n=1752);
4 RCTs of operant conditioning therapy (n=828);
8 RCTs of behavioural/cognitive therapy (n=1945);
1 RCTs of couple therapy (n=250);
5 RCTs of antidepressants (n=787);
8 RCTs of transcutaneous electrical nerve stimulation (n=2099);
7 RCTs of injections or laser (n=1856).
How were the studies combined?
Narrative discussion
How were differences between studies investigated?
Details of individual studies were presented in the tables and discussed in
the text.
Results of the review
Therapies used in the management of acute LBP: There is no conclusive evidence
of the effectiveness of manual therapies, whether in comparison to placebo or
other types of interventions. A few trials suggest that manual therapy is
more effective in patients with radiating pain and subacute or recurrent
exacerbation of pain than conventional physiotherapy.
The benefit of physiotherapy is not clear as compared with placebo. Recent
trials suggest that adequate reassurance and advice coupled with the early
resumption of normal activity may be more effective than physiotherapy
interventions.
Bed rest appears to have a deleterious effect on recovery and return to work.
Therapies used in the management of chronic LBP:
The evidence on the effectiveness of manipulation and conventional
physiotherapy for patients with chronic LBP is conflicting. Some evidence
suggests that manipulation and conventional physiotherapy may offer comparable
long-term therapeutic benefits, compared to placebo groups.
Limited evidence suggests that physical reconditioning can improve chronic LBP
sufferers' levels of functioning and pain report.
Back school appears to have little useful effect on knowledge or pain
perception and disability.
Relaxation and cognitive behavioural techniques improve short-term and
long-term pain perception. The effectiveness of operant conditioning and
cognitive therapy is uncertain in relieving either pain or disability.
Multidisciplinary treatment has been insufficiently evaluated.
Was any cost information reported?
The cost of LBP is estimated to account for 0.65% to 0.93% of the NHS
expenditure in 1992/93.
Author's conclusions
Research to date has been insufficiently rigorous to give clear indications of
the value of treatment for non-specific low back pain patients. No treatment
has been shown beyond doubt to be effective. Where there is reasonable
evidence to suggest that an intervention is effective, issues including the
most optimal timing and duration of treatment need to be explored.
CRD commentary
This is a very comprehensive review including many different types of
interventions. It is not possible to extract detailed results for all
interventions and the original report should be read for more information.
Subject index terms
Subject indexing assigned by CRD: Acupuncture-; Alternative-medicine;
Chiropractic-; Lasers-; Low-Back- Pain; Patient-Education; Physical-Therapy;
Transcutaneous-Electrical- Nerve-Stimulation
Correspondence address
Suzanne Richards, Research Assistant, Health Care Evaluation Unit, Department
of Social Medicine, University of Bristol, Canynge Hall, Whiteladies Road,
Bristol, BS8 2PR, England.
Copyright
University of York, 1998
Database no.: DARE-968102
