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Integrated exercise and psychosocial therapies appear to be effective to mitigate chronic low back pain.
According to a systematic review, exercise and psychosocial interventions might be more efficacious to promote self-efficacy for physical functioning when compared to waitlist, alternate interventions, usual care, and attention control conditions in the short-term and might be more efficacious when compared to alternate interventions and attention control conditions up to six-months post-intervention in chronic low back pain (CLBP)-affected patients.
Mark Vorensky et al. aimed to examine whether exercise and psychosocial therapies affected self-efficacy for managing pain and self-efficacy for physical functioning in people with CLBP contrasted to alternative treatments, attention controls, waitlists, and usual care. For a relevant literature search, electronic databases such as the Cochrane Library, PEDro, PsychINFO, Web of Science, CINAHL, Embase, and MEDLINE were explored. Incorporated randomized controlled studies used an exercise and psychosocial intervention for CLBP and assessed self-efficacy.
Independent reviewers gathered data, examined full texts, screened abstracts, and evaluated the risk of bias. Ranges of effect (Hedges' g), synthesis without meta-analysis, and GRADE were employed.
A total of 2207 subjects were incorporated (22 studies). While there were no differences when contrasted to alternative therapies, exercise and psychosocial therapies displayed positive short-term effects on self-efficacy to relieve pain contrasted to usual care (the range of effects: -0.02, 0.94) and controls (the range of effects: 0.69, 0.80), as well as intermediate effects contrasted to usual care (the range of effects: 0.11, 0.29).
The short-term effects of exercise and psychosocial therapies were better than those of substitute therapies (range of effects: 0.57, 0.71), usual care (range of effects: -0.15, 0.94), and controls (range of effects: 0.31, 0.56), and the intermediate effects were better than those of substitute therapies (one study, effect: 0.57) and controls (one study, effect: 0.56). Low to extremely low-quality data, frequently due to bias risk, imprecision, and clinical/statistical heterogeneity, hampered the conclusions.
In comparison to waitlists and standard care (but not alternate interventions), exercise and psychosocial therapies may be more successful in the short term for enhancing self-efficacy for managing pain. When contrasted to alternative therapies, attention controls, waitlists, and routine care, exercise and psychosocial interventions may be more successful in the intermediate- and short-term for improving self-efficacy for physical functioning. Future studies should take blinding techniques and measures of physical functioning self-efficacy into account.
Journal of Psychosomatic Research
Effect of integrated exercise therapy and psychosocial interventions on self-efficacy in patients with chronic low back pain: A systematic review
Mark Vorensky et al.
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