title: Advice to Stay Active or Structured Exercise in the Management of Sciatica: A Systematic Review and Meta-analysis.
abstract: METHODS
  A systematic review and meta-analysis.
  
  
  OBJECTIVE
  To evaluate the evidence on comparative effectiveness of advice to stay active versus supervised structured exercise in the management of sciatica.
  
  
  BACKGROUND
  Conservative management of sciatica usually includes interventions to promote physical activity in the form of advice to stay active or exercise, but there has been no systematic review directly comparing the effectiveness of these 2 approaches.
  
  
  METHODS
  Data Sources included MEDLINE, CINAHL, EMBASE, and PEDro databases. Studies were randomized controlled trials comparing advice with exercise. Two independent reviewers extracted data and assessed methodological quality using the PEDro scale. Pain and disability data were extracted for all time points and converted to a common 0 to 100 scale. Data were pooled with a random effects model for short, intermediate, and long-term follow-ups. The GRADE approach was used to summarize the strength of evidence.
  
  
  RESULTS
  Five trials were included in the meta-analysis, which showed a significant, although small effect favoring exercise over advice for reducing leg pain intensity in the short term (weighted mean difference: 11.43 [95% confidence interval, 0.71-22.16]) but no difference for disability (weighted mean difference: 1.45 [95% confidence interval, -2.86 to 5.76]). Furthermore, there was no difference at intermediate and long-term follow-ups between advice and exercise for patient-relevant outcomes.
  
  
  CONCLUSIONS
  There is low-quality evidence (GRADE) that exercise provides small, superior effects compared with advice to stay active on leg pain in the short term for patients experiencing sciatica. However, there is moderate-quality evidence showing no difference between advice to stay active and exercise on leg pain and disability status in people with sciatica in the long term.
  
  
  METHODS
  1.
authors.affiliation: *Faculty of Health Science, The University of Sydney, New South Wales, Australia †Institute of Sports Science and Clinical Biomechanics and Nordic Institute of Chiropractic and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark ‡The George Institute for Global Health; Sydney Medical School, The University of Sydney, New South Wales, Australia; and §Institute of Bone and Joint Research, Sydney Medical School, The University of Sydney, New South Wales, Australia.
authors.forename: Matt
authors.initials: M
authors.lastname: Fernandez
authors.forename: Jan
authors.initials: J
authors.lastname: Hartvigsen
authors.forename: Manuela L
authors.initials: ML
authors.lastname: Ferreira
authors.forename: Kathryn M
authors.initials: KM
authors.lastname: Refshauge
authors.forename: Aryane F
authors.initials: AF
authors.lastname: Machado
authors.forename: Ítalo R
authors.initials: ÍR
authors.lastname: Lemes
authors.forename: Chris G
authors.initials: CG
authors.lastname: Maher
authors.forename: Paulo H
authors.initials: PH
authors.lastname: Ferreira
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D004185:Disability Evaluation; D005081:Exercise Therapy; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009043:Motor Activity; D010147:Pain Measurement; D040242:Risk Reduction Behavior; D012585:Sciatica / Q000175:diagnosis / Q000503:physiopathology / Q000628:therapy*; D016896:Treatment Outcome; D055815:Young Adult