RSS Feeds
-
Response to Systematic Review on Exercise and Chronic LBP
Submit response14th June 2005
Dear Sir / Madam,
Hayden and colleagues have raised some interesting points in their recent systematic review of the use of exercise for the management of chronic low back pain (1). Whilst the task of analysing exercise type and quality is fraught with difficulties, typically stemming from the lack of methodological detail provided on the specific type(s) and dose of exercise being prescribed within randomised controlled trials (2), the findings from their comprehensive analysis have important implications for the clinical management of this particular patient group. They have clearly indicated that both the content and method of exercise programme delivery have an important influence on clinically relevant treatment outcomes. In particular, their analysis of the degree of supervision provided within trials, supports the recent findings of other authors (3, 4), that supervision does result in pain and functional improvements. The importance of encouraging exercise adherence in order to achieve the appropriate exercise dose is also highlighted by the authors as a key factor mediating the success of exercise programmes, and one, no doubt, that many clinicians would agree is a key limitation to the success of exercise-based rehabilitation.
Whilst recognising the value of Hayden and colleagues’ findings, we would like to draw your readers’ attention our previous review in this area: we also investigated similar aspects of exercise programme delivery, and came to strikingly similar conclusions (2) which in our view should have been acknowledged within this paper. Although our findings were not the result of a meta-regression analysis, we did conduct the review in accordance with the QUOROM, and Cochrane Methodological Quality Guidelines (5, 6), used similar methods of trial identification and data extraction, and reported similar limitations in the literature as that reported by Hayden et al.
Yours faithfully,
S. Dianne Liddle G. David Baxter Jacqueline H. Gracey
Health and Rehabilitation Sciences Research Institute University of Ulster Shore Road, Newtownabbey Co. Antrim BT37 OQB Northern Ireland
1. Hayden JA, van Tulder MW, Tomlinson G. Systematic review: strategies for using exercise therapy to improve outcomes in chronic low back pain. Annals of Internal Medicine 2005; 142: 776-785.
2. Liddle SD, Baxter GD, Gracey JH. Exercise and chronic low back pain: what works? Pain 2004; 107: 176-190.
3. Airakinsinen O, Brox JL, Cedraschi C, Hildebrandt J, Klaber- Moffett J, Kovacs F, Mannion AF, Reis S, Staal JB, Ursin H, Zanoli G. European guidelines for the management of chronic non-specific low back pain. COST B13 Working Group 2004, www.backpaineurope.org.
4. Maul I, Laubli T, Oliveri M, Krueger H. Long-term effects of supervised physical training in secondary prevention of low back pain. European Spine Journal 2005; epublished ahead of print.
5. Moher D, Cook DJ, Eastwood S, Olkin I, Rennie D, Stroup DF. Improving the quality of reports of meta-analyses of randomised controlled trials: The QUOROM Statement. The Lancet 1999; 354: 1896-1900.
6. Van Tulder MW, Assendelft WJJ, Koes BW, Bouter LM and the Editorial Board of the Cochrane Collaboration Back Review Group. Method guidelines for systematic reviews in the Cochrane Collaboration Back Review Group for Spinal Disorders. Spine 1997; 22: 2323-2330.
Conflict of Interest:
None declared