A Systematic Review on the Effectiveness of Physical and Rehabilitation Interventions for Chronic Non-specific Low Back Pain

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SOURCE:   European Spine Journal 2011 (Jan); 20 (1): 19–39

Marienke van Middelkoop • Sidney M. Rubinstein • Ton Kuijpers • Arianne P. Verhagen • Raymond Ostelo •
Bart W. Koes • Maurits W. van Tulder

Department of General Practice,
Erasmus MC, University Medical Center,
Rotterdam, The Netherlands.

This study has been included for completeness sake. It provides a broad assessment of many of the treatments available in the Supermarket Approach to the Management of Chronic Low Back Pain  

Strangely, it only mentions spinal manipulation in the Exercise therapy versus manual therapy/ manipulation section, and none of those studies included chiropractic (CMT) trials.

Perhaps they missed the numerous studies conducted by researchers at the Wolfe-Harris Center @ Northwestern Health Sciences University. They are certainly worth reviewing.

Low back pain (LBP) is a common and disabling disorder in western society. The management of LBP comprises a range of different intervention strategies including surgery, drug therapy, and non-medical interventions. The objective of the present study is to determine the effectiveness of physical and rehabilitation interventions (i.e. exercise therapy, back school, transcutaneous electrical nerve stimulation (TENS), low level laser therapy, education, massage, behavioural treatment, traction, multidisciplinary treatment, lumbar supports, and heat/cold therapy) for chronic LBP. The primary search was conducted in MEDLINE, EMBASE, CINAHL, CENTRAL, and PEDro up to 22 December 2008.

Existing Cochrane reviews for the individual interventions were screened for studies fulfilling the inclusion criteria. The search strategy outlined by the Cochrane Back Review Groups (CBRG) was followed. The following were included for selection criteria: (1) randomized controlled trials, (2) adult (≥ 18 years) population with chronic (≥ 12 weeks) non-specific LBP, and (3) evaluation of at least one of the main clinically relevant outcome measures (pain, functional status, perceived recovery, or return to work). Two reviewers independently selected studies and extracted data on study characteristics, risk of bias, and outcomes at short, intermediate, and long-term follow-up. The GRADE approach was used to determine the quality of evidence.

In total 83 randomized controlled trials met the inclusion criteria: exercise therapy (n = 37), back school (n = 5), TENS (n = 6), low level laser therapy (n = 3), behavioural treatment (n = 21), patient education (n = 1), traction (n = 1), and multidisciplinary treatment (n = 6).

Compared to usual care, exercise therapy improved post-treatment pain intensity and disability, and long-term function.

Behavioural treatment was found to be effective in reducing pain intensity at short-term follow-up compared to no treatment/waiting list controls.

Finally, multidisciplinary treatment was found to reduce pain intensity and disability at short-term follow-up compared to no treatment/waiting list controls.

There are more articles like this @ our:

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Overall, the level of evidence was low. Evidence from randomized controlled trials demonstrates that there is low quality evidence for the effectiveness of exercise therapy compared to usual care, there is low evidence for the effectiveness of behavioural therapy compared to no treatment and there is moderate evidence for the effectiveness of a multidisciplinary treatment compared to no treatment and other active treatments at reducing pain at short-term in the treatment of chronic low back pain.

Based on the heterogeneity of the populations, interventions, and comparison groups, we conclude that there are insufficient data to draw firm conclusion on the clinical effect of back schools, low-level laser therapy, patient education, massage, traction, superficial heat/cold, and lumbar supports for chronic LBP.

From the FULL TEXT Article


Low back pain (LBP) is related to disability and work absence and accounts for high economical costs in western societies [1]. The management of LBP comprises a range of different intervention strategies including surgery, drug therapy, and non-medical interventions. During the last years, a large number of randomized controlled trials (RCTs) have been published and these have been summarized in systematic reviews. Most of these systematic reviews focus on the effectiveness of a single intervention and describe the effectiveness on the different types of LBP. The current study presents an up-to-date overview on the current literature on physical and rehabilitation medicine in patients with chronic LBP. The physical and rehabilitation medicine interventions include exercise therapy, back schools, transcutaneous electrical nerve stimulation (TENS), superficial heat or cold, low-level laser therapy (LLLT), individual patient education, massage, behavioural treatment, lumbar supports, traction, and multidisciplinary rehabilitation. This systematic review will provide an overview on these physical and rehabilitation medicine interventions applied in chronic LBP patients and its effectiveness.

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