Graded activity and graded exposure for persistent nonspecific low back pain: a systematic review.
Background: Graded activity and graded exposure are increasingly being used in the management of persistent low back pain; however, their effectiveness remains poorly understood. Purpose: The aim of this study was to systematically review randomized controlled trials that evaluated the effectiveness...
| Publicado en: | Physical Therapy Vol. 90; no. 6; pp. 860 - 880 |
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| Autores principales: | , , , , |
| Formato: | research systematic review tables/charts Journal Article |
| Publicado: |
Oxford University Press / USA
Jun2010
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| Acceso en línea: | Ver este registro en EBSCOhost |
| fields | @attributes: recordID: 1 pdfLink: plink: https://search.ebscohost.com/login.aspx?direct=true&db=ccm&AN=105215465&site=ehost-live header: @attributes: shortDbName: ccm uiTerm: 105215465 longDbName: CINAHL Complete uiTag: AN controlInfo: bkinfo: dissinfo: jinfo: jid: 00319023 PTH jtl: Physical Therapy issn: 00319023 maglogo: N pubinfo: dt: Jun2010 vid: 90 iid: 6 pid: 10398 pub: Oxford University Press / USA artinfo: ui: 105215465 2010672291 10.2522/ptj.20090303 NLM20395306 105215465 ppf: 860 ppct: 20 formats: fmt: @attributes: type: P tig: atl: Graded activity and graded exposure for persistent nonspecific low back pain: a systematic review. aug: au: Macedo LG Smeets RJE Maher CG Latimer J McAuley JH sug: subj: Low Back Pain Rehabilitation Therapeutic Exercise Methods CINAHL Database Clinical Trials Combined Modality Therapy Embase Funding Source Human Medline Physical Therapy Practice, Evidence-Based Physiotherapy Evidence Database Psycinfo Research Instruments Scales Systematic Review ab: Background: Graded activity and graded exposure are increasingly being used in the management of persistent low back pain; however, their effectiveness remains poorly understood. Purpose: The aim of this study was to systematically review randomized controlled trials that evaluated the effectiveness of graded activity or graded exposure for persistent (>6 weeks in duration or recurrent) low back pain. Data Sources: Trials were electronically searched and rated for quality by use of the PEDro scale (values of 0-10). Study Selection: Randomized controlled trials of graded activity or graded exposure that included pain, disability, global perceived effect, or work status outcomes were included in the study. Data Extraction: Outcomes were converted to a scale from 0 to 100. Trials were pooled with software used for preparing and maintaining Cochrane reviews. Results are presented as weighted mean differences with 95% confidence intervals. Data Synthesis: Fifteen trials with 1,654 patients were included. The trials had a median quality score of 6 (range=3-9). Pooled effects from 6 trials comparing graded activity with a minimal intervention or no treatment favored graded activity, with 4 contrasts being statistically significant: mean values (95% confidence intervals) for pain in the short term, pain in the intermediate term, disability in the short term, and disability in the intermediate term were -6.2 (-9.4 to -3.0), -5.5 (-9.9 to -1.0), -6.5 (-10.1 to -3.0), and -3.9 (-7.4 to -0.4), respectively. None of the pooled effects from 6 trials comparing graded activity with another form of exercise, from 4 trials comparing graded activity with graded exposure, and from 2 trials comparing graded exposure with a waiting list were statistically significant. Limitations: Limitations of this review include the low quality of the studies, primarily those that evaluated graded exposure; the use of various types of outome measures; and differences in the implementation of the interventions, adding to the heterogeneity of the studies. Conclusions: The available evidence suggests that graded activity in the short term and intermediate term is slightly more effective than a minimal intervention but not more effective than other forms of exercise for persistent low back pain. The limited evidence suggests that graded exposure is as effective as minimal treatment or graded activity for persistent low back pain. pubtype: Academic Journal doctype: research systematic review tables/charts Journal Article ougenre: Article language: English refInfo: holdings: @attributes: islocal: N |
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