Clinical guidelines are silent on the recommendation of physical activity and exercise therapy for low back pain: A systematic review

Josielli Comachio, Manuela Loureiro Ferreira, Paul Jarle Mork, Andreas Holtermann, Emma Kwan-Yee Ho, Daniel Xin Mo Wang, Qianwen Lan, Emmanuel Stamatakis, Paula R. Beckenkamp, Paulo Henrique Ferreira

Research output: Contribution to journalJournal articleResearchpeer-review

Abstract

Objectives To synthesise and evaluate the quality of the recommendations for exercise therapy and physical activity from guidelines for the prevention and/or management of low back pain. Design Systematic review. Methods Included clinical practice guidelines for the management of low back pain published between 2014 and 2022 and searched in 9 databases until September 2022. The quality of evidence was evaluated with the Appraisal of Guidelines, Research and Evaluation tool (AGREE-II instrument). Results After screening 3448 studies, 18 clinical practice guidelines were included in this review. Only five (27 %) guidelines were judged as having a satisfactory quality of evidence (i.e., rigour of development and applicability), and 13 (72 %) of guidelines are discussed and rated as critical. Regarding physical activity, no guidelines provided recommendations for the primary prevention of low back pain or incorporated adequate physical activity aspects considering type, dosage, frequency, and intensity. For exercises, all (100 %) guidelines recommended at least one type of supervised exercise in the management of low back pain, and 16 (88 %) provided an overall recommendation for people to stay active. Conclusions Guidelines offer minimal or, sometimes, no detail regarding physical activity or specific exercise regimens for the management and prevention of low back pain. When some guidance is provided, the recommendations typically lack specificity concerning the type, intensity, duration, and frequency of exercise and, in many cases, they represent a combination of scarce available evidence and stakeholder perspectives.
Original languageEnglish
JournalJournal of Science and Medicine in Sport
Volume27
Issue number4
Pages (from-to)257-265
ISSN1440-2440
DOIs
Publication statusPublished - Jan 2024

Keywords

  • low back pain
  • physical activity
  • review

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