caa a22 4500 445831200 CHVBK 20180317145315.0 cr unu---uuuuu 170323e20110101xx s 000 0 eng 10.1007/s00586-010-1518-3 doi (NATIONALLICENCE)springer-10.1007/s00586-010-1518-3 A systematic review on the effectiveness of physical and rehabilitation interventions for chronic non-specific low back pain [Elektronische Daten] [Marienke van Middelkoop, Sidney Rubinstein, Ton Kuijpers, Arianne Verhagen, Raymond Ostelo, Bart Koes, Maurits van Tulder] Low back pain (LBP) is a common and disabling disorder in western society. The management of LBP comprises a range of different intervention strategies including surgery, drug therapy, and non-medical interventions. The objective of the present study is to determine the effectiveness of physical and rehabilitation interventions (i.e. exercise therapy, back school, transcutaneous electrical nerve stimulation (TENS), low level laser therapy, education, massage, behavioural treatment, traction, multidisciplinary treatment, lumbar supports, and heat/cold therapy) for chronic LBP. The primary search was conducted in MEDLINE, EMBASE, CINAHL, CENTRAL, and PEDro up to 22 December 2008. Existing Cochrane reviews for the individual interventions were screened for studies fulfilling the inclusion criteria. The search strategy outlined by the Cochrane Back Review Groups (CBRG) was followed. The following were included for selection criteria: (1) randomized controlled trials, (2) adult (≥18years) population with chronic (≥12weeks) non-specific LBP, and (3) evaluation of at least one of the main clinically relevant outcome measures (pain, functional status, perceived recovery, or return to work). Two reviewers independently selected studies and extracted data on study characteristics, risk of bias, and outcomes at short, intermediate, and long-term follow-up. The GRADE approach was used to determine the quality of evidence. In total 83 randomized controlled trials met the inclusion criteria: exercise therapy (n=37), back school (n=5), TENS (n=6), low level laser therapy (n=3), behavioural treatment (n=21), patient education (n=1), traction (n=1), and multidisciplinary treatment (n=6). Compared to usual care, exercise therapy improved post-treatment pain intensity and disability, and long-term function. Behavioural treatment was found to be effective in reducing pain intensity at short-term follow-up compared to no treatment/waiting list controls. Finally, multidisciplinary treatment was found to reduce pain intensity and disability at short-term follow-up compared to no treatment/waiting list controls. Overall, the level of evidence was low. Evidence from randomized controlled trials demonstrates that there is low quality evidence for the effectiveness of exercise therapy compared to usual care, there is low evidence for the effectiveness of behavioural therapy compared to no treatment and there is moderate evidence for the effectiveness of a multidisciplinary treatment compared to no treatment and other active treatments at reducing pain at short-term in the treatment of chronic low back pain. Based on the heterogeneity of the populations, interventions, and comparison groups, we conclude that there are insufficient data to draw firm conclusion on the clinical effect of back schools, low-level laser therapy, patient education, massage, traction, superficial heat/cold, and lumbar supports for chronic LBP. The Author(s), 2010 Systematic review nationallicence Exercise nationallicence Back school nationallicence TENS nationallicence Education nationallicence Multidisciplinary nationallicence Behavioural nationallicence Effectiveness of interventions nationallicence Efficacy nationallicence Low back pain nationallicence Meta-analyses nationallicence Treatment effects nationallicence Rehabilitation nationallicence Conservative nationallicence van Middelkoop Marienke Department of General Practice, Erasmus MC, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands aut Rubinstein Sidney Department of Epidemiology and Biostatistics and EMGO-Institute for Health and Care Research, VU University Medical Center, van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands aut Kuijpers Ton Dutch Institute for Health Care Improvement CBO, Utrecht, The Netherlands aut Verhagen Arianne Department of General Practice, Erasmus MC, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands aut Ostelo Raymond Department of Health Sciences and EMGO-Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands aut Koes Bart Department of General Practice, Erasmus MC, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands aut van Tulder Maurits Department of Health Sciences and EMGO-Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University, Amsterdam, The Netherlands aut European Spine Journal Springer-Verlag 20/1(2011-01-01), 19-39 0940-6719 20:1<19 2011 20 586 https://doi.org/10.1007/s00586-010-1518-3 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1007/s00586-010-1518-3 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- van Middelkoop Marienke Department of General Practice, Erasmus MC, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands aut NATIONALLICENCE 700 1- Rubinstein Sidney Department of Epidemiology and Biostatistics and EMGO-Institute for Health and Care Research, VU University Medical Center, van der Boechorststraat 7, 1081 BT, Amsterdam, The Netherlands aut NATIONALLICENCE 700 1- Kuijpers Ton Dutch Institute for Health Care Improvement CBO, Utrecht, The Netherlands aut NATIONALLICENCE 700 1- Verhagen Arianne Department of General Practice, Erasmus MC, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands aut NATIONALLICENCE 700 1- Ostelo Raymond Department of Health Sciences and EMGO-Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands aut NATIONALLICENCE 700 1- Koes Bart Department of General Practice, Erasmus MC, University Medical Center, PO Box 2040, 3000 CA, Rotterdam, The Netherlands aut NATIONALLICENCE 700 1- van Tulder Maurits Department of Health Sciences and EMGO-Institute for Health and Care Research, Faculty of Earth and Life Sciences, VU University, Amsterdam, The Netherlands aut NATIONALLICENCE 773 0- European Spine Journal Springer-Verlag 20/1(2011-01-01), 19-39 0940-6719 20:1<19 2011 20 586 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer