Exercises for prevention of recurrences of low-back pain.
BACKGROUND
Back pain is a common disorder that has a tendency to recur. It is unclear if exercises, either as part of treatment or as a post-treatment programme, can reduce back pain recurrences.


OBJECTIVE
To investigate the effectiveness of exercises for preventing new episodes of low-back pain or low-back pain-associated disability.


METHODS
We searched CENTRAL (The Cochrane Library 2009, issue 3), MEDLINE, EMBASE and CINAHL up to July 2009.


METHODS
Inclusion criteria were: participants who had experienced back pain before, an intervention that consisted of exercises without additional specific treatment and outcomes that measured recurrence of back pain or time to recurrence.


METHODS
Two review authors independently judged if references met the inclusion criteria. The same review authors independently extracted data and judged the risk of bias of the studies. Studies were divided into post-treatment intervention programmes and treatment studies. Study results were pooled with meta-analyses if participants, interventions, controls and outcomes were judged to be sufficiently homogenous.


RESULTS
We included 13 articles reporting on nine studies with nine interventions. Four studies with 407 participants evaluated post-treatment programmes and five studies with 1113 participants evaluated exercise as a treatment modality. Four studies had a low risk of bias, one study a high risk and the remainder an unclear risk of bias.We found moderate quality evidence that post-treatment exercises were more effective than no intervention for reducing the rate of recurrences at one year (Rate Ratio 0.50; 95% Confidence Interval 0.34 to 0.73). There was moderate quality evidence that the number of recurrences was significantly reduced in two studies (Mean Difference -0.35; 95% CI -0.60 to -0.10) at one-half to two years follow-up. There was very low quality evidence that the days on sick leave were reduced by post-treatment exercises (Mean Difference -4.37; 95% CI -7.74 to -0.99) at one-half to two years follow-up.We found conflicting evidence for the effectiveness of exercise treatment in reducing the number of recurrences or the recurrence rate.


CONCLUSIONS
There is moderate quality evidence that post-treatment exercise programmes can prevent recurrences of back pain but conflicting evidence was found for treatment exercise. Studies into the validity of measurement of recurrences and the effectiveness of post-treatment exercise are needed.
Choi
Brian Kl
BK
Health Services Research and Evaluation Division, Ministry of Health, College of Medicine Building, 16 College Road, Singapore, Singapore, 169854.
Verbeek
Jos H
JH
Tam
Wilson Wai-San
WW
Jiang
Johnny Y
JY
D005081:Exercise Therapy; D006801:Humans; D017116:Low Back Pain / Q000517:prevention & control*; D016032:Randomized Controlled Trials as Topic; D055502:Secondary Prevention