Effectiveness of multidisciplinary approaches including exercise to treat non-specific chronic low back pain: A systematic review and meta-analysis across multiple regions

Abstract

Objective: To determine the effectiveness of multidisciplinary interventions including exercise in improving health outcomes for patients with non-specific chronic low back pain (NSCLBP) across different regions. Methods: The search for studies was not restricted to a specific time period but was conducted based on the availability of existing literature within the selected databases. A comprehensive literature search was conducted in four databases: EBSCOhost (from 1995), PubMed (from 1996), Web of Science (from 1964), and Scopus (from 2004), up to November 3, 2021. After applying exclusion criteria, 31 studies published between 1998 and 2021 were selected for final inclusion. The methodological approach included both qualitative and quantitative analyses, ensuring a comprehensive evaluation of the available evidence. Study selection criteria: Multidisciplinary interventions including exercise aimed at relieving symptoms of NSCLBP were included. Outcomes analyzed were disability, pain, fear avoidance, quality of life, perceived change, depression, anxiety and stress. The Comprehensive Meta-Analysis software was used for statistical analyses. Results: Thirty-one studies were included in the qualitative analysis and 29 in the meta-analysis. The qualitative analysis showed improvements in favor of the intervention group (IG) in pain, fear avoidance, quality of life and perceived change. The meta-analysis reported significant pooled effect size (ES) in favor of the IGs in disability, pain, fear avoidance, quality of life, and perceived change among patients with NSCLBP. Conclusion: Multidisciplinary approaches including exercise appear to be effective in reducing disability, pain, fear avoidance, quality of life and perceived change, but not depression, anxiety or stress in patients with NSCLBP. The findings should be interpreted cautiously in light of substantial heterogeneity and the limited quality of the available evidence.