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Open Access 22-11-2023 | Systematic Review

Systematic Review to Inform a World Health Organization (WHO) Clinical Practice Guideline: Benefits and Harms of Structured Exercise Programs for Chronic Primary Low Back Pain in Adults

Authors: Leslie Verville, Rachel Ogilvie, Cesar A. Hincapié, Danielle Southerst, Hainan Yu, André Bussières, Douglas P. Gross, Paulo Pereira, Silvano Mior, Andrea C. Tricco, Christine Cedraschi, Ginny Brunton, Margareta Nordin, Gaelan Connell, Jessica J. Wong, Heather M. Shearer, Joyce G. B. Lee, Dan Wang, Jill A. Hayden, Carol Cancelliere

Published in: Journal of Occupational Rehabilitation | Issue 4/2023

Abstract

Purpose

Evaluate benefits and harms of structured exercise programs for chronic primary low back pain (CPLBP) in adults to inform a World Health Organization (WHO) standard clinical guideline.

Methods

We searched for randomized controlled trials (RCTs) in electronic databases (inception to 17 May 2022). Eligible RCTs targeted structured exercise programs compared to placebo/sham, usual care, or no intervention (including comparison interventions where the attributable effect of exercise could be isolated). We extracted outcomes, appraised risk of bias, conducted meta-analyses where appropriate, and assessed certainty of evidence using GRADE.

Results

We screened 2503 records (after initial screening through Cochrane RCT Classifier and Cochrane Crowd) and 398 full text RCTs. Thirteen RCTs rated with overall low or unclear risk of bias were synthesized. Assessing individual exercise types (predominantly very low certainty evidence), pain reduction was associated with aerobic exercise and Pilates vs. no intervention, and motor control exercise vs. sham. Improved function was associated with mixed exercise vs. usual care, and Pilates vs. no intervention. Temporary increased minor pain was associated with mixed exercise vs. no intervention, and yoga vs. usual care. Little to no difference was found for other comparisons and outcomes. When pooling exercise types, exercise vs. no intervention probably reduces pain in adults (8 RCTs, SMD = − 0.33, 95% CI − 0.58 to − 0.08) and functional limitations in adults and older adults (8 RCTs, SMD = − 0.31, 95% CI − 0.57 to − 0.05) (moderate certainty evidence).

Conclusions

With moderate certainty, structured exercise programs probably reduce pain and functional limitations in adults and older people with CPLBP.

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Abenhaim L, Rossignol M, Valat JP, Nordin M, Avouac B, Blotman F, et al. The role of activity in the therapeutic management of back pain Report of the International Paris Task Force on Back Pain. Spine (Phila Pa 1976. 2000;25(4 Suppl):1S-33S.CrossRefPubMed

Hayden JA, Ellis J, Ogilvie R, Malmivaara A, van Tulder MW. Exercise therapy for chronic low back pain. Cochrane Database Syst Rev. 2021;9:CD009790.PubMed

Powell KE, Paluch AE, Blair SN. Physical activity for health: What kind? How much? How intense? On top of what? Annu Rev Public Health. 2011;32:349–65.CrossRefPubMed

Hayden JA, Ellis J, Ogilvie R, Stewart SA, Bagg MK, Stanojevic S, et al. Some types of exercise are more effective than others in people with chronic low back pain: a network meta-analysis. J Physiother. 2021;67(4):252–62.CrossRefPubMed

Hayden JA, Group BEC-CRW. Commentary: collaborative systematic review may produce and share high-quality, comparative evidence more efficiently. J Clin Epidemiol. 2022;152:288–94.CrossRefPubMed

Cancelliere C, Verville L, Southerst D, Yu H, Hayden JA, Ogilvie R, Bussières A, Gross DP, Pereira P, Mior S, Tricco AC, Cedraschi C, Brunton G, Nordin M, Wong JJ, Shearer HM, Connell G, Hincapié CA. Systematic review procedures for the World Health Organization (WHO) evidence syntheses on benefits and harms of structured and standardized education/advice, structured exercise programs, transcutaneous electrical nerve stimulation (TENS), and needling therapies for the management of chronic low back pain in adults. J Occup Rehabil. 2023. https://doi.org/10.1007/s10926-023-10156-w.

Hayden JA, Ogilvie R, Kashif S, Singh S, Boulos L, Stewart S, et al. Exercise treatments for chronic low back pain: a network meta-analysis (protocol). Cochrane Database Syst Rev. Submitted revision, September 2022.

Herbert RD. How to estimate treatment effects from reports of clinical trials. I: Continuous outcomes. Aust J Physiother. 2000;46(3):229–35.CrossRefPubMed

Herbert RD. How to estimate treatment effects from reports of clinical trials. II: Dichotomous outcomes. Aust J Physiother. 2000;46(4):309–13.CrossRefPubMed

10.

Rubinstein SM, Terwee CB, Assendelft WJ, de Boer MR, van Tulder MW. Spinal manipulative therapy for acute low-back pain. Cochrane Database Syst Rev. 2012;2012(9):CD008880.PubMedPubMedCentral

11.

Dworkin RH, Turk DC, Wyrwich KW, Beaton D, Cleeland CS, Farrar JT, et al. Interpreting the clinical importance of treatment outcomes in chronic pain clinical trials: IMMPACT recommendations. J Pain. 2008;9(2):105–21.CrossRefPubMed

12.

Cohen J. Statistical power analysis for the behavioral sciences. 2nd ed. New Jersey (NJ): Lawrence Erlbaum Associates; 1988.

13.

Higgins JP, Altman DG, Gotzsche PC, Juni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011;343:d5928.CrossRefPubMedPubMedCentral

14.

Furlan AD, Malmivaara A, Chou R, Maher CG, Deyo RA, Schoene M, et al. 2015 updated method guideline for systematic reviews in the Cochrane Back and Neck Group. Spine (Phila Pa 1976). 2015;40(21):1660–73.CrossRefPubMed

15.

DistillerSR. Version 2023.2.1. 2023.2.1 ed. Ottawa, Canada: DistillerSR; 2023.

16.

Campbell M, McKenzie JE, Sowden A, Katikireddi SV, Brennan SE, Ellis S, et al. Synthesis without meta-analysis (SWiM) in systematic reviews: reporting guideline. BMJ. 2020;368:l6890.CrossRefPubMedPubMedCentral

17.

Schünemann HJ, Higgins JPT, Vist GE, Glasziou P, Akl EA, Skoetz N, et al. Chapter 14: Completing ‘Summary of findings’ tables and grading the certainty of the evidence. 2022 [cited January 5, 2022]. In: Cochrane Handbook for Systematic Reviews of Interventions version 63 (updated February 2022) [Internet]. Cochrane, [cited January 5, 2022]. Available from: www.training.cochrane.org/handbook.

18.

R Core Team. A language and environment for statistical computing. R Foundation for Statistical Computing. Vienna, Austria2022.

19.

Viechtbauer W. Conducting meta-analyses in R with the metafor package. J Stat Softwe. 2010;36(3):1–48.

20.

GRADEpro. GDT: GRADEpro Guideline Development Tool (Software]. McMaster University and Evidence Prime; 2021.

21.

Chhabra HS, Sharma S, Verma S. Smartphone app in self-management of chronic low back pain: a randomized controlled trial. Eur Spine J. 2018;27(11):2862–74.CrossRefPubMed

22.

Costa LO, Maher CG, Latimer J, Hodges PW, Herbert RD, Refshauge KM, et al. Motor control exercise for chronic low back pain: a randomized placebo-controlled trial. Phys Ther. 2009;89(12):1275–86.CrossRefPubMed

23.

Fukuda TY, Aquino LM, Pereira P, Ayres I, Feio AF, de Jesus FLA, et al. Does adding hip strengthening exercises to manual therapy and segmental stabilization improve outcomes in patients with nonspecific low back pain? A randomized controlled trial. Braz J Phys Ther. 2021;25(6):900–7.CrossRefPubMedPubMedCentral

24.

Jinnouchi H, Matsudaira K, Kitamura A, Kakihana H, Oka H, Hayama-Terada M, et al. Effects of brief self-exercise education on the management of chronic low back pain: a community-based, randomized, parallel-group pragmatic trial. Mod Rheumatol. 2020;31(4):890–8.CrossRefPubMed

25.

Miyamoto GC, Costa LO, Galvanin T, Cabral CM. Efficacy of the addition of modified Pilates exercises to a minimal intervention in patients with chronic low back pain: a randomized controlled trial. Phys Ther. 2013;93(3):310–20.CrossRefPubMed

26.

Nardin DMK, Stocco MR, Aguiar AF, Machado FA, de Oliveira RG, Andraus RAC. Effects of photobiomodulation and deep water running in patients with chronic non-specific low back pain: a randomized controlled trial. Lasers Med Sci. 2022;37(4):2135–44.CrossRefPubMed

27.

Rahbar M, Salekzamani Y, Jahanjou F, Eslamian F, Niroumand A, Dolatkhah N. Effect of hippotherapy simulator on pain, disability and range of motion of the spinal column in subjects with mechanical low back pain: a randomized single-blind clinical trial. J Back Musculoskelet Rehabil. 2018;31(6):1183–92.CrossRefPubMed

28.

Rotter G, Ortiz M, Binting S, Tomzik J, Reese F, Roll S, et al. Mindful walking in patients with chronic low back pain: a randomized controlled trial. J Integr Complement Med. 2022;28(6):474–83.CrossRefPubMedPubMedCentral

29.

Shamsi M, Ahmadi A, Mirzaei M, Jaberzadeh S. Effects of static stretching and strengthening exercises on flexion relaxation ratio in patients with LBP: a randomized clinical trial. J Bodyw Mov Ther. 2022;30:196–202.CrossRefPubMed

30.

Smeets R, Vlaeyen JWS, Hidding A, Kester ADM, van der Heijden G, Knottnerus AJ. Chronic low back pain: physical training, graded activity with problem solving training, or both? The one-year post-treatment results of a randomized controlled trial. Pain. 2008;134(3):263–76.CrossRefPubMed

31.

Takinaci Z. Clinical efficacy of spa therapy (balneotherapy) for chronic low back pain: a randomized single-blind trial. Eur J Integr Med. 2019;29:100928.CrossRef

32.

Tilbrook HE, Cox H, Hewitt CE, Kang’ombe AR, Chuang LH, Jayakody S, et al. Yoga for chronic low back pain: a randomized trial. Ann Intern Med. 2011;155(9):569–78.CrossRefPubMed

33.

Weiner DK, Perera S, Rudy TE, Glick RM, Shenoy S, Delitto A. Efficacy of percutaneous electrical nerve stimulation and therapeutic exercise for older adults with chronic low back pain: a randomized controlled trial. Pain. 2008;140(2):344–57.CrossRefPubMedPubMedCentral

34.

Harris PA, Taylor R, Thielke R, Payne J, Gonzalez N, Conde JG. Research electronic data capture (REDCap)–a metadata-driven methodology and workflow process for providing translational research informatics support. J Biomed Inform. 2009;42(2):377–81.CrossRefPubMed

35.

Harris PA, Taylor R, Minor BL, Elliott V, Fernandez M, O’Neal L, et al. The REDCap consortium: building an international community of software platform partners. J Biomed Inform. 2019;95:103208.CrossRefPubMedPubMedCentral

36.

World Bank Country and Lending Groups. [cited 2022 May 1, 2022]. Available from: https://datahelpdesk.worldbank.org/knowledgebase/articles/906519-world-bank-country-and-lending-groups.

37.

Abadi FH, Sankaravel M, Zainuddin FF, Elumalai G, Razli AI. The effect of aquatic exercise program on low-back pain disability in obese women. J Exerc Rehabil. 2019;15(6):855–60.CrossRefPubMedPubMedCentral

38.

Abdel-Aziem AA, Abdelraouf OR, El-Basatiny HMY, Draz AH. The effects of stabilization exercises combined with pelvic floor exercise in women with nonspecific low back pain: a randomized clinical study. J Chiropr Med. 2021;20(4):229–38.CrossRefPubMed

39.

Afzal MW, Ahmad A, Mohseni Bandpei MA, Gilani SA, Hanif A, Waqas MS. Effects of virtual reality exercises and routine physical therapy on pain intensity and functional disability in patients with chronic low back pain. J Pak Med Assoc. 2022;72(3):413–7.CrossRefPubMed

40.

Ahmadizadeh Z, Ehsani F, Samaei SA, Mirmohammadkhani M. The effect of stabilization exercises along with self-care training on transverse abdominal activity, pain, and disability in mothers with low back pain having children with cerebral palsy: a randomized controlled trial. Am J Phys Med Rehabil. 2020;99(2):156–60.CrossRefPubMed

41.

Ain SQT, Rehman SSU, Maryam M, Kiani SK. Effects of sustained natural apophyseal glides with and without thoracic posturecorrection techniques on mechanical back pain: a randomized control trial. J Pak Med Assoc. 2019;69(11):1584–7.

42.

Alikhajeh Y, Barabadi E, Rahimi GRM. A comparison of 6 weeks of aquatic exercise and Kinesio taping in patients with chronic nonspecific low back pain. J Sport Rehabil. 2021;30:37–42.CrossRef

43.

Alvani E, Shirvani H, Shamsoddini A. Neuromuscular exercises on pain intensity, functional disability, proprioception, and balance of military personnel with chronic low back pain. J Can Chiropr Assoc. 2021;65(2):193–206.PubMedPubMedCentral

44.

Ansari S, Elmieh A, Alipour A. The effect of aquatic exercise on functional disability, flexibility and function of trunk muscles in postmenopausal women with chronic non-specific low back pain: randomized controlled trial. Sci Sports. 2021;36(3):e103–10.CrossRef

45.

Barni L, Calabretta L, Lepori L, Pasquetti P, Gulisano M, Freddolini M. Does an aerobic exercise improve outcomes in older sedentary nonspecific low back pain subjects? A randomized controlled study. Top Geriatr Rehabil. 2018;34(2):88–94.CrossRef

46.

Bruehl S, Burns JW, Koltyn K, Gupta R, Buvanendran A, Edwards D, et al. Are endogenous opioid mechanisms involved in the effects of aerobic exercise training on chronic low back pain? A randomized controlled trial. Pain. 2020;161(12):2887–97.CrossRefPubMedPubMedCentral

47.

Dimer da Luz R, da Silva SM, Steffen Evaldt A, da Silva ML, Boff Daitx R, Dohnert MB. Neuromuscular electrical stimulation associated with core stability exercises in nonspecific postural low back pain: a randomized clinical trial. Muscles Ligaments Tendons J. 2019;9(3):446–556.CrossRef

48.

da Silva TMJC, da Silva NN, de Souza Rocha SH, de Oliveira DM, Monte-Silva KK, de Silva TA, et al. Back school program for back pain: education or physical exercise? ConScientiae Saúde. 2014;13(4):506–15.CrossRef

49.

Dalichau S, Scheele K. Status of aquatic functional training in the therapy of chronic back pain. Phys Med Rehab Kuror. 2003;13:35–41.CrossRef

50.

Dalichau S, Stein B, Schafer K, Buhlmann JJ, Menken P. Quantification of spinal configuration and postural capacity by ultrasound topometry for evaluation of different muscle strengthening programs in the therapy of back pain. Z Orthop. 2005;143:79–85.CrossRefPubMed

51.

Dineshkumar SK, Dibyendunarayan B, Ramalingam AT. Effect of abdominal drawing-in maneuver along with resisted ankle dorsi-flexion to activate transverse abdominis muscle in chronic non-specific low back pain. Rom J Phys Ther. 2015;21(36):40–7.

52.

Fouda KZ, Dewir IM, Abdelsalam MS. Effects of proprioceptive neuromuscular facilitation techniques in treating chronic nonspecific low back pain patients. Physiother Quart. 2021;29(2):32–7.CrossRef

53.

Gao F, Yuan S, Liu N, Zheng S. Effect observation of Baduanjin training on chronic nonspecific low back pain. Rehabil Med. 2018;28(4):13–7.

54.

Ge L, Huang H, Yu Q, Li Y, Li X, Li Z, et al. Effects of core stability training on older women with low back pain: a randomized controlled trial. Eur Rev Aging Phys Act. 2022;19(1):10.CrossRefPubMedPubMedCentral

55.

Gupta P, Mohanty PP, Pattnaik M. The effectiveness of aerobic exercise program for improving functional performance and quality of life in chronic low back pain. Indian J Physiother Occup Ther. 2019;13(2):155–60.CrossRef

56.

Hatefi M, Babakhani F, Ashrafizadeh M. The effect of static stretching exercises on hip range of motion, pain, and disability in patients with non-specific low back pain. J Exp Orthop. 2021;8(1):55.CrossRefPubMedPubMedCentral

57.

Heidari RS, Sahebozamani M, Karimi AF. Comparison of the effects of 8 weeks of core stability exercise on ball and sling exercise on the quality of life and pain in the female with non-specific chronic low back pain (NSLBP). J Zanjan University of Medical Sciences & Health Services. 2018.

58.

Hemmati S, Rajabi R, Karimi N, Jahandideh A. Effects of consecutive supervised core stability training on pain and disability in women with nonspecific chronic low back pain. Koomesh. 2011;12(3):244–52.

59.

Idowu OA, Adeniyi AF. Efficacy of graded activity with and without daily-monitored-walking on pain and back endurance among patients with concomitant low-back pain and type-2 diabetes: A randomized trial. Ethiop J Health Sci. 2020;30(2):233–42.PubMedPubMedCentral

60.

Joseph LH, Hancharoenkul B, Sitilertpisan P, Pirunsan U, Paungmali A. Effects of massage as a combination therapy with lumbopelvic stability exercises as compared to standard massage therapy in low back pain: A randomized cross-over study. Int J Ther Massage Bodywork. 2018;11(4):16–22.PubMedPubMedCentral

61.

Kanwal S, Yaqoob I, Shakil-Ur-Rehman S, Ghous M, Ghazal J, Namroz N. Effects of core muscle stability on low back pain and quality of life in post- menopausal women: a comparative study. J Pak Med Assoc. 2021;71(1(A)):37–40.PubMed

62.

Karimi N, Talimkhani A, Mosallanezhad Z, Arab AM, Keshavarz R. The effects of consecutive supervised functional lumbar stabilizing exercises on the postural balance and functional disability in low back pain. Iran Rehabil J. 2014;12(20):21–7.

63.

Karimzadeh F, Ghasemi GA, Letafatkar A. The effect of 8 weeks core stabilization exercises on pain and functional disability induced by low back pain in the mothers of children with cerebral palsy. Sci J Kurdistan Univ Med Sci. 2016;21(44):5931–94.

64.

Kell RT, Risi AD, Barden JM. The response of persons with chronic nonspecific low back pain to three different volumes of periodized musculoskeletal rehabilitation. J Strength Cond Res. 2011;25(4):1052–64.CrossRefPubMed

65.

Kim S, Jee Y. Effects of 3D moving platform exercise on physiological parameters and pain in patients with chronic low back pain. Medicina (Kaunas). 2020;56(7):1–15.

66.

Kim B, Yim J. Core stability and hip exercises improve physical function and activity in patients with non-specific low back pain: a randomized controlled trial. Tohoku J Exp Med. 2020;251(3):193–206.CrossRefPubMed

67.

Lang AE, Hendrick PA, Clay L, Mondal P, Trask CM, Bath B, et al. A randomized controlled trial investigating effects of an individualized pedometer driven walking program on chronic low back pain. BMC Musculoskelet Disord. 2021;22(1):206.CrossRefPubMedPubMedCentral

68.

Li L, Feng Z. Clinical observation of treating chronic nonspecific low back pain with Baduanjin combining sling exercise therapy. Rheumatism and Arthritis. 2015;4(4):16–7.

69.

Li Z, Yu Q, Luo H, Liang W, Li X, Ge L, et al. The effect of virtual reality training on anticipatory postural adjustments in patients with chronic nonspecific low back pain: a preliminary study. Neural Plast. 2021;2021:9975862.CrossRefPubMedPubMedCentral

70.

Liu J, Zhao W, Yuan Y. Effects of Tai Chi on the event-related potential of patients with chronic non-specific low back pain. Chin J Sports Med. 2018;37(10):826–32.

71.

Liu J, Yeung A, Xiao T, Tian X, Kong Z, Zou L, et al. Chen-style Tai Chi for individuals (aged 50 years old or above) with chronic non-specific low back pain: a randomized controlled trial. Int J Environ Res Public Health. 2019;16(3):517.CrossRefPubMedPubMedCentral

72.

Madadi-Shad M, Jafarnezhadgero AA, Sheikhalizade H, Dionisio VC. Effect of a corrective exercise program on gait kinetics and muscle activities in older adults with both low back pain and pronated feet: a double-blind, randomized controlled trial. Gait Posture. 2020;76:339–45.CrossRefPubMed

73.

McIlveen B, Robertson VJ. A randomised controlled study of the outcome of hydrotherapy for subjects with low back or back and leg pain. Physiotherapy. 1998;84(1):17–26.CrossRef

74.

Mendes PRF, Gomes SRA, Costa LDO, Liguori A, Bulhoes LCC, Brasileiro JS. Core stabilisation exercises reduce chronic low back pain in Air Force fighter pilots: a randomised controlled trial. BMJ Mil Health. 2022.

75.

Noormohammadpour P, Kordi M, Mansournia MA, Akbari-Fakhrabadi M, Kordi R. The role of a multi-step core stability exercise program in the treatment of nurses with chronic low back pain: A single-blinded randomized controlled trial. Asian Spine J. 2018;12(3):490–502.CrossRefPubMedPubMedCentral

76.

Park S, Park S, Min S, Kim C-J, Jee Y-S. A randomized controlled trial investigating the effects of equine simulator riding on low back pain, morphological changes, and trunk musculature in elderly women. Medicina. 2020;56(610):1–14.

77.

Prado ERA, Meireles SM, Carvalho ACA, Mazoca MF, Motta Neto AM, Barboza Da Silva R, et al. Influence of isostretching on patients with chronic low back pain. A randomized controlled trial. Physiother Theory Pract. 2021;37(2):287–94.CrossRefPubMed

78.

Raoul T, Malfériot J, Barizien N, Lhuissier FJ. Effects of a spinal extensor muscle strengthening program in chronic low back pain triathletes. Randomized controlled study in 67 athletes. J Traumatologie du Sport. 2019;36(3):183–93.CrossRef

79.

Rathi M. Effect of pelvic floor muscle strengthening exercises in chronic low back pain. Indian J Physiother Occup Ther. 2013;7(1):121–5.

80.

Raza S, Awan WA, Ghauri MW, Mahmood T, Abbas S. Effectiveness of spinal stabilization exercises with and without stretching of Latissimus dorsi Muscle in chronic mechanical low back pain. Rawal Med J. 2020;45(4):857–62.

81.

Sedaghati P, Ardjmand A, Sedaghati N. Comparison of the effects of different training approaches on dynamic balance and pain intensity in the patients with chronic back pain. Sci J Kurdistan Univ Medical Sci. 2017;90:6–13.

82.

Shariat A, Alizadeh R, Moradi V, Afsharnia E, Hakakzadeh A, Ansari NN, et al. The impact of modified exercise and relaxation therapy on chronic lower back pain in office workers: a randomized clinical trial. J Exerc Rehabil. 2019;15(5):703–8.CrossRefPubMedPubMedCentral

83.

Shu J, Li D, Tao W, Chen S. Observation on the curative effect of massage manipulation combined with core strength training in patients with chronic nonspecific low back pain. Evid Based Complement Alternat Med. 2021;2021:7534577.CrossRefPubMedPubMedCentral

84.

Sokhangoi Y, Noorabadi MH, Noorabadi MS. The effect of Pilates exercises on chronic non-specific low back pain and stable range of motion in women 40 to 60 years old. Sci Res J Zanjan Univ Med Sci. 2017;25(108):20–30.

85.

Srivastav N, Joshi S, Kushwah SS. Comparison between effectiveness of lumbar stabilization exercises and conventional physical therapy in the management of mechanical low back pain Indian. J Physiother Occup Ther. 2018;12(4):28–33.

86.

Suh JH, Kim H, Jung GP, Ko JY, Ryu JS. The effect of lumbar stabilization and walking exercises on chronic low back pain: a randomized controlled trial. Medicine (Baltimore). 2019;98(26):e16173.CrossRefPubMed

87.

Wattamwar RB, Nadkarni K. Effect of conventional occupational therapy and yoga in chronic low back pain. Indian J Occup Ther. 2012;45(3):13–20.

88.

Xu C, Fu Z, Wang X. Effect of transversus abdominis muscle training on pressure-pain threshold in patients with chronic low back pain. BMC Sports Sci Med Rehabil. 2021;13(1):35.CrossRefPubMedPubMedCentral

89.

Yalfani A, Abedi M, Raeisi Z. Effects of an 8-week virtual reality training program on pain, fall risk, and quality of life in elderly women with chronic low back pain: Double-blind randomized clinical trial. Games Health J. 2022;11(2):85–92.CrossRefPubMed

90.

Zadro JR, Shirley D, Simic M, Mousavi SJ, Ceprnja D, Maka K, et al. Video-game-based exercises for older people with chronic low back pain: a randomized controlled trial (GAMEBACK). Phys Ther. 2019;99(1):14–27.CrossRefPubMed

91.

Zakari UU, Bello B, Sokumbi GO, Yakasai AM, Danazumi MS. Comparison of the effects of positional release therapy and lumbar stabilization exercises in the management of chronic mechanical low back pain - Randomized controlled trial. Crit Rev Phys Rehabil Med. 2019;31(4):321–32.CrossRef

92.

Hopewell S, McDonald S, Clark MJ, Egger M. Grey literature in meta-analyses of randomized trials of health care interventions. Cochrane Database Syst Rev. 2007;2007(2):MR000010.PubMedPubMedCentral

93.

Hartling L, Featherstone R, Nuspl M, Shave K, Dryden DM, Vandermeer B. Grey literature in systematic reviews: a cross-sectional study of the contribution of non-English reports, unpublished studies and dissertations to the results of meta-analyses in child-relevant reviews. BMC Med Res Methodol. 2017;17(1):64.CrossRefPubMedPubMedCentral

Title: Systematic Review to Inform a World Health Organization (WHO) Clinical Practice Guideline: Benefits and Harms of Structured Exercise Programs for Chronic Primary Low Back Pain in Adults
Authors: Leslie Verville
Rachel Ogilvie
Cesar A. Hincapié
Danielle Southerst
Hainan Yu
André Bussières
Douglas P. Gross
Paulo Pereira
Silvano Mior
Andrea C. Tricco
Christine Cedraschi
Ginny Brunton
Margareta Nordin
Gaelan Connell
Jessica J. Wong
Heather M. Shearer
Joyce G. B. Lee
Dan Wang
Jill A. Hayden
Carol Cancelliere
Publication date: 22-11-2023
Publisher: Springer US
Published in: Journal of Occupational Rehabilitation / Issue 4/2023
Print ISSN: 1053-0487
Electronic ISSN: 1573-3688
DOI: https://doi.org/10.1007/s10926-023-10124-4

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Systematic Review to Inform a World Health Organization (WHO) Clinical Practice Guideline: Benefits and Harms of Structured Exercise Programs for Chronic Primary Low Back Pain in Adults

Abstract

Purpose

Methods

Results

Conclusions

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusions

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