Golden Oldie - Is a positive clinical outcome after exercise therapy for chronic non-specific low back pain contingent upon a corresponding improvement in the targeted aspect(s) of performance? A systematic review
- Exercise does not need to ‘fix’ a physical impairment to provide benefit for pain or disability.
BACKGROUND & OBJECTIVE
Exercise is currently part of best practice for the treatment of chronic low back pain (cLBP) and is included in the majority of guidelines regarding treatment of cLBP. Currently, the effects of exercise are reported as modest and the most effective type and dosage of exercise is still unknown (1). One of the reasons cited for this is the heterogeneity of presentations of low back pain and the uniformity of exercise-based therapy. One proposed remedy to this is the concept of sub-grouping patients and providing tailored exercise interventions. However, there is little evidence to support this approach. Although current evidence into exercise programs for chronic back pain looks at outcomes such as pain and disability, they rarely report if these are related to the targeted physical aspect of performance. In this classic paper, Steiger et al aimed to test the clinical presumption that physical change is required for change in pain or disability.
Rather than trying to find the right exercise for a specific physical impairment, instead we should be focusing on patient-centred factors that are likely to increase engagement with exercise.
The authors employed a systematic review to explore this area. Studies were considered eligible for inclusion if they were a randomized controlled trial (RCT) or a non-randomized controlled trial (non-RCT). The studies had to examine the results of a physical