The effectiveness of physiotherapy functional restoration for post-acute low back pain: a systematic review.
BACKGROUND
The effectiveness of multidisciplinary treatment for post-acute (>6 weeks) low back pain (LBP) has been established. Physiotherapists have sufficient training to conduct less intensive functional restoration. The effectiveness of physiotherapy functional restoration (PFR) has not been evaluated using current systematic review methodology.


OBJECTIVE
To determine the effects of PFR for post-acute LBP.


METHODS
Electronic databases searched include: MEDLINE, EMBASE, CINAHL, PsycINFO, PEDro and Cochrane CENTRAL. TRIAL ELIGIBILITY CRITERIA: Randomised controlled trials of physiotherapy treatment for post-acute LBP combining exercise and cognitive-behavioural intervention compared with other intervention, no intervention or placebo. TRIAL APPRAISAL AND SYNTHESIS METHODS: Two authors independently extracted data. Risk of bias was assessed using the PEDro scale and overall quality of the body of evidence was assessed using GRADE (Grading of Recommendations, Assessment, Development and Evaluation). Treatment effect sizes and 95% confidence intervals were calculated for pain, function and sick leave.


RESULTS
Sixteen trials were included. Heterogeneity prevented meta-analysis for most comparisons. Meta-analyses showed moderate to high quality evidence of significant but small effects favouring PFR compared with advice for intermediate term function and intermediate and long term pain. There was however low to moderate quality evidence that PFR was no more effective than a range of other treatment types. Heterogeneous trials frequently contributed to very low quality evidence.


CONCLUSIONS
Moderate to high quality evidence was found of small effects favouring PFR compared with advice. Preliminary evidence suggested PFR is not different to other treatment types. Further high quality research is required replicating existing trial protocols.
Low Back Research Team, Musculoskeletal Research Centre, Department of Physiotherapy, School of Allied Health, Faculty of Health Sciences, La Trobe University, 3086, Australia. matt.c.richards@gmail.com
Matthew C
MC
Richards
Jon J
JJ
Ford
Sarah L
SL
Slater
Andrew J
AJ
Hahne
Luke D
LD
Surkitt
Megan
M
Davidson
Joan M
JM
McMeeken
D006801:Humans; D017116:Low Back Pain / Q000534:rehabilitation*; D026741:Physical Therapy Modalities; D016032:Randomized Controlled Trials as Topic