Which specific modes of exercise training are most effective for treating low back pain? Network meta-analysis

Finding Predictive Factors of Stabilization Exercise Adherence in Randomized Controlled Trials on Low Back Pain: An Individual Data Reanalysis Using Machine Learning Techniques

OBJECTIVE

To identify predictors of adherence in supervised and self-administered exercise interventions for individuals with low back pain.

DESIGN

Cohort study.

SETTING

Rehabilitation.

PARTICIPANTS

This preplanned reanalysis within the Medicine in Spine Exercise Network included 1511 participants with low back pain (57% female, mean age 40.9 years, SD ±14 years).

INTERVENTIONS

Participants underwent an initial 3-week supervised phase of sensorimotor exercises, followed by a 9-week self-administered phase.

MAIN OUTCOME MEASURES

Biological, psychological, and social factors potentially impacting training adherence were evaluated. During the supervised phase, adherence was tracked through a standardized training log. During the self-administered phase, adherence was monitored via a diary, with adherence calculated as the percentage of scheduled versus completed sessions. Adherence was analyzed both as an absolute percentage and as a dichotomized variable (adherent vs nonadherent, with a 70% adherence cut-off). Predictors for adherence were identified using Gradient Boosting Machines and Random Forests (R package caret). Seventy percent of the observations were used for training, whereas 30% were retained as a hold-out test-set.

RESULTS

The average overall adherence was 64% (±31%), with 81% (±28%) adherence during the supervised phase and 58% (±39%) in the self-administered phase. The root mean square error for the test-set ranged from 36.2 (R2=0.18, self-administered phase) to 19.3 (R2=0.47, supervised phase); prediction accuracy for dichotomized models was between 64% and 83%. Predictors of low to intermediate adherence included poorer baseline postural control, decline in exercise levels, and fluctuations in pain intensity (both increases and decreases).

CONCLUSION

Identified predictors could aid in recognizing individuals at higher risk for nonadherence in low back pain exercise therapy settings.

Barriers and Facilitators to Physical Activity and Exercise Among People With Chronic Low Back Pain: A Qualitative Evidence Synthesis

OBJECTIVE: To investigate the barriers and facilitators to physical activity and exercise among people with chronic low back pain (CLBP). DESIGN: A qualitative evidence synthesis. LITERATURE SEARCH: We searched the MEDLINE, EMBASE, CINAHL, SPORTDiscus, and PsycINFO databases from inception to July 2023. This review was prospectively registered on the Open Science Framework (OSF) (https://archive.org/details/osf-registrations-uwnqh-v1). STUDY SELECTION CRITERIA: Qualitative or mixed-methods studies with a qualitative approach were included. Studies must have recruited adults, of both sexes, aged 18 years or older with CLBP. DATA SYNTHESIS: We used a thematic analysis approach in our review. First, participant quotes in the "Results" section of included studies were analyzed and coded. Second, the codes were used to create our coding framework. Then, the coding framework was applied to included studies. Finally, 2 reviewers independently analyzed the themes constructed in our qualitative evidence synthesis to identify barriers and facilitators for people with CLBP to engage in physical activity. RESULTS: Fifty-seven studies were included. The quality assessment (Critical Appraisal Skills Program) revealed that most studies (77%) had minor concerns. Barriers to physical activity were mainly related to pain intensity, fear of movement, intervention type, lack of information, motivation, and support. Facilitators of physical activity were adequate information, professional and social support, perceived benefits, and favorable conditions to engage in physical activity. Based on the GRADE-CERQual, most themes and subthemes presented moderate quality of evidence. CONCLUSION: The barriers to people with chronic LBP engaging in physical activity included pain intensity and fear of reinjury, type of intervention, lack of information, motivation and support, and occupational and socioenvironmental factors. The main facilitators were receiving information and support from health professionals, motivational activities, knowledge about benefits of the intervention, and external factors. J Orthop Sports Phys Ther 2025;55(5):1-19. Epub 7 April 2025. doi:10.2519/jospt.2025.12905.

Therapeutic Exercise is Effective in Reducing the Intensity of Nonspecific Low Back Pain in Children and Adolescents: A Systematic Review and Network Meta-analysis

OBJECTIVE

To compare the different physiotherapy treatments and determine the most effective treatment to reduce the nonspecific low back pain (NSLBP) intensity in children and adolescents.

DATA SOURCES

Eight databases (Cochrane Library, MEDLINE, PEDro, Web of Science, LILACS, IBECS, PsycINFO, and SCOPUS), and 2 health-specialized journals (BMJ and Spine) were searched from inception to May 2023, with no language restriction.

STUDY SELECTION

Individuals aged 6-18 years with NSLBP were selected, and physical therapy treatments were considered. Studies were required to be controlled clinical trials with pretest and posttest evaluations, and to report pain intensity.

DATA EXTRACTION

Data extraction and risk of bias assessment were performed independently by 2 reviewers.

DATA SYNTHESIS

A meta-analysis of 11 controlled trials with 827 participants found that physiotherapy treatments effectively reduced NSLBP intensity on posttest measurement (d+=0.75; 95% confidence interval [CI], 0.30-1.20) and 6-month follow-up (d+=0.35; 95% CI, -0.72 to 1.40). Network meta-analysis showed both therapeutic exercise (d+=1.11; 95% CI, 0.48-1.74) and a combination of therapeutic exercise and manual therapy (d+=1.45; 95% CI, 0.40-2.49) were effective compared to no treatment. There were no significant differences between therapeutic exercise and the combination of therapeutic exercise and manual therapy.

CONCLUSIONS

Physical exercise has proven to be the most effective treatment for addressing the intensity of NSLBP in children and adolescents. While combining it with manual therapy may yield even better results, it is crucial to emphasize that physical exercise should serve as the cornerstone in the physiotherapeutic approach to managing NSLBP intensity in this age group.

Exercise for low back pain in adolescents and children

OBJECTIVES

This is a protocol for a Cochrane Review (intervention). The objectives are as follows: To assess the benefits and harms of exercise compared to placebo/sham/attention control or no treatment for low back pain in adolescents and children.

Efficacy and safety of electrical stimulation for functional impairment and pain in patients with rheumatoid arthritis: a protocol for systematic review and network meta-analysis of RCTs

OBJECTIVE

Several studies have indicated that transcutaneous electrical nerve stimulation, functional electrical stimulation, neuromuscular electrical stimulation and electroacupuncture exhibit certain therapeutic effects in the treatment of rheumatoid arthritis (RA). However, definitive proof of the effectiveness of different types of electrical stimulation in relieving the different symptomatic manifestations of RA is required. This study aims to analyse the efficacy (health assessment questionnaire, visual analogue scale, etc), safety (adverse reactions) of electrical stimulation for functional impairment (morning stiffness and decreased muscle strength) and pain (joint tenderness and swelling) of RA, and to explore their comparative advantages and potential benefits for patients.

METHODS

We will conduct a systematic and comprehensive search of eight databases, and the search will proceed from the beginning to 5 September 2024. Two reviewers will independently screen the retrieved literature to determine the final included studies. Two reviewers will independently assess the risk of bias for all included eligible studies using the Cochrane Risk of Bias tool (V.2.0). Data synthesis will be performed using a random-effects model for network meta-analysis to compare the efficacy and safety of different electrical stimulations. The surface under the cumulative ranking curve will be used to demonstrate the probability of the benefits and harms of interventions. Funnel plots will be used to detect potential publication bias and small sample study effects. The strength of the evidence will be assessed through the Grading of Recommendations, Assessment, Development and Evaluation framework.

ETHICS AND DISSEMINATION

Our study data comes from public databases, and the entire study does not directly involve patients and the public, so ethical approval is not required. The final study results will be peer-reviewed and published in a journal.

PROSPERO REGISTRATION NUMBER

CRD42024586835.

Neuroprotective effect and possible mechanism of edaravone in rat models of spinal cord injury: a systematic review and network meta-analysis

Objective

The present review was developed to critically evaluate the neuroprotective effects of edaravone for experimental rat models of spinal cord injury (SCI) and generalize the possible mechanisms.

Methods

Systematic searches were carried out on databases including PubMed, Embase, Web of Science, Scopus, and Cochrane Library from their inception to March 2024. Controlled studies that assessed the neurological roles of edaravone on rats following SCI were selected. The Basso, Beattie, and Bresnahan (BBB) locomotor rating scale, residual white matter area, and malondialdehyde (MDA) level of the SCI rats were systematically searched by two reviewers.

Results

Ten eligible publications were included. Meta-analyses showed increased BBB scores in edaravone-treated rats compared with control ones. The effect size gradually increased from day 7 (seven studies, n = 246, weighted mean difference (WMD) = 1.96, 95% confidence interval (CI) = 1.23 to 2.68, P < 0.00001) to day 28 (seven studies, n = 222, WMD = 4.41, 95% CI = 3.19 to 5.63, P < 0.00001) after injury and then maintained stably in the following time. Meanwhile, edaravone treatment was associated with an amendment in the spared area of white matter and a lowering in the MDA expression in the lesion area. The subgroup analyses revealed that rats treated with edaravone exhibited superior locomotor recovery in compression injury models than contusion ones. In network analyses, the surface under the cumulative ranking curve gradually increased up to a dose of 5-6 mg/(kg·d) of edaravone, after which it plateaued. Mechanism analysis suggested edaravone can ameliorate oxidative stress, mitigate neuroinflammation, and counteract neuron apoptosis and ferroptosis via multiple signaling pathways to exert its neuroprotective effects.

Conclusion

Collectively, with a protective effect and a systematic action mechanism, edaravone warrants further investigation in SCI research and treatment. Nonetheless, in light of the limitations in the included studies, the findings in this review should be interpreted with caution.

Systematic Review Registration

https://www.crd.york.ac.uk/PROSPERO/view/CRD42022374914.

Effectiveness of Basic Body Awareness Therapy on Body Awareness, Pain, Disability and Quality of Life in Patients With Chronic Low Back Pain: A Pilot Study

AimWhile there are several conservative therapy methods used for patients with chronic low back pain (CLBP), there remains a need for more holistic approaches. This pilot study was designed to evaluate the effectiveness of Basic Body Awareness Therapy (BBAT) in patients with CLBP.MethodsTwenty-eight patients with CLBP, 14 in the Conventional Therapy (CT) group and 14 in the BBAT group, were included in our study. Both groups received CT for 6 weeks, which included electrotherapy, hot pack, and general exercises. The BBAT group received BBAT in addition to CT. The Short Form McGill Pain Questionnaire (SF-MPQ) was used to assess pain, the SF-12 was used to evaluate quality of life and the Awareness Body Chart (ABC), Body Awareness Questionnaire (BAQ) and Fremantle Back Awareness Questionnaires (FreBAQ) were used to evaluate body awareness. Oswestry Disability Index (ODI) and Physical Impairment Index were used to assess disability.ResultsGreater improvements were observed in BBAT group compared to CT group in the emotional index and total scores of the SF-MPQ, as well as the SF-12 mental health scores (p < .05). BBAT produced greater improvements in body awareness values for the cervical-lumbar region, chest/abdomen, back, shoulder, thigh/hip, lower leg, and overall score of the ABC compared to CT (p < .05). However, there were no significant differences between the groups in the FreBAQ and BAQ scores (p > .05).ConclusionIn patients with CLBP, the addition of BBAT to CT resulted in positive outcomes such as increased body awareness, decreased pain, and improved mental health.

Benefits and harms of exercise therapy and physical activity for low back pain: An umbrella review

PURPOSE

The purpose of this umbrella review is to synthesize the evidence from systematic reviews on the benefits and harms of exercise therapy and physical activity (PA) for the secondary prevention and management of low back pain (LBP).

METHODS

An umbrella review was conducted to evaluate the effectiveness of exercise therapy and PA in the management and secondary prevention of LBP. A systematic search was performed in Medline via Ovid, CINAHL, Scopus, Web of Science, Cochrane Database of Systematic Reviews, and Physiotherapy Evidence Database (PEDro), including reference lists of relevant reviews, covering studies published between January 2010 and May 20, 2024. Eligible studies were systematic reviews of randomized controlled trials and observational studies, with or without meta-analyses. The primary outcome for secondary prevention was LBP recurrence, while for management, primary outcomes included pain intensity and disability, with adverse events as secondary outcomes. Data were extracted across immediate, short-term, intermediate, and long-term follow-up periods. The GRADE framework was used to assess the certainty of evidence, and the AMSTAR tool was applied by 2 independent reviewers (JC, QL, and/or DXMW) to evaluate the quality of the included reviews. The study was prospectively registered on the Open Science Framework (OSF) (registration DOI: https://doi.org/10.17605/OSF.IO/9P).

RESULTS

A total of 70 systematic reviews were included, 43 with meta-analyses, 7 with network meta-analyses, and 20 without meta-analyses. Six (out of 10) reviews with meta-analyses for secondary prevention indicated a small benefit from general exercises and leisure-time PA (low-to-moderate certainty). For LBP management, 35 (out of 36) reviews reported that exercise therapies such as Pilates, motor control, mixed exercise, Tai Chi, water-based exercises, and yoga showed small beneficial effects on pain and disability compared to minimal intervention mainly in the short-term (low-to-moderate certainty). Seven network meta-analyses favored motor control and Pilates over other forms of exercise to reduce pain (low certainty). Adverse events were reported in less than 31% of the reviews, predominantly involving post-exercise soreness and temporary increases in pain, mainly in yoga-related studies. Adverse events were considered minor, and no serious adverse events were reported.

CONCLUSION

There is low-to-moderate certainty that exercise therapy and leisure-time PA are beneficial for improving pain and preventing the recurrence of LBP. However, evidence on the potential harms of these interventions is limited, and adverse events related to exercise and PA remain under-investigated.

State-of-the-Art Personalized Therapy Approaches for Chronic Non-Specific Low Back Pain: Understanding the Mechanisms and Drivers

Chronic non-specific low back pain (CNSLBP) is a debilitating condition that affects millions of people worldwide, significantly impacting quality of life and imposing a substantial socioeconomic burden. Traditional treatment approaches often rely on a one-size-fits-all strategy, failing to account for individual variations in pathophysiological mechanisms, drivers, and the principles of personalized medicine. Furthermore, an overemphasis on biomechanical findings from imaging may lead to ineffective interventions and unnecessary surgical procedures, obscuring other important factors that contribute to pain perception. While highlighting the limitations of universal treatment approaches, in this review we present a practical clinical approach aimed at elucidating the main pathophysiological mechanisms and various factors underlying the development and maintenance of CNSLBP in order to create a personalized treatment program. In conclusion, this review underscores the need for personalized therapeutic strategies that take into account the unique characteristics of each patient, recognizing the complex interaction of biological, psychological, social, and other factors that contribute to the development of individual pain. By combining a comprehensive understanding of the complexities of this condition, we aim to improve clinical outcomes and provide information on the development of effective personalized treatment algorithms, particularly in the field of neurological practice.

The McKenzie Method delivered by credentialed therapists for chronic low back pain with directional preference: systematic review with meta-analysis

OBJECTIVE

To determine the effectiveness of the McKenzie Method compared to any conservative interventions on pain and disability in patients with chronic low back pain (LBP) with directional preference (DP).

METHODS

We searched six electronic databases up to September 2022. Eligible randomized controlled trials were those assessing the McKenzie Method delivered by credentialed therapists for chronic LBP with DP. Two reviewers independently selected studies, extracted data, assessed risk of bias with the revised Cochrane Risk of Bias 2.0 tool and certainty of evidence with the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.

RESULTS

Five trials (n = 743) were included. There was low-certainty evidence that the McKenzie Method, compared to all other interventions combined, produced clinically important reductions in short-term pain (mean difference [MD] -1.11 points on a 10-point scale; 95% CI -1.83 to -0.40) and in intermediate-term disability (standardized mean difference [SMD] -0.53; 95% CI -0.97 to -0.09). Low-to-moderate certainty evidence showed that the McKenzie Method also resulted in clinically important improvements in short-term pain (MD -1.53; 95% CI -2.51 to -0.54) and disability (SMD -0.50; 95% CI -0.74 to -0.25) when compared specifically to other exercise approaches, and in intermediate-term pain (MD -2.10; 95% CI -2.94 to -1.26) and disability (SMD -1.01; 95% CI -1.58 to -0.43) as well as long-term disability (SMD -0,59; 95% CI -1.14 to -0.03) when compared to minimal intervention. Low-certainty evidence showed usually small, clinically unimportant effects in comparison to manual therapy.

CONCLUSION

We found low-to-moderate certainty evidence that the McKenzie Method was superior to all other interventions combined for up to 6 months for pain and up to 12 months for disability, with clinically important differences versus exercise in the short term and versus minimal interventions in the intermediate term. The only clinically important long-term effect was on disability compared to minimal intervention.

Non-pharmacological and non-surgical treatments for low back pain in adults: an overview of Cochrane reviews

BACKGROUND

Low back pain (LBP) is a significant public health issue due to its high prevalence and associated disability burden. Clinical practice guidelines recommend non-pharmacological/non-surgical interventions for managing pain and function in people with LBP.

OBJECTIVES

To provide accessible, high-quality evidence on the effects of non-pharmacological and non-surgical interventions for people with LBP and to highlight areas of remaining uncertainty and gaps in the evidence regarding the effects of these interventions for people with LBP.

METHODS

We searched the Cochrane Database of Systematic Reviews from inception to 15 April 2023, to identify Cochrane reviews of randomised controlled trials testing the effect of non-pharmacological/non-surgical interventions, unrestricted by language. Major outcomes were pain intensity, function and safety. Two authors independently assessed eligibility, extracted data and assessed the quality of the reviews using AMSTAR 2 (A MeaSurement Tool to Assess Systematic Reviews) and the certainty of the evidence using GRADE. The primary comparison was placebo/sham.

MAIN RESULTS

We included 31 Cochrane reviews of 644 trials that randomised 97,183 adults with LBP. We have high confidence in the findings of 19 reviews, moderate confidence in the findings of two reviews, and low confidence in the findings of 10 reviews. We present results for non-pharmacological/non-surgical interventions compared to placebo/sham or no treatment/usual care at short-term (≤ three months) follow-up. Placebo/sham comparisons Acute/subacute LBP Compared to placebo, there is probably no difference in function (at one-week follow-up) for spinal manipulation (standardised mean difference (SMD) -0.08, 95% confidence interval (CI) -0.37 to 0.21; 2 trials, 205 participants; moderate-certainty evidence). Data for safety were reported only for heated back wrap. Compared to placebo, heated back wrap may result in skin pinkness (6/128 participants versus 1/130; 2 trials; low-certainty evidence). Chronic LBP Compared to sham acupuncture, acupuncture probably provides a small improvement in function (SMD -0.38, 95% CI -0.69 to -0.07; 3 trials, 957 participants; moderate-certainty evidence). Compared to sham traction, there is probably no difference in pain intensity for traction (0 to 100 scale, mean difference (MD) -4, 95% CI -17.7 to 9.7; 1 trial, 60 participants; moderate-certainty evidence). Data for safety were reported only for acupuncture. There may be no difference between acupuncture and sham acupuncture for safety outcomes (risk ratio (RR) 0.68, 95% CI 0.42 to 1.10; I2 = 0%; 4 trials, 465 participants; low-certainty evidence). No treatment/usual care comparisons Acute/subacute LBP Compared to advice to rest, advice to stay active probably provides a small reduction in pain intensity (SMD -0.22, 95% CI -0.02 to -0.41; 2 trials, 401 participants; moderate-certainty evidence). Compared to advice to rest, advice to stay active probably provides a small improvement in function (SMD -0.29, 95% CI -0.09 to -0.49; 2 trials, 400 participants; moderate-certainty evidence). Data for safety were reported only for massage. There may be no difference between massage and usual care for safety (risk difference 0, 95% CI -0.07 to 0.07; 1 trial, 51 participants; low-certainty evidence). Chronic LBP Compared to no treatment, acupuncture probably provides a medium reduction in pain intensity (0 to 100 scale, mean difference (MD) -10.1, 95% CI -16.8 to -3.4; 3 trials, 144 participants; moderate-certainty evidence), and a small improvement in function (SMD -0.39, 95% CI -0.72 to -0.06; 3 trials, 144 participants; moderate-certainty evidence). Compared to usual care, acupuncture probably provides a small improvement in function (MD 9.4, 95% CI 6.15 to 12.65; 1 trial, 734 participants; moderate-certainty evidence). Compared to no treatment/usual care, exercise therapies probably provide a small to medium reduction in pain intensity (0 to 100 scale, MD -15.2, 95% CI -18.3 to -12.2; 35 trials, 2746 participants; moderate-certainty evidence), and probably provide a small improvement in function (0 to 100 scale, MD -6.8, 95% CI -8.3 to -5.3; 38 trials, 2942 participants; moderate-certainty evidence). Compared to usual care, multidisciplinary therapies probably provide a medium reduction in pain intensity (SMD -0.55, 95% CI -0.83 to -0.28; 9 trials, 879 participants; moderate-certainty evidence), and probably provide a small improvement in function (SMD -0.41, 95% CI -0.62 to -0.19; 9 trials, 939 participants; moderate-certainty evidence). Compared to no treatment, psychological therapies using operant approaches probably provide a small reduction in pain intensity (SMD -0.43, 95% CI -0.75 to -0.11; 3 trials, 153 participants; moderate-certainty evidence). Compared to usual care, psychological therapies (including progressive muscle relaxation and behavioural approaches) probably provide a small reduction in pain intensity (0 to 100 scale, MD -5.18, 95% CI -9.79 to -0.57; 2 trials, 330 participants; moderate-certainty evidence), but there is probably no difference in function (SMD -0.2, 95% CI -0.41 to 0.02; 2 trials, 330 participants; moderate-certainty evidence). It is uncertain whether there is a difference between non-pharmacological/non-surgical interventions and no treatment/usual care for safety (very low-certainty evidence).

AUTHORS' CONCLUSIONS

Spinal manipulation probably makes no difference to function compared to placebo for people with acute/subacute LBP. Acupuncture probably improves function slightly for people with chronic LBP, compared to sham acupuncture. There is probably no difference between traction and sham traction for pain intensity in people with chronic LBP. Compared to advice to rest, advice to stay active probably reduces pain intensity slightly and improves function slightly for people with acute LBP. Acupuncture probably reduces pain intensity, and improves function slightly for people with chronic LBP, compared to no treatment. Acupuncture probably improves function slightly for people with chronic LBP, compared to usual care. Exercise therapies probably reduce pain intensity, and improve function slightly for people with chronic LBP, compared to no treatment/usual care. Multidisciplinary therapies probably reduce pain intensity, and improve function slightly for people with chronic LBP, compared to usual care. Compared to usual care, psychological therapies probably reduce pain intensity slightly, but probably make no difference to function for people with chronic LBP.

A comparison of Contractile properties of posterior chain muscles and trunk strength in females with non-specific chronic low back pain

ObjectiveThe purpose of this study was to compare the contractile properties of posterior chain muscles and isokinetic trunk strength in females with or without non-specific chronic low back pain (NSCLBP).MethodAll participants (control group: n = 22, NSCLBP group: n = 22) were assessed using tensiomyography to evaluate the contractile properties of the posterior chain muscles, and all participants were also assessed for isokinetic trunk strength. An independent t-test was performed to compare the tensiomyography variables and isokinetic trunk strength test results between group.ResultsResult of tensiomyography, we found that the contraction time significant differences in the maximal radial muscle displacement, and velocity of contraction between groups in erector spinae. Semitendinosus revealed significant differences in all variables between groups. Additionally, the isokinetic trunk strength test revealed significant differences in all variables between groups.ConclusionThese findings suggest that due to the characteristics of NSCLBP, such as increased muscle stiffness, fat infiltration, and muscle fatigue, kinesiophobia, physical deconditioning syndrome, the posterior chain muscles of the NSCLBP group showed higher muscle stiffness and slower contraction speed than the control group. Also in the NSCLBP group, trunk isokinetic muscle strength was lower than in the control group, and flexor and extensor muscles were unbalanced.

Physical activity and factors associated with the costs of low back pain among adults after 18 months of follow-up: a cohort study

BACKGROUND

Chronic low back pain (CLBP) is a substantial health problem that causes considerable economic losses. Several studies have demonstrated the protective effect of habitual physical activity; however, little data are available regarding its impact on the costs associated with CLBP.

OBJECTIVES

The primary aim of this study was to analyze the costs of CLBP in the Brazilian Health System and associated factors among adults.

DESIGN AND SETTING

An 18-month cohort study was conducted in two basic health units in Presidente Prudente (SP), Brazil.

METHODS

A total of 198 patients were interviewed and evaluated four times: at baseline, with retrospective data covering the previous 12 months, and at six, 12, and 18 months. The Nordic and Baecke questionnaires were used to classify CLBP, and the Baecke questionnaire was used for physical activity assessment. The costs were calculated by reviewing the demand for services from medical records. Body mass index (kg/m2) was determined using body mass and height values collected during the interviews. The questionnaire included confounding variables, such as sex, age, ethnicity, and socioeconomic status.

RESULTS

A high prevalence of CLBP was observed, which was associated with female sex and younger age. CLBP resulted in high costs for medical consultations (without: US$ 34.25 ± 23.21; with: US$ 39.62 ± 27.25; P = 0.049), while cycling was negatively associated with costs (rho = -0.289; P = 0.049).

CONCLUSION

Lower back pain was associated with higher costs of medical consultations, while cycling was associated with reduced costs.

Effects of a Postural Hammock in People with Chronic Neck Pain and Chronic Low Back Pain: A Randomized Controlled Trial

Background and Objectives: Musculoskeletal disorders (MD) affect over 1.7 billion people worldwide, with neck and low back pain being prevalent and debilitating conditions. Current treatments include various interventions, but novel approaches are needed to improve functionality and reduce disability. To evaluate the effects of a postural hammock on pain and functionality in people with chronic neck and low back pain. Materials and Methods: A randomized controlled trial was conducted with participants experiencing chronic neck and/or low back pain. They were assigned to either an experimental group using a postural hammock or a control group lying on a mat. Participants underwent five sessions of 10 min each over five consecutive days. Results: Forty-three subjects completed the study. While both groups showed improvements, the experimental group exhibited significant increases in hamstring flexibility and pain tolerance, measured through the Visual Analog Scale (VAS) and pressure pain thresholds (PPT). Postural hammock use demonstrated potential benefits in pain management and flexibility compared to conventional methods. Conclusions: Using a postural hammock may offer benefits for individuals with chronic back pain. Future research should explore combining hammock therapy with other interventions to enhance outcomes and improve the quality of life for patients with back pain.

Therapeutic quality of exercise interventions for chronic low back pain: a meta-research study using i-CONTENT tool

OBJECTIVE

To assess the therapeutic quality of exercise interventions delivered in chronic low back pain (cLBP) trials using the international Consensus on Therapeutic Exercise aNd Training (i-CONTENT) tool and its inter-rater agreement.

METHODS

We performed a meta-research study, starting from the trials' arms included in the published Cochrane review (2021) 'Exercise therapy for chronic low back pain'. Two pairs of independent reviewers applied the i-CONTENT tool, a standardised tool designed to ensure the quality of exercise therapy intervention, in a random sample of 100 different exercise arms. We assessed the inter-rater agreement of each category calculating the specific agreement. A percentage of 70% was considered satisfactory.

RESULTS

We included 100 arms from 68 randomised controlled trials published between 1991 and 2019. The most assessed exercise types were core strengthening (n=27 arms) and motor control (n=13 arms). Among alternative approaches, yoga (n=11) and Pilates (n=7) were the most representative. Overall, most exercise interventions were rated as having a low risk of ineffectiveness for patient selection (100%), exercise type (92%), outcome type and timing (89%) and qualified supervisor (84%). Conversely, some items showed more uncertainty: the safety of exercise programmes was rated as 'probably low risk' in 58% of cases, exercise dosage in 34% and adherence to exercise in 44%. The items related to exercise dosage (31%) and adherence (29%) had heterogenous judgements, scoring as high risk of ineffectiveness or probably not done. Among all exercise types, Pilates scored best in all domains. A satisfactory specific agreement for 'low risk category' was achieved in all items, except dosage of exercise (60%) and adherence to exercise (54%).

CONCLUSION

Exercises delivered for patients with cLBP generally demonstrate favourable therapeutic quality, although some exercise modalities may present poor therapeutic quality related to dosage and adherence. While the i-CONTENT judgements generally showed satisfactory specific agreement between raters, disagreements arose in evaluating some crucial items.

Comparing the efficacy of physical therapy interventions in Alzheimer's disease: a network meta-analysis

Alzheimer's disease (AD) is a progressive and debilitating neurodegenerative disorder that significantly impairs cognitive function and daily living abilities, representing a major public health challenge. Given the multifactorial nature of AD, effective therapeutic interventions targeting both cognitive and functional decline are critical. This study aimed to conduct a comprehensive comparison of the therapeutic effects of music therapy, acupuncture therapy, game therapy, cognitive training therapy, and exercise therapy on AD patients through a network meta-analysis. Randomized controlled trials (RCTs) published up until 2024 were systematically retrieved from multiple databases. Data were extracted, including the first author, publication year, country, total sample size, mean participant age, type and duration of intervention, and outcome measures such as the Mini-Mental State Examination, Activities of Daily Living, and Alzheimer's Disease Assessment Scale-Cognitive Subscale. Statistical analyses were performed using the RevMan 5.3 and Stata 17 software. The analysis included 52 RCTs with a total of 3,409 participants, offering a strong dataset. The results indicated that game therapy produced statistically significant improvements in mental state and daily living abilities, while acupuncture therapy yielded the most pronounced improvements in cognitive function among AD patients. Notably, the comparative efficacy of these interventions suggests that game therapy may offer short-term benefits, particularly for mental health and functional abilities, whereas acupuncture therapy demonstrated superior long-term cognitive enhancements. In conclusion, tailored physical and cognitive interventions such as game therapy and acupuncture therapy may hold significant potential in optimizing treatment outcomes for AD patients, with implications for both clinical practice and future research.

A Critical Review of Trunk and Hip Exercise Prescription: Applying Evidence for a Modern Approach

Exercise targeting the trunk and hip (core) musculature is common practice in rehabilitation and performance training. Historical underpinnings of core exercise focus on providing stability to the spine, thus improving the function of the spine and extremities, while instability has been postulated to result in pathology and impaired performance. Mechanistic studies on the topic are often conflicting and indeterminate, suggesting the theoretical underpinnings of targeted core exercise may be over assumed in common practice. The best modes of intervention also remain undefined, with combined methods having potential to optimize outcomes. This includes moving beyond isolated exercise camps and being inclusive of both targeted exercise and progressive multi-joint movements. The purpose of this clinical commentary is to describe the historical mechanisms of the stability-instability continuum and the role of exercise intervention. A spectrum of ideologies related to core exercise are examined, while appreciating positive outcomes of exercise interventions across healthy and pathological populations. Finally, exercise summaries were compiled to improve critical reasoning within current practice and inspire future investigations.

Level of Evidence

5.

Meteorin-like protein alleviates intervertebral disc degeneration by suppressing lipid accumulation in nucleus pulposus cells via PPARα-CPT1A activation

Disturbances in lipid metabolism are closely related to intervertebral disc degeneration (IDD). However, the lipid metabolism characteristics of nucleus pulposus (NP) cells during IDD are unclear. Exercise protects against IDD and acts as a potent mediator of organ metabolism, in which muscle-secreted myokines actively participate. However, whether exercise-induced myokines alleviate IDD by regulating lipid metabolism in NP cells remains unknown. The present study revealed that lipid accumulation is the metabolic reprogramming phenotype in NP cells during IDD, which was attributed to an imbalance between increased fatty acid/triglyceride synthesis and diminished utilization, and was further associated with extracellular matrix (ECM) degradation and cell senescence. To explore the interaction between exercise and IDD, Sprague-Dawley rats were subjected to five weeks of treadmill running exercise, and rats in the exercise group exhibited less severe IDD than did those in the sedentary group. The expression of meteorin-like protein (Metrnl), a newly-discovered myokine that participates in lipid metabolism regulation, was observed to increase in muscle, serum and NP tissue after exercise. Moreover, Metrnl ameliorated lipid accumulation in NP cells and further alleviated ECM degradation and cell senescence. Mechanistically, Metrnl activated the fatty acid β-oxidation rate-limiting enzyme carnitine palmitoyltransferase 1A (CPT1A) via peroxisome proliferator-activated receptor α (PPARα) to increase lipid utilization in NP cells. This study provides insight into the lipid metabolic features of NP cells in IDD and reveals the intrinsic connections among exercise, metabolism and IDD, with the myokine Metrnl emerging as a pivotal mediator with therapeutic potential.

Ten Minutes of Core Stabilisation Exercise Result in Local Exercise-Induced Hypoalgesia in Patients With Chronic Unspecific Low Back Pain

BACKGROUND

Core stabilisation training is known to be effective in managing pain in patients suffering from chronic low back pain (CLBP). Yet, acute effects of core stabilisation exercise on exercise-induced hypoalgesia (EIH) are largely unknown. This study aimed to examine the EIH effects of an easy-to-perform core stabilisation exercise in CLBP patients and to explore associations between EIH and potential influencing factors (i.e., physical activity, catastrophizing, kinesiophobia, subjective pain state and exercise exertion).

METHODS

Thirty patients with unspecific CLBP finished this randomised controlled crossover trial. Patients performed a 10-min isometric core stabilisation exercise and a 10-min control session. Before and after, pain sensitivity was measured via pressure pain thresholds [Newton/cm2] locally (low back; PPTlocal) and remotely (forehead, thumb; PPTremote). Correlation analyses were performed between EIH and influencing factors.

RESULTS

A 'Time' × 'Intervention' interaction (p < 0.001) was observed for PPTlocal with post hoc analysis revealing higher values post exercise (p < 0.001; pre: 56.6 ± 20.6, post: 67.5 ± 26.1). No differences were observed for the control session (p = 0.894; pre: 58.5 ± 24.0, post: 58.4 ± 23.3). No such effect was observed for PPTremote (p = 0.014). Post hoc analyses showed no differences following the exercise session (p = 0.103; pre: 41.3 ± 12.5, post: 42.5 ± 13.6), while lower PPTremote post values were observed post control compared to pre values (p = 0.031; 42.5 ± 14.5, post: 41.3 ± 13.7). The only significant moderate correlation was observed between ΔPPTlocal of the exercise session and catastrophizing with rho = -0.381.

CONCLUSION

A 10-min isometric core stabilisation exercise results in local lumbar EIH, while no systemic effects are observed. A higher degree of catastrophizing is associated with lower hypoalgesic responses.

SIGNIFICANCE

This study shows for the first time that a brief and easy-to-perform 10-min core stabilisation exercise produces significant local pain relief (EIH) in patients with unspecific CLBP. The effect is localised to the lumbar region, with no observed impact on remote sites. Higher pain catastrophizing seems to be linked to reduced hypoalgesic response. These findings support the use of short core stabilisation exercises as an effective, immediate, non-pharmacological pain management strategy for these patients.

Can physiotherapy in an interdisciplinary pain rehabilitation setting improve physical function? A long-term mixed methods follow-up study

PURPOSE

The aim of this study was to describe chronic pain patients' perception of their physical function and treatment factors for improving or maintaining physical function long-term after the completion of an Interdisciplinary Pain Rehabilitation Program (IPRP) and to compare physical function before, directly after and at long-term follow-up (16-20 months after treatment).

MATERIALS AND METHODS

Patients with severe nonmalignant chronic pain, participating in an IPRP at a specialist clinic, were eligible for inclusion in a convergent mixed methods study. Quantitative data included aerobic capacity, level of physical activity (PA) and self-efficacy for exercise. Qualitative data were collected through semi-structured interviews.

RESULTS

The qualitative analysis resulted in one theme: Orientation change and two categories: Permission to feel self-worth and Reclaiming life, which illuminated factors that enabled a sustained increase in PA. The quantitative data (n = 11) showed a significantly increased maximal oxygen uptake (VO2max) from 2.46 l/min (SD = 0.9) at baseline to 2.63 l/min (SD = 0.9, p = .03) on completion of the program. VO2max was sustained at long-term follow-up (2.56 l/min (SD = 1.0, p = .24).

CONCLUSION

This study indicates that an orientation change process through an IPRP can lead to increased physical function and a sustainable level of PA. Furthermore, it highlights the importance of a person-centered approach to enable sustainable change in patients with chronic pain.

Videoconference-Supervised Group Exercise Reduces Low Back Pain in Eldercare Workers: Results from the ReViEEW Randomised Controlled Trial

PURPOSE

To assess the effects of a group exercise intervention conducted by real-time videoconference on the low back pain of eldercare workers.

METHODS

We randomly assigned 130 eldercare workers to an experimental group (EG: n = 65) or control group (CG: n = 65). Participants from both groups took part in routine prevention programs carried out in their workplace, and participants from the EG received an additional 12-week resistance-exercise intervention supervised by real-time videoconference. Assessments were conducted before and after the intervention, and the primary outcome was average low back pain intensity during the last 7 days, measured by the 0-10 numerical rating scale. Secondary outcomes included additional measures of low back, neck, shoulder and hand/wrist pain, as well as psycho-affective parameters, medication consumption and muscle performance. Both intention-to-treat and per-protocol analyses were applied with a group-by-time ANCOVA including baseline measurements as covariates.

RESULTS

125 participants completed post-intervention assessments (EG: n = 63, CG: n = 62). The intention-to-treat analysis showed an effect favouring the EG on average low back pain intensity (p = 0.034). Improvements in additional low back and hand/wrist pain outcomes were also observed, as well as on upper limb muscle performance (p < 0.05). The per-protocol analysis demonstrated additional benefits in depression, quality of life, hypnotic/anxiolytic medication consumption and lower limb and trunk muscle performance in participants with ≥ 50% adherence (p < 0.05).

CONCLUSIONS

The intervention was effective for reducing the low back and hand/wrist pain of eldercare workers and increasing upper limb muscle performance. The per-protocol analysis showed additional benefits in psycho-affective parameters, medication consumption and muscle performance.

TRIAL REGISTRATION

ClinicalTrials.gov, NCT05050526. Registered 20 September 2021-Prospectively registered, https://www.

CLINICALTRIALS

gov/study/NCT05050526.

Impact of isolated lumbar extension strength training on reducing nonspecific low back pain, disability, and improving function: a systematic review and meta-analysis

Nonspecific low back pain (LBP), a prevalent condition with a lifetime prevalence of up to 84%, presents a considerable burden on individuals and healthcare systems. Isolated lumbar extension (ILEX) has been studied for its ability to exercise the lumbar region with more controlled activation of the erector spinae and other paravertebral muscles. It aims to serve as a specific resistance training method to improve outcomes related to pain, disability, and physical functionality in adults with nonspecific low back pain (LBP). This systematic review and meta-analysis aimed to evaluate and summarize the effects of ILEX in alleviating pain, reducing disability, and improving physical functionality in adults with chronic LBP. Searches were conducted on October 14, 2024, across key databases, including PubMed, Scopus, and Web of Science. Eligibility criteria included adults (> 18 years old) with chronic LBP participating in resistance training focused on ILEX, with comparators comprising true control or active control groups, all from randomized clinical trials. The RoB2 was used to assess the risk of bias in the studies, while the GRADE scale was employed to evaluate the certainty of the evidence. The meta-analysis calculated Hedges' g effect sizes (ES) with 95% CIs and PIs for main outcomes, using the DerSimonian and Laird random-effects model to address inter-study variability, I² for heterogeneity, and the extended Egger's test for publication bias, all performed with SPSS Software. After screening, a total of 8 randomized studies were included, with 381 participants overall. The results indicated a significant favorable effect of ILEX compared to the true control group in pain-related outcomes (ES = - 0.633, p = 0.004). However, there was a non-significant effect of ILEX compared to the true control group in disability-related outcomes (ES = - 0.292, p = 0.190) and isometric strength outcomes (ES = 0.967, p = 0.150). The GRADE scale indicated that the certainty of the evidence is very low.ILEX significantly reduces pain intensity in individuals with low back pain, indicating its potential as an effective intervention, but its impact on disability and physical functionality is less consistent, warranting cautious use alongside pelvic stabilization to optimize rehabilitation outcomes.

Non-pharmacological therapeutic paradigms in stress-induced depression: from novel therapeutic perspective with focus on cell-based strategies

Major depressive disorder (MDD) is considered a psychiatric disorder and have a relationship with stressful events. Although the common therapeutic approaches against MDD are diverse, a large number of patients do not present an adequate response to antidepressant treatments. On the other hand, effective non-pharmacological treatments for MDD and their tolerability are addressed. Several affective treatments for MDD are used but non-pharmacological strategies for decreasing the common depression-related drugs side effects have been focused recently. However, the potential of extracellular vesicles (EVs) derived from mesenchymal stem cells (MSCs), microRNAs (miRNAs) as cell-based therapeutic paradigms, besides other non-pharmacological strategies including mitochondrial transfer, plasma, transcranial direct current stimulation (tDCS), transcranial magnetic stimulation (TMS), and exercise therapy needs to further study. This review explores the therapeutic potential of cell-based therapeutic non-pharmacological paradigms for MDD treatment. In addition, plasma therapy, mitotherapy, and exercise therapy in several in vitro and in vivo conditions in experimental disease models along with tDCS and TMS will be discussed as novel non-pharmacological promising therapeutic approaches.

Optimal exercise intensity for improving executive function in patients with attention deficit hyperactivity disorder: systematic review and network meta-analysis

This study aimed to compare and rank the effectiveness of optimal exercise intensity in improving executive function in patients with ADHD (Attention deficit hyperactivity disorder, ADHD) through a comprehensive comparison of direct and indirect evidence. A systematic search was performed in five electronic databases to explore the optimal exercise intensity for improving executive function in patients with ADHD by directly and indirectly comparing a variety of exercise intervention intensities. In addition, the isolated effects of exercise on improving executive function in patients with ADHD were explored through classical meta-analysis of paired direct comparisons. Twenty-nine studies were retrieved and included in this study. Classical paired meta-analysis showed that for the patients with ADHD in the age group of 7-17 years, statistical difference was observed for all the parameters of exercise interventions (intensity, frequency, period, and training method), the three dimensions of executive function, the use of medication or not, the high and low quality of the methodological approach. Network meta-analysis showed that high-intensity exercise training was optimal for improving working memory (97.4%) and inhibitory function (85.7%) in patients with ADHD. Meanwhile, moderate-intensity exercise training was optimal for improving cognitive flexibility (77.3%) in patients with ADHD. Moderate to high intensity exercise training shows potential for improving executive function in these patients. Therefore, we recommend applying high-intensity exercise intervention to improve executive function in patients with ADHD to achieve substantial improvement.

Effect of individual physiotherapy and telerehabilitation on back pain and quality of life in people with multiple sclerosis with mild and moderate disability

BACKGROUND

Back pain is a common but often underestimated symptom of patients with MS that can negatively influence their quality of life. However there are only limited number of studies comparing the effect of different types of exercise and use of telerehabilitation on back pain in MS. Therefore, the aim of the study is to compare whether telerehabilitation alone is as effective as conventional outpatient physiotherapy followed by online exercise.

METHODS

This single-centre intervention study compared the impact of different individual outpatient physiotherapy treatments (Group 1 - individual Pilates exercise or Group 2 - strength training) and telerehabilitation alone (individual Pilates exercise with a physiotherapist online). The primary objective was to compare the effect of interventions on back pain (assessed using the Visual Analogue Scale and McGill Pain Questionnaire) and quality of life (Multiple Sclerosis Quality of Life-54). Secondary aims were to compare effect of interventions on spine and thorax mobility, functional mobility (assessed using the Timed 25 foot walk test, Six Spot Step test), respiratory muscle strenght and patient reported outcomes (assessed using he Hospital Anxiety and Depression Scale, Fatigue Severity Scale).

RESULTS

45 people with MS were enrolled in the study (3 men, age:48.4± SD 11,5, Expanded Disability Status Scale (EDSS): 3.3±SD 1,1) and 36 people completed the entire exercise program. All types of exercise intervention showed a positive effect on the reduction of back pain, quality of life and fatigue. The interventions also increased respiratory muscle strength and increased thorax mobility, but we did not find any effect of interventions on gait tests. There were no difference in effect on outcome measures between different types of exercise interventions.

CONCLUSION

Telerehabilitation, involving individual exercise sessions with a physiotherapist, has a comparable effect on reducing back pain, improving quality of life, and enhancing respiratory muscle strength in people with MS as individual Pilates or strength training.

Evaluation of the efficacy of a novel lumbar exoskeleton with multiple interventions for patients with lumbar disc herniation: a multicenter randomized controlled trial of non-inferiority

Background

Lumbar disc herniation (LDH) occurs when the nucleus pulposus or annulus fibrosus protrudes into the intervertebral space, potentially compressing nerve roots and causing symptoms such as sciatica, restricted mobility, and lower extremity weakness. The development of portable lumbar exoskeleton devices offers a new approach, combining traction, range of motion (ROM) exercises, and resistance training in a single system, potentially reducing treatment complexity and enhancing LDH patient outcomes.

Objective

This study aims to evaluate the efficacy and safety of a novel lumbar exoskeleton device compared to traditional traction methods combined with rehabilitation therapy for patients with LDH.

Methods

A multicenter, non-inferiority randomized controlled trial was conducted with 118 participants diagnosed with LDH. Participants were randomly assigned to the Exoskeleton Group or the Traction Group. The Exoskeleton Group used the novel device for traction, ROM, and resistance training, while the Traction Group underwent traditional traction and rehabilitation therapy. Outcomes included efficacy rate after 10 treatments, Visual Analogue Scale (VAS), Oswestry Disability Index (ODI), and lumbar ROM-were assessed at 3, 6, and 10 treatments.

Results

A total of 118 eligible participants were recruited. After 10 treatments, both groups showed significant improvements in VAS scores, ODI, and lumbar ROM compared to baseline (P < 0.001). However, there was no significant difference in the overall efficacy rate between the two groups (P = 0.748).

Conclusion

The novel lumbar exoskeleton device demonstrates comparable efficacy and safety to traditional traction therapy combined with rehabilitation, offering a promising alternative for the conservative treatment of LDH.

Effects of a 16-week dance intervention on loneliness and self-esteem in left behind children: a randomised controlled trial

Loneliness and low self-esteem are among the more prominent mental health problems among left-behind children, but most of the current research stays in cross-sectional surveys, with fewer studies proposing specific solutions. In addition, although the effective impact of dance interventions on loneliness and self-esteem has been demonstrated, the impact in the group of left-behind children remains under-explored. Therefore, this study validated the effectiveness of a dance intervention on loneliness and self-esteem in left-behind children through a 16-week randomised controlled trial. Stratified sampling was used to select one primary school from each of the 14 cities in Hunan Province, with a maximum of 100 children recruited from each primary school. Independent researchers used SPSS 29.0 to randomly assign the eligible 1270 participants to the Experimental group (n = 635) and Control group (n = 635) in a 1:1 ratio. The Experimental group performed 45 min of moderate-intensity dance training five times a week. The Control group maintained their original living conditions. Participants were measured three times using the Children's Loneliness Scale and Rosenberg's Self-Esteem Scale: baseline (T0), after 8 weeks (T1), and post-intervention (16 weeks, T2). Linear mixed-effects models for repeated measures were used to test the effects of time, group and time × group interactions. (a) The average age of the 1261 participants was 10 years (SD = 3.52), with high levels of loneliness (42.48 ± 12.04) and low levels of self-esteem (26.75 ± 6.39). (b) There was a significant negative correlation between loneliness and self-esteem among the LBC (p < 0.001, r = - 0.390). (c) After the dance intervention, the LBC's loneliness significantly decreased [F (2, 1258) = 74.516, ηp2 = 0.106, p < 0.001] and their self-esteem significantly increased [F (2, 1258) = 73.64, ηp2 = 0.104, p < 0.001]. A 16-week dance intervention is an effective strategy to improve loneliness and self-esteem in LBC. Given the acceptability and practicality of the dance intervention, it could be included in a health programme to improve loneliness and self-esteem in LBC.

How effective is the addition of specific exercise therapy for patients after anterior cruciate ligament surgery? A systematic review and meta-analysis

Context

Anterior cruciate ligament (ACL) injuries are prevalent in sports and often require surgical intervention followed by rehabilitation. Several rehabilitation methods have been used for patients after ACL surgery.

Objective

This study aimed to assess the overall efficacy of exercise therapy in improving outcomes for patients following ACL surgery using a systematic review and meta-analysis of randomized controlled trials (RCTs).

Data sources

PubMed, Web of Science, Embase, and the Cochrane Library were searched for randomized controlled trials published from 1 January 2000 to 30 August 2024. Study quality was assessed using the Cochrane Risk-of-Bias tool.

Study selection

A total of 11 randomized controlled trials (whole-body vibration training = 4, core-stability training = 2, strength training = 3, blood flow restriction training = 1, and aquatic training = 1) involving 552 anterior cruciate ligament surgery patients were included.

Data extraction

Two researchers individually screened the key information for each eligible study and evaluated the quality of the studies. Any dispute was discussed by a third researcher.

Results

Compared with conventional therapy, exercise therapy significantly reduced pain scores (mean difference: -0.53, 95% CI: -0.82 to -0.24, and p < 0.001) and improved muscle strength (flexion: 13.76 and extension: 12.46) and knee function (effect size: 2.06 and p = 0.001). Secondary outcomes, although less pronounced, also demonstrated improvement.

Limitation

The sources of heterogeneity among the included studies were not fully identified, particularly concerning variations in exercise protocols or patient characteristics. Additionally, the therapeutic effects of specific exercise modalities (e.g., strength training versus aquatic training) were not directly compared.

Conclusion

Exercise therapy is effective in reducing pain, enhancing muscle strength, and improving knee function in ACL surgery patients. These findings underscore the importance of integrating tailored exercise therapies into rehabilitation programs.

Systematic review registration number

https://www.crd.york.ac.uk/PROSPERO/, identifier registration number. CRD42023476653.

Comparative effectiveness of physical activity interventions on cognitive functions in children and adolescents with Neurodevelopmental Disorders: a systematic review and network meta-analysis of randomized controlled trials

BACKGROUND

Physical activity (PA) interventions have been shown to yield positive effects on cognitive functions. However, it is unclear which type of PA intervention is the most effective in children and adolescents with Neurodevelopmental Disorders (NDDs). This study aimed to compare the effectiveness of different types of PA interventions on cognitive functions in children and adolescents with NDDs, with additional analyses examining intervention effects across specific NDD types including attention-deficit/hyperactivity disorder (ADHD) and autism spectrum disorder (ASD).

METHODS

In this systematic review and network meta-analysis, seven databases (Web of Science, PubMed, Medline, APA PsycINFO, Embase, CINAHL, and SPORTDiscus) for randomized controlled trials from database inception to September 2023 were searched. Randomized controlled trials comparing the effectiveness of PA intervention with any non-pharmacological treatment or control group on cognitive functions in children and adolescents diagnosed with NDDs aged 5-17 years were included. Frequentist network meta-analyses were performed based on standardized mean differences (SMD) using random effects models to examine post-intervention differences in cognitive functions, including attention, memory, and executive functions. Intervention dropout was assessed as a measure of treatment acceptability.

RESULTS

Thirty-one randomized controlled trials (n = 1,403, mean age 10.0 ± 1.9 years) with 66 arms were included in the network. Mind-body exercise (MBE; SMD = 1.91 for attention; 0.92 for executive functions), exergaming (SMD = 1.58 for attention; 0.97 for memory; 0.94 for executive functions), and multi-component physical activity (MPA; SMD = 0.79 for executive functions) were associated with moderate to substantial cognitive improvements compared with usual care, whereas the effectiveness of aerobic exercise (AE) was non-significant. Exergaming (SMD = 0.78, 95%CI 0.12 to 1.45) and MPA (SMD = 0.64, 95%CI 0.11 to 1.18) were more effective than AE for executive functions. When analyzing specific NDD types, exergaming lost its superiority over usual care for attention and memory in ADHD, nor for executive functions in ASD. Instead, MPA demonstrated significant benefits across these domains and populations. The certainty of evidence for these comparisons was very low to low. No significant differences in acceptability were observed among MBE, exergaming, and MPA.

CONCLUSIONS

The findings in this study suggest that MBE, exergaming, and MPA were effective interventions for improving domain-specific cognitive functions in children and adolescents with NDDs. AE demonstrated non-significant effectiveness for all outcomes. MBE emerges as particularly advantageous for attention. MPA yielded consistent improvements in memory and executive functions across NDD types. Further high-quality randomized controlled trials of direct comparisons are needed to confirm and expand on the findings from this NMA.

TRIAL REGISTRATION

PROSPERO CRD42023409606.

Running is acceptable and efficacious in adults with non-specific chronic low back pain: the ASTEROID randomised controlled trial

OBJECTIVES

Running is one of the most accessible forms of exercise, yet its suitability for adults with chronic low back pain (LBP) is unknown. This study assessed the efficacy and acceptability of running in adults with chronic LBP.

METHODS

This two-arm parallel (1:1) individually randomised controlled trial allocated 40 participants (mean (SD) age: 33 (6) years, female: 50%) with non-specific chronic LBP to a 12-week intervention or waitlist control. The intervention was a progressive run-walk interval programme comprising three 30-min sessions per week that were digitally delivered and remotely supported by an exercise physiologist. Efficacy outcomes were self-reported pain intensity (100-point visual analogue scale) and disability (Oswestry Disability Index). Acceptability outcomes were attrition, adherence and adverse events.

RESULTS

At 12-week follow-up, the intervention improved average pain intensity (mean net difference (95% CI): -15.30 (-25.33, -5.27) points, p=0.003), current pain intensity (-19.35 (-32.01, -6.69) points, p=0.003) and disability (-5.20 (-10.12, -0.24) points, P=0.038), compared with control. There was no attrition, and mean (SD) training adherence was 70% (20%; ie, 2.1 of 3 sessions per week). Nine non-serious adverse events deemed likely study-related were reported (lower limb injury/pain: n=7, syncope associated with an underlying condition: n=1, LBP: n=1).

CONCLUSIONS

A run-walk programme was considered an acceptable intervention by the participants to improve the pain intensity and disability in individuals aged 18-45 years with non-specific chronic LBP when compared with the control. An individualised and conservative run-walk programme should be considered a suitable form of physical activity for adults with chronic LBP.

TRIAL REGISTRATION NUMBER

Australian New Zealand Clinical Trials Registry: ACTRN12622001276741. Registered on 29 September 2022.

Impact of Body Mass Index and VO2 Max on Symptoms, Physical Activity, and Physical Function in a Multinational Sample of People with HIV

People with HIV (PWH) are at increased risk for metabolic disorders affecting body mass index (BMI), chronic symptoms, and impaired physical function and capacity. Although physical activity improves health and well-being, PWH often do not meet activity recommendations necessary to achieve these benefits. Despite the known impact of symptoms, physical activity, and physical function on health, little is known about the relationships and interactions between these variables and BMI and maximum oxygen consumption during exercise (VO2 max) in a multinational population of PWH. We examined the relationship of BMI with PROMIS-29 measures, physical activity, strength, flexibility, and VO2 max in a diverse sample of PWH. Additionally, we examined the relationship of VO2 max with PROMIS-29 measures. Data from 810 PWH who participated in a cross-sectional study conducted by the International Nursing Network for HIV Research (Study VII) were analyzed. Participants were recruited from 8 sites across the United States, Thailand, and South Africa. BMI was calculated from collected height and weight data. Physical function and symptoms were assessed using the PROMIS-29 measure. Physical activity was assessed using the 7-day Physical Activity Recall. VO2 max was calculated using sex at birth, age, BMI and the 6-minute Walk Test. Data were analyzed using descriptive, correlational, and regression statistical analyses. Participants had an average age of 49.1 (± 11.1) years, 44% were female, and the average BMI of the sample group was 27 kg/m2 (± 6.7). Increased BMI was associated with decreased 6-minute Walk Test (β=-2.18, p < 0.001), flexibility (β=-0.279, p < 0.001), and VO2 max (β=-0.598, p < 0.001), even after controlling for covariates (age, sex at birth, country, years living with HIV, and antiretroviral therapy status). BMI was not associated with self-reported physical activity. Increased VO2 max was associated with increased physical function (β = 0.069, p < 0.001), and decreased pain (β=-0.047, p < 0.006), even after controlling for covariates (country, years living with HIV, and antiretroviral therapy status). Future research should explore development of effective and sustainable symptom self-management interventions in PWH accounting for the potential impact of BMI and VO2 max.

Stepped Care for Patients to Optimize Whole Recovery (SC-POWR): An Effectiveness Trial Evaluating a Stepped Care Model for Individuals With Opioid Use Disorder and Chronic Pain

Many patients who receive treatment for opioid use disorder (OUD) report experiencing chronic pain (CP), which is associated with high levels of ongoing nonmedical opioid use and low retention in OUD treatment. In pilot studies of patients with OUD receiving buprenorphine or methadone who had CP, cognitive behavioral therapy (CBT) attenuated nonmedical opioid use compared with treatment-as-usual (TAU), but patients in both treatment arms exhibited similar pain improvements. Adding exercise and stress reduction to this model may augment pain-related outcomes. With funding from National Institutes of Health, we plan to conduct a randomized clinical trial of 316 patients with OUD and CP to test the effectiveness of TAU compared with Stepped Care for Patients to Optimize Whole Recovery (SC-POWR) to reduce nonmedical opioid use and pain (primary outcomes) (Aim 1) and decrease pain intensity and interference, alcohol use, anxiety, depression and stress, and improve sleep (secondary outcomes) (Aim 2). Eligible participants will be randomized to receive TAU (buprenorphine or methadone and at least once a month individual or group counseling) or SC-POWR (ie, TAU and up to 12 CBT sessions) for 24 weeks. Based on prespecified nonresponse criteria, SC-POWR may be stepped up at week 6 to receive onsite weekly group sessions of exercise (Wii Fit, Tai Chi) and "stepped up" again at week 15 to receive weekly group sessions of stress reduction (relaxation training, auricular acupuncture). They will be followed for another 24 weeks to evaluate durability of treatment response for illicit opioid use, alcohol use, pain, anxiety, depression, stress, sleep, and retention in medications for OUD (Aim 3).

How to conduct and report checking transitivity and inconsistency in network-meta-analysis: a narrative review including practical worked examples, code and source data for sports and exercise medicine researchers

The use of network meta-analysis (NMA) in sport and exercise medicine (SEM) research continues to rise as it enables the comparison of multiple interventions that may not have been assessed in a single randomised controlled trial. NMA can then inform clinicians on potentially better interventions. Despite the increased use of NMA, we have observed that in the SEM field, a key challenge for author groups can be the assessment and reporting of key assumptions, in particular transitivity and consistency. This paper provides SEM researchers with a practical guide on how to approach the transitivity and consistency assumptions of NMA. Using a previously published NMA in the SEM field, we provide the statistical code, source data and worked examples to facilitate understanding and best practice of NMA in the particular field. We hope these resources result in improved conduct and reporting of NMA that ultimately leads to advances in the SEM field.

Effect of Reformer Spring Resistance Modifications on Core Muscle Activity During Basic Core Muscle Exercises

BACKGROUND

Core muscles serve as a central group within the functional kinetic chain, stabilizing the spine during movement. The Reformer is one of the most popular and primary pieces used in Pilates core exercises, requiring effective control of core muscles. The purpose of this study was to investigate the effect of Reformer spring resistance on core muscle activity.

METHOD

18 healthy adult females (age: 29.83 ± 4.22 years, body height: 164.98 ± 4.14 cm, body mass: 53.67 ± 5.32 kg) participated in this study. Surface electromyography was recorded from six muscles: rectus abdominis, internal oblique, erector spinae, multifidus, rectus femoris, and biceps femoris during core exercises. Participants performed three core exercises (hip roll, knee-off, and elephant) under three different Reformer spring conditions (fixed platform, platform connected to springs with moderate resistance, platform connected to springs with low resistance).

RESULTS

During the hip roll exercise, mean muscle activity of the rectus abdominis, erector spinae, multifidus, and biceps femoris was significantly increased on the low-resistance spring platform compared to the moderate-resistance platform and fixed platform conditions (p < 0.001). During the knee-off exercise, mean muscle activity of the rectus abdominis, internal oblique, erector spinae, and multifidus significantly increased on the low-resistance platform compared to the fixed platform (p < 0.001). Furthermore, during the elephant exercise, mean muscle activity of the rectus abdominis, internal oblique, and rectus femoris significantly increased on the low-resistance spring platform compared to the fixed platform (p < 0.001).

CONCLUSIONS

These findings suggest the unstable platform caused by the Reformer spring modification impacts core muscle activity during basic core exercises. Therefore, when designing core exercise programs using the Reformer, platform instability should be considered a key factor for rehabilitation and core stability.

Does Trunk Self-Elongation Instruction Lead to Changes in Effective Trunk Height and Spino-Pelvic Parameters? A Radiographic Analysis

BACKGROUND/OBJECTIVES

The aim of this study was to evaluate changes in trunk height and variations in spino-pelvic parameters during trunk self-elongation. Two populations were studied: non-athletes and gymnasts, who differ in their engagement with core-strengthening exercises.

METHODS

EOS biplanar radiographs were taken on 14 non-athletes and 24 gymnasts in both neutral and trunk self-elongation positions. Three-dimensional reconstructions of the pelvis and spine were used to calculate effective trunk height, thoracic and lumbar contributions, and spino-pelvic parameters.

RESULTS

Trunk self-elongation resulted in a significant increase in trunk height for both groups (7 mm on average, range: -1 to 14 mm), accompanied by a reduction in thoracic kyphosis for all participants (-10° for non-athletes and -17° for gymnasts, on average) and a reduction in lumbar lordosis in most participants (-5° for non-athletes and -7° for gymnasts, on average). However, some individuals in both groups exhibited an increase in lumbar lordosis, which reduced the contribution of the lumbar region to overall trunk height.

CONCLUSIONS

Trunk self-elongation instruction effectively increases trunk height, but additional instructions, such as pelvic retroversion, may enhance its effectiveness.

Comparison of Isometric and Dynamic Bridging Exercises on Low Back Muscle Oxygenation

Bridging exercises are commonly performed by people with low back pain (LBP). However, the effect of the contraction mode in a bridging exercise on the hemodynamics of the low back muscle has not been investigated in people with and without LBP. The objective of this study was to assess the effect of the mode of bridging exercise on oxygenation of the low back muscle. A near-infrared spectroscopy was used to measure hemodynamic responses of the erector spinae between isometric and dynamic bridging exercises in 16 healthy participants. The results demonstrated that during exercise, the isometric bridging exercise significantly decreased oxyhemoglobin and deoxy-hemoglobin compared to the dynamic bridging exercise (oxyhemoglobin, t=- 3.109, p=0.007, Cohen's d=0.68 and deoxy-hemoglobin, t=- 2.193, P=0.046, Cohen's d=0.60). The results also demonstrated that after exercise, the dynamic bridging exercise induced a significantly higher oxygenation response (oxygenation, t=- 2.178, P=0.048, Cohen's d=0.43). This study indicates that the dynamic bridging exercise is more effective in improving oxygenation of low back muscles.

Longitudinal impact of leisure-time physical activity on pain intensity and daily activity limitation in people with low back pain. Findings from the PAMPA cohort

OBJECTIVE

We aimed to prospectively evaluate the association between leisure-time physical activity and outcomes related to low back pain (LBP), such as pain intensity and daily activity limitation.

METHODS

We analyzed data from the PAMPA (Prospective Study about Mental and Physical Health) cohort, a longitudinal study with adults residing in Southern Brazil. Participants answered an online-based, self-administered questionnaire. Physical activity was assessed as minutes per week, and those who reported engaging in 150 min/week or more were considered active. We also assessed the types of activities participants engaged. Pain intensity was assessed with a numeric pain rating scale (from 0 to 10), and participants reported whether their pain restricted their daily activities. Generalized linear models were used to investigate the association between physical activity and LBP outcomes.

RESULTS

Data from 991 individuals (82.7% women) aged 38.9 ± 13.9 were analyzed. Pain intensity was higher in those inactive in waves one (β: 0.54; 95 % CI 0.23, 0.86), three (β: 0.38; 95% CI 0.02, 0.75), and four (β: 0.48; 95% CI 0.06, 0.90). Also, being physically inactive at wave one was associated with a higher probability of daily activity limitation at waves two (IRR 1.77; 95% CI 1.27; 2.46), three (IRR 1.63; 95% CI 1.17, 2.29), and four (IRR 1.73; 95% CI 1.20, 2.50).

CONCLUSION

Not practicing at least 150 min/week of physical activity resulted in higher levels of pain and an increased risk of daily activity limitation in individuals with LBP. Moreover, various forms of activities have shown to be advantageous in alleviating pain among this group.

Exercise-based telerehabilitation in chronic low back pain - a scoping review

BACKGROUND

Low back pain is a major global health problem. Physiotherapy involving exercises is considered first-line treatment. In recent years digital tools including telerehabilitation have increased, but the interventions are diverse. The aim of this study was to map how telerehabilitation approaches are used in studies evaluating exercise-based rehabilitation in patients with chronic low back pain.

METHODS

A systematic literature search was conducted in PubMed, Cinahl and Cochrane Central between January 2017 and January 2024 for original studies on adults, 18 years or older, with chronic low back pain who received exercise-based telerehabilitation.

RESULTS

The database search resulted in 1019 articles. Out of 37 full texts that were screened 28 articles were included in the analysis. The included studies showed a wide variation regarding technological solutions, interventions and outcome measures. The exercise-based telerehabilitation was usually delivered asynchronously via a smartphone application. The most common clinical outcome measure was pain and disability/physical function. Telerehabilitation compared to conventional exercise therapy showed similar clinical improvements.

CONCLUSIONS

This scoping review confirms the heterogeneity within this research area but also contributes by mapping and demonstrating some knowledge gaps in the literature. Further research focusing on synchronous and group interventions are needed. The new technologies described in the included studies provide added value through functional improvements and task redesign.

TRIAL REGISTRATION

OSF https//doi.org/10.17605/OSF.IO/EMKCG.

What specific exercise training is most effective exercise training method for patients on maintenance hemodialysis with sarcopenia: a network meta-analysis

Objective

The present study aimed to investigate the influence of different exercise methods on sarcopenia patients receiving maintenance hemodialysis (MHD) by conducting a network meta-analysis.

Methods

The PubMed, Embase, Cochrane Library, Web of Science, China National Knowledge Infrastructure (CNKI), and Wanfang databases were searched online for relevant articles published until May 2024. Based on the inclusion and exclusion criteria, we selected 10 articles that compared the effects of 7 exercise interventions on sarcopenia patients receiving MHD.

Results

The results of network meta-analysis showed that resistance training (RT) [standardized mean difference (SMD) = 4.54; 95% confidence interval (CI): 3.27-5.80] significantly improved the handgrip strength (HGS) of sarcopenia patients receiving MHD as compared to Baduanjin exercise (BAE) (SMD = 4.19; 95% CI: 2.31-6.07), bicycle exercise (BIE) (SMD = 4.06; 95% CI: 0.02-8.10), and combined movement (CE) (SMD = 3.50; 95% CI: 3.13-3.87). Compared to normal care (NC), BAE (SMD = 0.15; 95% CI: 0.07-0.23), RT (SMD = 0.34; 95% CI: 0.06-0.62), and CE (SMD = 0.37; 95% CI: 0.16-0.58) significantly improved skeletal muscle mass index (SMI) in sarcopenia patients receiving MHD.

Conclusion

This study showed that RT has a positive effect on improving HGS in sarcopenia patients receiving MHD. CE also showed good results in enhancing SMI in MHD patients with sarcopenia. More randomized controlled trials are required to better understand the effectiveness of these exercise interventions and the potential underlying mechanisms.

Multimodal intervention based on physical exercise, mindfulness, behaviour change and education to improve pain and health in patients with chronic primary low back pain: a study protocol of the HEALTHYBACK randomised controlled trial

The HEALTHYBACK trial is based on a multimodal intervention to determine the effectiveness of a supervised physical exercise, mindfulness, behaviour change and pain neuroscience education programme on several health variables in individuals with chronic primary low back pain (CPLBP). The study will be a randomised controlled trial among 70 individuals diagnosed with CPLBP (aged 18-65 years). The intervention will be conducted in person within a hospital setting for 16 weeks and comprises a first phase (16 sessions supervised physical exercise (2 days/week, 45 min/session), mindfulness (1 day/week, 2.5 hours/session), behaviour change (daily/24 hours via a wrist-worn activity prompting device) and pain neuroscience education (1 day/biweekly, 2 hours/session)) and a second phase (16 sessions functional full-body muscle strengthening exercise, 3 days/week, 50 min/session). The primary outcomes will include perceived acute pain, pain pressure threshold, conditioned pain modulation, temporal summation of pain and disability due to pain. Secondary measures will include physical fitness, body composition, gait parameters, device-measured physical activity and sedentary behaviour, haematological profile, self-reported sedentary behaviour, quality of life, pain catastrophising, mental health, sleep duration and quality, and symptoms related to central sensitisation. The groups will undergo pretest (before the intervention), post-test (after each phase of the intervention) and retest (at a 6-week detraining period after the intervention) measurements. The results will determine the effectiveness of multidimensional interventions on several health parameters in individuals with CPLBP. They will provide knowledge for pain management and functioning in affected individuals, which might diminish the need for primary healthcare services. Trial registration number: NCT06114264.

Can resistance exercise prevent breast cancer-related lymphoedema? A systematic review and metanalysis protocol

INTRODUCTION

Evidence shows that resistance training (RT) reduces lymphoedema in patients with breast cancer-related lymphoedema (BRCL), making it a safe and efficient intervention. However, it is uncertain if RT is safe and effective in patients at risk of developing BRCL. This systematic review (SR) protocol aims to describe all methodological aspects in order to evaluate the short-, medium- and long-term effects of RT on the prevention of BCRL.

MATERIALS AND METHODS

Throughout 2024, randomised clinical trials (RCTs) will be identified in electronic databases MEDLINE/PubMed, Embase, Cochrane Central Register of Controlled Trials, PEDro and LILACS. Only studies in English, Spanish and Portuguese will be included. Grey literature and clinical trial registration will also be reviewed. The primary outcome will be the occurrence of lymphoedema and quality of life. Second, pain intensity, upper limb function, range of movement, grip strength and adverse events will be considered. The individual studies' risk of bias will be evaluated using the Cochrane Risk of Bias 2.0 tool. Pairwise meta-analyses using a frequentist approach and random effects model will be conducted. The Grading of Recommendations Assessment, Development and Evaluation system will be used to evaluate the certainty of the evidence.

ETHICS AND DISSEMINATION

This protocol does not require the approval of an ethics committee, as it is a secondary study. The results will be disseminated through peer-reviewed publications.

PROSPERO REGISTRATION NUMBER

CRD42023455720.

Research hotspots and frontiers in non-specific low back pain: a bibliometric analysis

Background

Extensive research has been conducted worldwide on non-specific low back pain (NSLBP), some researchers published a bibliometric analysis of NSLBP in 2020, but there have been no supplements or updates since then. Therefore, this study aimed to analyze the research hotspots and frontiers in NSLBP over the last decade.

Methods

Primary sources on NSLBP were obtained from the Web of Science Core Collection database from 2014 to 2023. CiteSpace V6.2. R7 (64-bit) and VOSviewer 1.6.19 software were used to analyze the number and centrality of journals, countries, institutions, authors, references, and keywords, and the functions of co-occurrence and clustering were applied to draw a visual knowledge map.

Results

In the past decade, the annual publication volume of studies on NSLBP has shown an overall upward trend year by year, with obvious temporal stages and great development potential. In total, 2,103 articles contained six types of literature, with the highest proportion being original research articles (1,633 articles, 77.65%), published in 200 journals. BMC Musculoskeletal Discourses (90 articles, 4.28%) had the highest number of publications, and the British Medical Journal had the highest impact factor (105.7). Furthermore, the United States of America (329 articles, 15.64%) had the highest publication volume, the University of Sydney (139 articles, 6.61%) was the research institution with the highest production, Maher, Chris G (36 articles, 1.71%) was the author with the most published articles, and Hoy, D (571 articles, 27.15%) was the most frequently cited author. The most cited of articles is "Non-specific low back pain" published in the LANCET, with 1,256 citations.

Conclusion

This article summarizes the current research status of NSLBP and predicts future research hotspots and frontiers. In recent years, adolescents have become a high-risk group for NSLBP. Pain neuroscience education, motor control, spinal manipulative therapy, and acupuncture are effective means to treat NSLBP. Biomechanics and trunk muscles as entry points are effective ideas for the treatment of NSLBP pain. Furthermore, anxiety, neck pain, non-specific musculoskeletal pain, fibromyalgia, and musculoskeletal disorders are diseases that are closely related to NSLBP. In the future, attention should be paid to the design of research plans, increasing the research intensity of randomized controlled trials, strengthening follow-up, and the timely updating of guidelines, which will result in higher quality and high-level scientific evidence for research on NSLBP.

Effects of progessive vs. constant protocol whole-body vibration on muscle activation, pain, disability and functional performance in non-specific chronic low back pain patients: a randomized clinical trial

Background and Objective

Non-specific chronic low back pain (NSCLBP) is a prevalent condition causing significant disability and functional impairment. Whole-body vibration exercise (WBVE) has emerged as a new treatment method, but additional research is necessary to determine the optimal parameters of WBVE that would be beneficial for patients experiencing chronic low back pain (CLBP). This study aims to investigate the effects of two type of WBVE (constant vs progressive) on pain, disability, functional performance, and muscle activity in patients with NSCLBP.

Methods

Thirty-two individuals diagnosed with chronic low back pain (CLBP) without any specific causes were enrolled and randomly assigned to one of two intervention groups: a constant/fixed protocol WBVE group or a progressive protocol WBVE group. Participants underwent WBVE sessions for around 30 min, thrice weekly over a period of 8 weeks. Primary outcomes assessed included pain intensity, functional disability, functional performance, and electromyographic activity of core musculature, measured at baseline and upon completion of the intervention period. Temporal changes of each outcome variable across different periods and between groups were measured with repeated measures 2×2 mixed ANOVA. Further, the paired t-test was performed to compare pre- and post-treatment values within each group.

Results

Significant improvements were observed in both the constant and progressive WBVE protocol groups. Pain intensity decreased by 64.2% (p < 0.001) in the constant group and by 61.1% (p < 0.001) in the progressive group. Functional disability decreased by 48.1% (p < 0.001) in the constant group and by 53.3% (p < 0.001) in the progressive group. Functional performance improved by 16.5% (p < 0.001) in the constant group and by 16.9% (p < 0.001) in the progressive group. Electromyography (EMG) demonstrated significant improvements across all measured variables except % maximum voluntary isometric contraction (%MVIC) of external obliques (EO) in both intervention groups with time (p < 0.001). There was no statistically significant difference in the magnitude of improvement between the constant and progressive WBVE protocols (p > 0.05), indicating both modalities' effectiveness in ameliorating CLBP symptoms and associated functional impairments.

Conclusion

The study demonstrates that both progressive and constant WBVE protocols are equally effective in reducing pain and disability in NSCLBP patients. These findings support the inclusion of progressive WBVE in clinical practice, offering a flexible treatment option that can be tailored to individual patient needs, ensuring both tolerability and effectiveness. This contributes valuable evidence towards optimizing WBVE protocols for managing NSCLBP.

Association of aerobic and muscle-strengthening activity with chronic low back pain: population-based study

BACKGROUND CONTEXT

Chronic low back pain (CLBP) is a significant global health burden, primarily affecting the middle-aged and older; However, there is a lack of clear, evidence-based guidelines for leisure-time physical activity aimed at preventing CLBP.

PURPOSE

This study sought to delineate the association between aerobic physical activity (APA) and muscle strengthening activities (MSA) and the prevalence of CLBP.

STUDY DESIGN

This was a population-based study conducted across the United States.

PATIENT SAMPLE

This nationwide study utilizes deidentified data from 22 consecutive rounds of the National Health Interview Survey (NHIS) from 1997 to 2018.

OUTCOME MEASURES

The primary outcome was self-reported CLBP.

METHODS

We analyzed the prevalence of CLBP in a representative sample of 324,793 middle-aged and older people. Among 263,871 individuals, we used multiple logistic regression to investigate individual and joint association between the amount of APA and MSA with CLBP.

RESULTS

In total, 263,871 participants (mean age, 59.0 years; SD, 9.7) were included in the final analysis. From 1997 to 2018, the prevalence of CLBP was approximately 32%, with an annual increase. Engaging in APA for 75 to 150 minutes weekly was associated with a modest reduction in CLBP risk (OR [95% CI] = 0.97 [0.97-0.98]). Similar benefits were seen with 150 to 225, 225 to 300, and >300 minutes. Engaging in MSA 2 to 3 times and 4 to 5 times weekly also reduced CLBP risk (0.98 [0.98-0.99] and 0.98 [0.97-0.99], respectively). Optimal reductions of CLBP risk may be associated with balanced levels of APA and MSA, with recommended amounts being 225 to 300 min/w of APA and 4 to 5 times/w of MSA (0.92 [0.89-0.95]).

CONCLUSIONS

The study found engaging in over 75 minutes of APA and 2 to 5 weekly MSA sessions is associated with a reduced risk of CLBP. Furthermore, a balanced combination of APA and MSA may correspond to the greatest reduction in CLBP risk.

The Physical and Psychological Effects of Telerehabilitation-Based Exercise for Patients With Nonspecific Low Back Pain: Prospective Randomized Controlled Trial

Background

Physical therapy has demonstrated efficacy in managing nonspecific low back pain (NLBP) among patients. Nevertheless, the prevalence of NLBP poses a challenge, as the existing medical infrastructure may be insufficient to care for the large patient population, particularly in geographically remote regions. Telerehabilitation emerges as a promising method to address this concern by offering a method to deliver superior medical care to a greater number of patients with NLBP.

Objective

The purpose of this study is to demonstrate the physical and psychological effectiveness of a user-centered telerehabilitation program, consisting of a smartphone app and integrated sensors, for patients with NLBP.

Methods

This was a single-center, prospective, randomized controlled trial for individuals with NLBP for a duration exceeding 3 months. All participants were assigned randomly to either the telerehabilitation-based exercise group (TBEG) or the outpatient-based exercise group (OBEG). All participants completed a 30-minute regimen of strength and stretching exercises 3 times per week, for a total of 8 weeks, and were required to complete assessment questionnaires at 0, 2, 4, and 8 weeks. The TBEG completed home-based exercises and questionnaires using a telerehabilitation program, while the OBEG completed them in outpatient rehabilitation. The Oswestry Disability Index (ODI) served as the primary outcome measure, assessing physical disability. Secondary outcomes included the Numeric Pain Rating Scale, Fear-Avoidance Beliefs Questionnaire, and 36-item Short-Form Health Survey.

Results

In total, 54 of 129 eligible patients were enrolled and randomly assigned to the study. The completion of all the interventions and assessments in the TBEG and OBEG was 89% (24/27) and 81% (22/27). The findings indicate that no statistical significance was found in the difference of ODI scores between the TBEG and the OBEG at 2 weeks (mean difference -0.91; odds ratio [OR] 0.78, 95% CI -5.96 to 4.14; P=.72), 4 weeks (mean difference -3.80; OR 1.33, 95% CI -9.86 to -2.25; P=.21), and 8 weeks (mean difference -3.24; OR 0.92, 95% CI -8.65 to 2.17; P=.24). The improvement of the ODI in the TBEG (mean -16.42, SD 7.30) and OBEG (mean -13.18, SD 8.48) was higher than 10 after an 8-week intervention. No statistically significant differences were observed between the 2 groups at the 8-week mark regarding the Fear-Avoidance Beliefs Questionnaire (mean difference 8.88; OR 1.04, 95% CI -2.29 to 20.06; P=.12) and Numeric Pain Rating Scale (mean difference -0.39; OR 0.44, 95% CI -2.10 to 1.31; P=.64). In the subgroup analysis, there was no statistically significant difference in outcomes between the 2 groups.

Conclusions

Telerehabilitation interventions demonstrate comparable therapeutic efficacy for individuals with NLBP when compared to conventional outpatient-based physical therapy, yielding comparable outcomes in pain reduction and improvement in functional limitations.

How effective are allied health group interventions for the management of adults with long-term conditions? An umbrella review of systematic reviews and its applicability to the Australian primary health system

BACKGROUND

Group allied health interventions for people with chronic conditions may be a solution to increasing access to allied health in primary care. This umbrella review aimed to determine the effectiveness of allied health group interventions to improve health-related outcomes for adults with chronic conditions and the applicability of the findings to the Australian primary health care context.

METHODS

An umbrella review of systematic reviews conducted April-July 2022, searching eight databases. Systematic reviews were eligible if they included randomised controlled trials (RCT) or quasi-RCTs, community dwelling adults aged ≥ 18, at least one chronic condition, group intervention in scope for allied health professionals, and published in English after 2000. Studies were excluded if interventions were conducted in hospital or aged care facilities, out of scope for allied health, or unsupervised.

RESULTS

Two thousand three hundred eighty-five systematic reviews were identified: after screening and full text review 154 were included and data extracted from 90. The chronic conditions included: cancer (n = 15), cardiovascular disease (n = 6), mixed chronic conditions (n = 3), kidney disease (n = 1), low back pain (n = 12), respiratory disease (n = 8), diabetes (n = 14), heart failure (n = 9), risk of falls (n = 5), hypertension (n = 4, osteoarthritis (n = 6) and stroke (n = 8). Most group interventions included prescribed exercise and were in scope for physiotherapists and exercise physiologists. Overall, allied health group exercise programs for community dwelling adults improved health outcomes for most chronic conditions. Aggregated data from the systematic reviews suggests programs of 45-60 min per session, 2-3 times per week for 12 weeks. Lifestyle education and support for people with type-2 diabetes improved glycaemic control.

CONCLUSIONS

Prescribed group exercise delivered by allied health professionals, predominantly by exercise physiologists and physiotherapists, significantly improved health outcomes for community dwelling adults with a broad range of chronic conditions.

Clinical Examination, Diagnosis, and Conservative Treatment of Chronic Low Back Pain: A Narrative Review

Chronic low back pain is one of the most frequent reasons for medical consultation. It is important to make the correct diagnosis to select the most appropriate treatment in a stepwise approach. In this narrative review, we focus on the clinical examination, the diagnosis, and the conservative treatment of chronic non-specific low back pain. Belgian guidelines for low back pain were used as a basis, followed by a snowball search starting from two articles. Besides that, the Cochrane database was consulted using the following research areas: "multidisciplinary biopsychosocial rehabilitation", "physical examination of lumbar spine", and "rehabilitation back pain". Lastly, we took information from three handbooks. The diagnosis of low back pain starts with a thorough history, including red, yellow, orange, black, and blue flags. Physical, neurological, sensory, and motor testing is performed and complemented with specific tests for low back pain. With a focus on the conservative treatment, pharmacological and non-pharmacological treatments are possible. For CNSLBP, conservative management is advised, starting with reassurance and clear patient education about the condition. While additional treatments, such as manipulation, massage, and acupuncture, can be considered, their effectiveness is not well supported by evidence. Our center emphasizes exercise within a multidisciplinary biopsychosocial rehabilitation program, and although evidence for this approach is limited, we have seen positive outcomes, including improved mobility, strength, and higher return-to-work rates, particularly with the David Spine Concept (DSC).

Integrated Approach to Chronic Pain-The Role of Psychosocial Factors and Multidisciplinary Treatment: A Narrative Review

BACKGROUND

Chronic non-malignant pain represents a growing global public health priority. Chronic pain is multifactorial, with numerous biological, psychological, and social factors contributing to this pain syndrome. It affects not only the patients, impairing their quality of life, but also their family and social environment. Chronic pain is a diagnosis and requires effective and sustainable treatment strategies.

OBJECTIVE

Our aim was to critically review the available evidence on the importance of different approaches in treating patients with chronic non-malignant pain, emphasizing the effectiveness of integrating psychological and social factors within a multidisciplinary framework.

METHODS

This was a non-systematic narrative review of the basic and recent literature analyzing approaches to the treatment of chronic non-malignant pain. The inclusion criteria for the papers were chronic non-malignant pain, treatment approach, review, and original research papers published in English in the last five years (PubMed search), and the basic literature was selected from the references of new papers according to the knowledge and experience of the authors.

RESULTS

This literature review included 120 papers, of which 83 were basic, and 37 were new, published in the last 5 years (2018-2023). The results show that both the basic and newly published literature advocate for a biopsychosocial approach to treating chronic pain.

CONCLUSIONS

New findings, compared to the earlier literature, indicate a new classification of chronic pain into primary and secondary. Chronic pain should be approached with a biopsychosocial model within a multidisciplinary treatment framework. This model addresses the complex interplay of biological, psychological, and social factors, offering a holistic strategy for effective pain management.

DOSage of Exercise for chronic low back pain disorders (DOSE): protocol for a systematic review with dose-response network meta-analysis

Chronic low back disorders are the leading cause of direct and indirect healthcare burden globally. Exercise training improves pain intensity, mental health and physical function. However, the optimal prescription variables are unknown. We aim to compare the efficacy of various exercise dosages for chronic low back disorders to identify the optimal prescription variables. Six databases (Medline, SPORTDiscus, CINAHL, PsycINFO, EMBASE and CENTRAL), trial registries (ClinicalTrials.gov and WHO International Clinical Trials Registry Platform) and reference lists of prior systematic reviews will be searched, and we will conduct forward and backward citation tracking. We will include peer-reviewed randomised controlled trials (individual, cluster or cross-over trials) published in English or German language comparing exercise training to other exercise training or non-exercise training interventions (conservative, non-surgical, non-pharmacological, non-invasive treatments, placebo, sham, usual/standard care, no-treatment control, waitlist control) in adults with chronic low back disorders. Outcomes will include pain intensity, disability, mental health, adverse events, adherence rate, dropout rate and work capacity. Version 2 of the Cochrane risk-of-bias tool will be employed. The dose will be categorised as cumulative dose (total and weekly minutes of exercise training) and individual dose prescription variables (intervention duration, session duration, frequency and intensity). Dose-response model-based network meta-analysis will be used to assess the comparative efficacy of different exercise doses to determine a dose-response relationship. The certainty of evidence will be assessed using the Grading of Recommendations Assessment, Development and Evaluation. Information about optimal exercise training dosage will help in enhancing treatment outcomes.

Effects of a Mat Pilates Exercise Program Associated with Photobiomodulation Therapy in Patients with Chronic Nonspecific Low Back Pain: A Randomized, Double-Blind, Sham-Controlled Trial

OBJECTIVE

To investigate the effects of combining a Pilates program with photobiomodulation therapy (PBMT) in patients with chronic nonspecific low back pain (CNLBP).

METHODS

Thirty-eight adults with CNLBP were randomly assigned to two groups: Pilates exercise + active PBMT (PIL + PBMT) or Pilates exercise + sham PBMT (PIL + SHAM). Both groups performed an 8-week mat Pilates program and received PBMT on their lumbar muscles 10 min before and after each session. The following variables were assessed before and after intervention: peak pain intensity, postural balance (i.e., center of the pressure [A-COP], velocity anteroposterior [Vel AP], and velocity mediolateral [Vel ML]), perceived disability (i.e., Oswestry Disability Index [ODI] and Roland Morris Disability Questionnaire [RMDQ]), and pain-related fear of movement (i.e., Tampa Scale of Kinesiophobia [TSK], Fear Avoidance Beliefs Questionnaire [FABQ], and Pain Catastrophizing Scale [PCS]).

RESULTS

Postural balance variables showed no statistically significant differences (p > 0.05) across time or between groups. The groups showed similar (p < 0.05) reductions in peak pain intensity, ODI, RMDQ, and PCS scores, but no statistically significant difference (p > 0.05) in TSK and FABQ scores.

CONCLUSION

The mat Pilates program reduced peak pain intensity, perceived disability, and pain catastrophizing in adults with CNLBP, but PBMT had no additional effect on these variables. Mat Pilates alone or combined with PBMT was not able to improve postural balance.