The DOI matches its Crossref record; 136 of the 136 references it cites were found in a registry or an index; none of the 52 sources its claims cite is checked for support yet.
Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews
Open accessAbstract
BACKGROUND: Chronic pain is defined as pain lasting beyond normal tissue healing time, generally taken to be 12 weeks. It contributes to disability, anxiety, depression, sleep disturbances, poor quality of life, and healthcare costs. Chronic pain has a weighted mean prevalence in adults of 20%.For many years, the treatment choice for chronic pain included recommendations for rest and inactivity. However, exercise may have specific benefits in reducing the severity of chronic pain, as well as more general benefits associated with improved overall physical and mental health, and physical functioning.Physical activity and exercise programmes are increasingly being promoted and offered in various healthcare systems, and for a variety of chronic pain conditions. It is therefore important at this stage to establish the efficacy and safety of these programmes, and furthermore to address the critical factors that determine their success or failure. OBJECTIVES: To provide an overview of Cochrane Reviews of adults with chronic pain to determine (1) the effectiveness of different physical activity and exercise interventions in reducing pain severity and its impact on function, quality of life, and healthcare use; and (2) the evidence for any adverse effects or harm associated with physical activity and exercise interventions. METHODS: We searched theCochrane Database of Systematic Reviews (CDSR) on the Cochrane Library (CDSR 2016, Issue 1) for systematic reviews of randomised controlled trials (RCTs), after which we tracked any included reviews for updates, and tracked protocols in case of full review publication until an arbitrary cut-off date of 21 March 2016 (CDSR 2016, Issue 3). We assessed the methodological quality of the reviews using the AMSTAR tool, and also planned to analyse data for each painful condition based on quality of the evidence.We extracted data for (1) self-reported pain severity, (2) physical function (objectively or subjectively measured), (3) psychological function, (4) quality of life, (5) adherence to the prescribed intervention, (6) healthcare use/attendance, (7) adverse events, and (8) death.Due to the limited data available, we were unable to directly compare and analyse interventions, and have instead reported the evidence qualitatively. MAIN RESULTS: We included 21 reviews with 381 included studies and 37,143 participants. Of these, 264 studies (19,642 participants) examined exercise versus no exercise/minimal intervention in adults with chronic pain and were used in the qualitative analysis.Pain conditions included rheumatoid arthritis, osteoarthritis, fibromyalgia, low back pain, intermittent claudication, dysmenorrhoea, mechanical neck disorder, spinal cord injury, postpolio syndrome, and patellofemoral pain. None of the reviews assessed 'chronic pain' or 'chronic widespread pain' as a general term or specific condition. Interventions included aerobic, strength, flexibility, range of motion, and core or balance training programmes, as well as yoga, Pilates, and tai chi.Reviews were well performed and reported (based on AMSTAR), and included studies had acceptable risk of bias (with inadequate reporting of attrition and reporting biases). However the quality of evidence was low due to participant numbers (most included studies had fewer than 50 participants in total), length of intervention and follow-up (rarely assessed beyond three to six months). We pooled the results from relevant reviews where appropriate, though results should be interpreted with caution due to the low quality evidence. Pain severity: several reviews noted favourable results from exercise: only three reviews that reported pain severity found no statistically significant changes in usual or mean pain from any intervention. However, results were inconsistent across interventions and follow-up, as exercise did not consistently bring about a change (positive or negative) in self-reported pain scores at any single point. Physical function: was the most commonly reported outcome measure. Physical function was significantly improved as a result of the intervention in 14 reviews, though even these statistically significant results had only small-to-moderate effect sizes (only one review reported large effect sizes). Psychological function and quality of life: had variable results: results were either favourable to exercise (generally small and moderate effect size, with two reviews reporting significant, large effect sizes for quality of life), or showed no difference between groups. There were no negative effects. Adherence to the prescribed intervention: could not be assessed in any review. However, risk of withdrawal/dropout was slightly higher in the exercising group (82.8/1000 participants versus 81/1000 participants), though the group difference was non-significant. Healthcare use/attendance: was not reported in any review. Adverse events, potential harm, and death: only 25% of included studies (across 18 reviews
Overview
Integrity signals
Registry
Cites
Statistics
Verification
Claims the paper makes
0 of 52 cited sources checked · 0 supported · 0 flagged
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“None of the included reviews assessed 'chronic pain' or 'chronic widespread pain' as a general term or specific condition.”
§ Physical activity and exercise for chronic pain in adults > Specificity of chronic pain condition of included reviews
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“However, when reported, most included studies in the reviews implemented the programme twice a week (or stated at least twice a week).”
§ Physical activity and exercise for chronic pain in adults > Frequency
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesThe paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Few studies quantified the intensity of each session.”
§ Physical activity and exercise for chronic pain in adults > Intensity
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesNone of the sources cited for this claim have been checked yet.
In the paper
“Interventions assessed by the included reviews varied in length from a single session (Fransen 2015) to 30 months (Fransen 2015).”
§ Physical activity and exercise for chronic pain in adults > Duration of intervention
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesThe paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“One review reported a non-significant reduction in risk of death as a result of the intervention.”
§ Physical activity and exercise for chronic pain in adults > Summary of main results
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Pooling all available data for withdrawals/dropout/attrition gave an RR of 1.02 (95% CI 0.94 to 1.12) in favour of the control group (6 reviews, 30 studies, n = 2256, control withdrawal 81/1000, intervention withdrawal 82.8/ 1000).”
§ Physical activity and exercise for chronic pain in adults > Adherence to the prescribed intervention
Strength:plain· not yet calibratedn = 2,256Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“five reviews had appropriate conclusions, did not mention quality of the evidence in the conclusion, but did discuss it in detail earlier in the review (Bartels 2007;Cramp 2013;Han 2004;Hayden 2005;Lauret 2014);”
§ Physical activity and exercise for chronic pain in adults > Interpretation of results/conclusions by original review authors
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“(over one-third of all trials that reported them found no adverse events related to the intervention)”
§ Physical activity and exercise for chronic pain in adults > Adverse events (not death)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesA result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Overall, only three reviews that assessed pain did not provide baseline or control group scores for comparison (Busch 2013;Cramp 2013;Hurkmans 2009).”
§ Physical activity and exercise for chronic pain in adults > Reported baseline pain score
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesNone of the sources cited for this claim have been checked yet.
In the paper
“Three reviews found at least 30% pain reduction from baseline (post-intervention -strength training: Busch 2007; Busch 2013, at short-term follow-up: van der Heijden 2015).”
§ Physical activity and exercise for chronic pain in adults > Treatment effect
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passes
- Probably not a substantial claim. 53
- It may state two separate claims as one. 100
- The quote only partly states this claim. 6
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Ultimately, of the 75 titles requiring further assessment, 10 were reviews at protocol stage only (five of which have potential to be included once published as a full review, one which was unclear, and four that were excluded based on information within the protocol).Hence, we excluded 54 titles (10 protocols and 44 full reviews; Figure 1), reasons for which are listed in Table 2.”
§ Physical activity and exercise for chronic pain in adults > Description of included reviews
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The 21 included reviews were published by five different Cochrane Review groups: 11 from the Cochrane Musculoskeletal Group (Bartels 2007;Bidonde 2014;Busch 2007;Busch 2013;Cramp 2013;Fransen 2014;Fransen 2015;Han 2004; Hurkmans 2009; Regnaux 2015; Silva 2010); four from the Cochrane Neck and Back Group previously the Cochrane Back Group) (Gross 2015a; Hayden 2005; Saragiotto 2016; Yamato 2015);”
- Also stated in: § Specificity of chronic pain condition of included reviews · plain
“two from the Cochrane Peripheral Vascular Diseases Group (Lane 2014; Lauret 2014); one from the Cochrane Menstrual Disorders and Subfertility Group (Brown 2010); one from the Cochrane Injuries Group (Boldt 2014); one from the Cochrane Neuromuscular Group (Koopman 2015); and one from the Cochrane Bone, Joint and Muscle Trauma”
§ Physical activity and exercise for chronic pain in adults > Specificity of chronic pain condition of included reviews
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one. The quote only partly states this claim.
- Also stated in: § Specificity of chronic pain condition of included reviews · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Of these, 264 studies (19,642 participants) examined exercise versus no exercise/minimal intervention in adults with chronic pain (the focus of this overview) and so were used in the qualitative analysis.”
§ Physical activity and exercise for chronic pain in adults > R E S U L T S
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Interventions assessed included: any specified style of land-based exercise or physical activity such as one designed to improve strength, range of movement, aerobic capacity, or a combination of these”
§ Physical activity and exercise for chronic pain in adults > Exercise and physical activity interventions implemented in the included reviews
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one. The quote only partly states this claim.
None of the sources cited for this claim have been checked yet.
In the paper
“There was large variation in the exercise or physical activity intervention being implemented, ranging from just once a week (Bidonde 2014;Busch 2007;Fransen 2014;Fransen 2015;Han 2004;Saragiotto 2016), to twice a day (Boldt 2014), and some performing a short series of exercises (two-minute duration) every 15 minutes during the day (Gross 2015a).”
§ Physical activity and exercise for chronic pain in adults > Frequency
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Baseline intensity was often accepted as low/moderate, with the aim to progress over the intervention period to 70% to 85% of HRmax or heart rate reserve (HRR) for aerobic interventions (Brown 2010;Cramp 2013;Hurkmans 2009), 70% to 80% of an individual's 1-RM, or 50% to 70% maximum voluntary contraction (Koopman 2015) in strength/resistance training programmes (Busch 2013;Hurkmans 2009).”
§ Physical activity and exercise for chronic pain in adults > Intensity
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The search strategy was performed in the Cochrane Library only, and revealed 475 potentially relevant titles, of which 75 were assessed as full papers.”
§ Physical activity and exercise for chronic pain in adults > Description of included reviews
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Following abstract and full paper assessment, 21 reviews fulfilled the inclusion criteria: four in rheumatoid arthritis (Cramp 2013;Han 2004;Hurkmans 2009;Silva 2010), four in osteoarthritis (Bartels 2007;Fransen 2014;Fransen 2015;Regnaux 2015), three in fibromyalgia (Bidonde 2014;Busch 2007;Busch 2013), three in low back pain (Hayden 2005;Saragiotto 2016;Yamato 2015)”
- Also stated in: § Specificity of chronic pain condition of included reviews · plain
“two in intermittent claudication (Lane 2014;Lauret 2014), one in dysmenorrhoea (Brown 2010), one in mechanical neck disorder (Gross 2015a), one in spinal cord injury (Boldt 2014), one in postpolio syndrome (Koopman 2015), and one in patellofemoral pain (van der Heijden 2015).”
§ Physical activity and exercise for chronic pain in adults > Specificity of chronic pain condition of included reviews
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- Also stated in: § Specificity of chronic pain condition of included reviews · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“We included 21 reviews with 381 included studies, totalling 37,143 participants.”
§ Physical activity and exercise for chronic pain in adults > R E S U L T S
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“physical function/disability was the most commonly reported outcome measure, and was the primary measure in eight out of the 21 reviews.”
§ Physical activity and exercise for chronic pain in adults > Summary of main results
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Without these two reviews, only a small percentage (7.8% or 18/229) of the included studies would have scored low risk of performance bias (blinding of participants and personnel), but by including them (all 35 studies from those two reviews assessed as low risk of bias) the overall proportion of studies assessed as having low risk of bias was closer to 20% (53/264).”
§ Physical activity and exercise for chronic pain in adults > Performance and detection bias (blinding participants, personnel, outcome assessors)
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Overall, results were inconsistent across interventions and followup (see Table 9), as exercise did not consistently bring about a change (positive or negative) in self-reported pain scores at any single point.”
§ Physical activity and exercise for chronic pain in adults > Treatment effect
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Second tier evidence (at least 30% pain reduction from baseline, study duration between four and eight weeks, and more than 200 participants in total or 100 participants per arm) was also lacking in these reviews; three reviews found at least 30% reduction in pain from baseline (Busch 2007;Busch 2013;van der Heijden 2015)”
§ Physical activity and exercise for chronic pain in adults > Reported baseline pain score
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Reporting bias was classed as low risk in only 46% of included studies.However, it is important to note this was not due to the remainder having high risk of bias, but instead 'unclear', as trial protocols were not always published or accessible to the review authors to accurately assess/interpret.”
§ Physical activity and exercise for chronic pain in adults > Reporting bias (selective reporting)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The remaining 14 reviews showed that the intervention produced a statistically significant benefit over the control at a minimum of one reported time point”
§ Physical activity and exercise for chronic pain in adults > Treatment effect
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesThe quote only partly states this claim.
None of the sources cited for this claim have been checked yet.
In the paper
“In other reviews, intensity was described more loosely as “variable” or “low intensity (very light) to maximum effort (vigorous)” ( Bidonde 2014; Fransen 2014; Lane 2014; Regnaux 2015), “low intensity” (Fransen 2014;Gross 2015a;Han 2004;Silva 2010), or “moderate or moderate-to-high” (Cramp 2013;Fransen 2015).”
§ Physical activity and exercise for chronic pain in adults > Intensity
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Selection bias had the largest proportion of included studies with low risk of bias (63% and 42% of studies adequately undertaking and reporting the methods used).”
§ Physical activity and exercise for chronic pain in adults > Selection bias (randomisation and allocation concealment)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Only 26 out of 264 included studies (10%) across the 21 reviews reported over 100 participants in total (or 50 per arm), a further 6% (15/264) included over 200 participants per arm.”
§ Physical activity and exercise for chronic pain in adults > Study/sample/group size
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“However, results were inconsistent across interventions and followup, as the intervention did not consistently bring about a change (positive or negative) in self-reported pain scores at any single point.”
§ Physical activity and exercise for chronic pain in adults > Summary of main results
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“There were no negative effects.”
§ Physical activity and exercise for chronic pain in adults > Summary of main results
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“Of the seven reviews claiming to report “long term” follow-up, one classed long-term as longer than six weeks (intermediate term as one to six weeks' follow-up) (Boldt 2014).The remaining six reviews defined long-term follow up as over 12 months (one year) post-intervention (Gross 2015a;Hayden 2005;Hurkmans 2009;Regnaux 2015;Saragiotto 2016;van der Heijden 2015).”
§ Physical activity and exercise for chronic pain in adults > Long-term follow-up
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Due to the difficulty of blinding participants to their group allocation, review authors assessed the risk of bias in different ways, which may cause confusion: whereas the majority declared this lack of possible blinding to be high risk of bias or unclear, two reviews labelled such cases as low risk of bias in order not to exclude these studies unnecessarily from their analysis (Lane 2014;Lauret”
§ Physical activity and exercise for chronic pain in adults > Performance and detection bias (blinding participants, personnel, outcome assessors)
Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- Rests on an assumption: Blinding participants and personnel to exercise or physical activity allocation is very difficult.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The lowest score was 6/11 ( Silva 2010) though five categories were not applicable (n/a) due to there being no included studies.”
§ Physical activity and exercise for chronic pain in adults > Methodological quality of included reviews AMSTAR quality assessment of included reviews
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Five reviews did not report “post-intervention” but at short-term, mid/intermediate-term, and long-term postrandomisation (short, mid, and long term: Boldt 2014; short and intermediate term: Koopman 2015; Yamato 2015; short and long-term: Hurkmans 2009; van der Heijden 2015).”
§ Physical activity and exercise for chronic pain in adults > Time points reported
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Our assessment criteria stated that we would accept the information as graded evidence when reported as the number of participants achieving a 50% (first tier evidence) or 30% (second tier evidence) reduction in pain, but none of the included reviews reported results in this way, and so instead we used the reported absolute and relative change values.”
§ Physical activity and exercise for chronic pain in adults > Reported baseline pain score
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Of the remaining reviews that did report studies examining intervention versus control (no physical activity or exercise, or minimal intervention), two did not report pain as an absolute or relative score of severity, intensity, or change as a result of the intervention (Brown 2010;Han 2004), and one review assessed pain-free time and distance during exercise (they did not assess pain using a mean”
§ Physical activity and exercise for chronic pain in adults > Primary outcome Self-reported pain (severity)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“and three reviews needed further comment as the strength of the conclusions were not appropriate based on the available data (Brown 2010;Fransen 2014), or we were unable to agree with their interpretation due to difficulty in extracting the data (van der Heijden 2015).”
§ Physical activity and exercise for chronic pain in adults > Interpretation of results/conclusions by original review authors
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“A version of quality of life assessment was reported in nine reviews.Six were termed quality of life or health-related quality of life (HRQoL) (Bartels 2007;Boldt 2014;Fransen 2014;Fransen 2015;Gross 2015a;Lauret 2014).”
- Also stated in: § Quality of life · plain
“Other reviews assessed global perceived effect (Gross 2015a), global wellbeing (Busch 2007), global assessment (Hayden 2005), global impression of recovery (Saragiotto 2016;Yamato 2015), health assessment questionnaire (Silva 2010), multi-dimensional function (Bidonde 2014;Busch 2013), and work status (Hayden 2005).”
§ Physical activity and exercise for chronic pain in adults > Quality of life
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
- Also stated in: § Quality of life · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“However, five reviews assessed withdrawals or dropouts (Bidonde 2014;Fransen 2014;Han 2004;Regnaux 2015;Saragiotto 2016), one reported all-cause attrition (Busch 2013), and another reported the discontinuation rate (Silva 2010).”
§ Physical activity and exercise for chronic pain in adults > Adherence to the prescribed intervention
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Three reviews reported change data (Bartels 2007;Busch 2007;Busch 2013), but we were able to use control group baseline and earliest control group scores as assumed or approximate baseline measures for the intervention groups in nine reviews ( Bartels 2007; Busch 2007; Fransen 2014; Fransen 2015; Gross 2015a; Koopman 2015; Saragiotto 2016; van der Heijden 2015; Yamato 2015).”
§ Physical activity and exercise for chronic pain in adults > Reported baseline pain score
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“there were variable results for psychological function and quality of life: results were either favourable to exercise (two reviews reporting significantly large effect sizes for quality of life), or showed no difference between groups.”
§ Physical activity and exercise for chronic pain in adults > Summary of main results
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Individual sessions varied in length from two minutes (Gross 2015a), to 90 minutes (Busch 2013;Cramp 2013;Han 2004) or 120 minutes (Boldt 2014), but mostly situated around 45 to 60 minutes.”
§ Physical activity and exercise for chronic pain in adults > Duration (per session)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“There were significant effects in favour of the intervention for mental health (Bartels 2007) and depression (Busch 2013) scores, and “variable effect” for depression (Cramp 2013).”
§ Physical activity and exercise for chronic pain in adults > Treatment effect
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“In the remaining reviews, a cursory statement was commonly made regarding the review authors' conflicts of interests, however, fulfilling the AMSTAR criteria also requires a statement to be made regarding any conflict of interest for any of the included studies.”
§ Physical activity and exercise for chronic pain in adults > Methodological quality of included reviews AMSTAR quality assessment of included reviews
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“However, there was also no effect or no differences between control and intervention groups reported for mental health (Bidonde 2014;Busch 2013), anxiety (Cramp 2013), and depression (Boldt 2014).”
§ Physical activity and exercise for chronic pain in adults > Treatment effect
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“Additionally, seven reviews reported clinically significant results (minimally important difference: reduction in pain from baseline of at least 10 points on a 0 to 100 scale or an absolute improvement of at least 10% to 20%, Dworkin 2008) as a result of the exercise intervention”
§ Physical activity and exercise for chronic pain in adults > Treatment effect
What the sources say
- Not checked yetcites Dworkin 2008 source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one. The quote only partly states this claim.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Physical function was significantly (statistically) improved as a result of the intervention in 14 reviews, though even these statistically significant results had only smallto-moderate effect sizes in all but one review.”
§ Physical activity and exercise for chronic pain in adults > Summary of main results
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“The format for reporting bias has changed, and therefore some earlier reviews (that are yet to be updated) did not assess bias using the same format.Others reported additional criteria as 'other bias' including the similarity of baseline characteristics, and similarity of timing points.”
§ Physical activity and exercise for chronic pain in adults > Other bias
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Criteria which scored badly using the AMSTAR tool were characteristics of included studies (question six of Table 1), reporting of publication bias (question 10 of Table 1), and conflict of interest declarations (question 11 of Table 1).”
§ Physical activity and exercise for chronic pain in adults > Methodological quality of included reviews AMSTAR quality assessment of included reviews
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Assessment of publication bias was omitted entirely in five reviews (Bartels 2007;Fransen 2014;Fransen 2015;Han 2004;Hurkmans 2009), and when it was assessed, it was reported using only a simple statement (with no test values, analyses used, or diagrams to demonstrate the result; Busch 2007;Koopman 2015).”
§ Physical activity and exercise for chronic pain in adults > Methodological quality of included reviews AMSTAR quality assessment of included reviews
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“The remaining 15 reviews reported a mean or usual pain score for exercise (intervention) and no-exercise (control) groups ( Bartels 2007; Bidonde 2014; Boldt 2014; Busch 2007; Busch 2013; Cramp 2013; Fransen 2014; Fransen 2015; Gross 2015a; Hayden 2005; Hurkmans 2009; Koopman 2015; Saragiotto 2016; van der Heijden 2015; Yamato 2015).”
§ Physical activity and exercise for chronic pain in adults > Primary outcome Self-reported pain (severity)
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
None of the sources cited for this claim have been checked yet.
In the paper
“We could not extract relevant data for one review as they compared two different exercise interventions and a control but did not report the data compared to the control (Regnaux 2015).”
§ Physical activity and exercise for chronic pain in adults > Primary outcome Self-reported pain (severity)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“No review achieved a perfect score of 11/11, though five achieved 10/11 (Boldt 2014 Busch 2013; Hayden 2005; Koopman 2015; Regnaux 2015) and eight scored 9/11 (Cramp 2013; Gross 2015a; Hurkmans 2009; Lane 2014; Lauret 2014; Saragiotto 2016; van der Heijden 2015; Yamato 2015).”
§ Physical activity and exercise for chronic pain in adults > Methodological quality of included reviews AMSTAR quality assessment of included reviews
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Reviews also analysed outcome measures immediately post-intervention and at one or more follow-up points.”
§ Physical activity and exercise for chronic pain in adults > Time points reported
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“One review assessed participants in an ongoing fashion “over three menstrual cycles” (Brown 2010).”
§ Physical activity and exercise for chronic pain in adults > Time points reported
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Four of the 19 reviews that reported data, reported results at a single time point only ('post-intervention': Bidonde 2014;Busch 2007;Cramp 2013;Han 2004).”
§ Physical activity and exercise for chronic pain in adults > Time points reported
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“two reviews had appropriate conclusions but had only limited discussion of quality or did not adequately consider the quality of the evidence in the interpretation of the results (Hurkmans 2009;Lane 2014);”
§ Physical activity and exercise for chronic pain in adults > Interpretation of results/conclusions by original review authors
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Consequently results from relevant reviews have been pooled (all tier three quality) where appropriate, though results should be interpreted with caution due to the low quality evidence.”
§ Physical activity and exercise for chronic pain in adults > Reported baseline pain score
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Two reviews which reported physical function had no data to extract (Lauret 2014;Silva 2010), and for one review we were unable to extract the relevant data (Regnaux 2015).”
§ Physical activity and exercise for chronic pain in adults > Treatment effect
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Included study characteristics were limited, often reporting the “inclusion criteria” used to recruit participants in the study instead of the characteristics of actual included participants, and excluding information such as participants' age, gender split, ethnicity, and disease status.”
§ Physical activity and exercise for chronic pain in adults > Methodological quality of included reviews AMSTAR quality assessment of included reviews
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The remaining 223 studies (84%) had fewer than 50 participants per arm (or sample size was not reported), often not reaching 50 in total.”
§ Physical activity and exercise for chronic pain in adults > Study/sample/group size
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Based on five studies within the review, death had an RR of 0.71 (95% CI 0.28 to 1.78) in favour of exercise as being protective, though was not statistically significant (P = 0.47).”
§ Physical activity and exercise for chronic pain in adults > Death
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Two reviews only assessed a specific adverse event (”
§ Physical activity and exercise for chronic pain in adults > Adverse events (not death)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one. The quote only partly states this claim.
In the paper
“One protocol that had potential to be included was published in 2006 with no full review available yet (Craane 2006).”
§ Physical activity and exercise for chronic pain in adults > Overall completeness and applicability of evidence
What the sources say
- Not checked yetcites Craane 2006 source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“However, risk of withdrawal/dropout was slightly higher in the exercising group (82.8/1000 participants versus 81/1000 participants), though the group difference was not significant.”
§ Physical activity and exercise for chronic pain in adults > Summary of main results
Strength:plain· not yet calibratedn = 1,000Tests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Measures of physical function were the primary outcome measure in eight out of 21 reviews (Busch 2013;Han 2004;Hayden 2005;Hurkmans 2009;Koopman 2015;Lane 2014;Lauret 2014;Silva 2010), and a reported (non-primary) outcome measure in nine more reviews”
- Also stated in: § Secondary outcomes · plain
“Only Boldt 2014 and Brown 2010 did not list physical function (or disability, or activity limitation) as a potential outcome measure.”
§ Physical activity and exercise for chronic pain in adults > Secondary outcomes
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- Also stated in: § Secondary outcomes · plain
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Two reviews mentioned in the methods as planned analyses, though was not mentioned again (Brown 2010;van der Heijden 2015), and a third review mentioned it in the methods, but appeared to use it interchangeably with reporting bias causing great confusion (Bidonde 2014).”
§ Physical activity and exercise for chronic pain in adults > Methodological quality of included reviews AMSTAR quality assessment of included reviews
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“one review calculated an RR for the adverse events, showing a reduced risk for amputation in the intervention group (two amputations in the usual care/control group: RR 0.20, 95% CI 0.01 to 4.15, based on one study in one review, Lane 2014).”
§ Physical activity and exercise for chronic pain in adults > Adverse events (not death)
What the sources say
- Not checked yetcites Lane 2014 source
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“However, it is important to note that the shorter sessions were often performed more regularly than longer sessions.”
§ Physical activity and exercise for chronic pain in adults > Duration (per session)
Strength:plain· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Adverse events were largely reported as a total number per trial, though one review separately reported results for the intervention group versus the control group (Saragiotto 2016), and two others reported adverse events for the intervention group only (Boldt 2014;Regnaux 2015).”
§ Physical activity and exercise for chronic pain in adults > Adverse events (not death)
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“The included reviews did not discuss the possible impact of this non-reporting by the original trials”
§ Physical activity and exercise for chronic pain in adults > Overall completeness and applicability of evidence
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“the labelling of participants as having mild-moderate pain was a cautious one within this overview due to the lack of specific data available at baseline assessment; only three reviews included baseline pain scores in the intervention group, and two further reviews provided control group baseline scores.”
§ Physical activity and exercise for chronic pain in adults > Overall completeness and applicability of evidence
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- The authors state this as an assumption: The majority of the included population had mild-to-moderate pain severity, assumed because of the lack of exact baseline group data.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“A number of studies within the reviews had adequately long interventions, but planned follow-up was limited to less than one year (12 months) in all but six reviews.”
§ Physical activity and exercise for chronic pain in adults > Quality of the evidence
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Other than issues surrounding blinding (which are problematic in exercise intervention studies due to the nature of the intervention), the trials did not consistently and adequately report potential attrition and reporting biases, with less than half of studies within these reviews at low risk of bias.”
§ Physical activity and exercise for chronic pain in adults > Quality of the evidence
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“Statistically significant post-intervention in hip + knee OA group, but not clinically significant”
§ Physical activity and exercise for chronic pain in adults > A D D I T I O N A L T A B L E S
What the sources say
- Not checked yetcites Bartels 2007 source
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“The most commonly reported adverse events were increased soreness or muscle pain, which subsided after several weeks of the intervention.”
§ Physical activity and exercise for chronic pain in adults > Implications for practice
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“All 21 included reviews scored well across the AMSTAR assessment, though this is likely due to the stringent reporting guidelines implemented by Cochrane prior to publication.”
§ Physical activity and exercise for chronic pain in adults > Quality of the evidence
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“In summary, the quality of the evidence was low (third tier): within this overview we found no tier one or tier two evidence.”
§ Physical activity and exercise for chronic pain in adults > Quality of the evidence
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Of the 21 included reviews, 12 used a pain measure as their primary outcome (Bartels 2007 Boldt 2014; Brown 2010; Busch 2007; Fransen 2014; Fransen 2015; Gross 2015a; Hayden 2005; Regnaux 2015; Saragiotto 2016; van der Heijden 2015; Yamato 2015), and the remaining nine reviews included the measure as a secondary outcome only.”
§ Physical activity and exercise for chronic pain in adults > Quality of the evidence
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Occasionally results were not discussed with regards to the quality of the evidence or risk of bias”
§ Physical activity and exercise for chronic pain in adults > Quality of the evidence
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Additionally, not all exercise sessions were supervised or baseline fitness/physical ability was assessed subjectively, and consequently it was not reported whether the intervention was fulfilled as described, or whether the dose was enough to elicit a physiological response.”
§ Physical activity and exercise for chronic pain in adults > Quality of the evidence
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“only 54% adequately described the exercise intervention”
§ Physical activity and exercise for chronic pain in adults > A D D I T I O N A L T A B L E S
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. The quote only partly states this claim.
In the paper
“Adverse events were recorded (and reported), but none occurred”
§ Physical activity and exercise for chronic pain in adults > A D D I T I O N A L T A B L E S
What the sources say
- Not checked yetcites Bartels 2007 source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“None of the included reviews examined generalised or widespread chronic pain as a global condition, each instead examined specific conditions that included chronic pain as a symptom or result of the ongoing condition”
§ Physical activity and exercise for chronic pain in adults > Overall completeness and applicability of evidence
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“This is a summary overview of current Cochrane Reviews, we are not aware of any overviews or reviews summarising non-Cochrane reviews.”
§ Physical activity and exercise for chronic pain in adults > Agreements and disagreements with other studies or reviews
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✗ Based: failsProbably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“No mention of quality/risk of bias in conclusions, though found to be high quality in results section”
§ Physical activity and exercise for chronic pain in adults > A D D I T I O N A L T A B L E S
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Interpretation of the available data, and conclusions drawn by the review authors, were appropriate, although the conclusions were sometimes stronger than warranted by the available data.”
§ Physical activity and exercise for chronic pain in adults > Quality of the evidence
Strength:plain· not yet calibratedTests✓ Asserted: passes✗ Checkable: fails✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“None of the studies met the ACSM exercise guidelines specified for aerobic or strength training.Only 1 study met the ACSM guidelines for flexibility training”
§ Physical activity and exercise for chronic pain in adults > A D D I T I O N A L T A B L E S
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Intervention length ranged from a single session to regular sessions over a period of 30 months, though the majority were between eight and 12 weeks.”
§ Physical activity and exercise for chronic pain in adults > Quality of the evidence
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
In the paper
“Function was significantly improved in people with hip + knee OA immediately post-intervention only -small effect size only”
§ Physical activity and exercise for chronic pain in adults > A D D I T I O N A L T A B L E S
What the sources say
- Not checked yetcites Bartels 2007 source
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
A result the paper reports from its own data — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Total 30 studies, n = 2256 82.8/1000 81/1000 Calculated RR 1.02 (95% CI 0.94 to 1.12) Calculated OR 1.05 (95% CI 0.88 to 1.25)”
§ Physical activity and exercise for chronic pain in adults > A D D I T I O N A L T A B L E S
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
None of the sources cited for this claim have been checked yet.
In the paper
“exercise is of great importance for cardiovascular (Vigorito 2014) and bone health (Sakuma 2012).”
§ Physical activity and exercise for chronic pain in adults > Why it is important to do this overview
What the sources say
- Not checked yetcites Vigorito 2014 source
- Not checked yetcites Sakuma 2012
Strength:boosted· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“All extracted data and methodological quality assessment were taken from the most recent published version of the full review.”
§ Physical activity and exercise for chronic pain in adults > Description of included reviews
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“However due to the limited data available, we were unable to directly compare and analyse interventions, and have instead reported the evidence qualitatively only.”
§ Physical activity and exercise for chronic pain in adults > Data synthesis
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“Aerobic exercise is also strongly linked to weight loss (Messier 2013)”
§ Physical activity and exercise for chronic pain in adults > How the intervention might work
What the sources say
- Not checked yetcites Messier 2013 source
Strength:boosted· not yet calibratedCausal:correlational· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“Exercise may have specific benefits in reducing the severity of chronic pain, as well as more general benefits associated with improved overall physical and mental health, and physical functioning”
- Also stated in: § How the intervention might work · hedged
“Exercise may have specific benefits in reducing the severity of chronic pain, as well as more general benefits associated with improved overall physical and mental health, and physical functioning of people with chronic pain”
§ Physical activity and exercise for chronic pain in adults > Abstract
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- Also stated in: § How the intervention might work · hedged
In the paper
“Two overview authors (LG, CC) independently assessed each included review to see if it satisfied the criteria specified in the 'assessment of multiple systematic reviews' (AMSTAR) measurement tool (Shea 2007), for rigorous methodological quality.”
§ Physical activity and exercise for chronic pain in adults > Quality of included reviews
What the sources say
- Not checked yetcites Shea 2007 source
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
In the paper
“Data were not entered for analysis into Cochrane's statistical software due to the lack of relevant and comparable data (RevMan 2014).”
§ Physical activity and exercise for chronic pain in adults > Data extraction and management
What the sources say
- Not checked yetcites RevMan 2014
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“We did not consider the use of mean changes in pain scores as high quality because responses to pain interventions are not Gaussian, and few people have the mean response.”
§ Physical activity and exercise for chronic pain in adults > Quality of evidence in included reviews
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“Resistance training through repetitive full range-of-motion exercise around the lumbar spine (in chronic low back pain) may affect disc metabolism itself, with the possibility that the exercise programme could improve metabolic exchange in the lumbar discs and aid in repair (Mooney 2006).”
§ Physical activity and exercise for chronic pain in adults > How the intervention might work
What the sources say
- Not checked yetcites Mooney 2006
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“We planned to compare only like with like (where possible); for example in study duration, which can be an additional source of bias if insufficient in length (Moore 2010).”
§ Physical activity and exercise for chronic pain in adults > Data synthesis
What the sources say
- Not checked yetcites Moore 2010 source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“Training to improve balance and flexibility also has benefits as it reduces the risk of falls, and the potential for further pain or injury (Harvard 2013).”
§ Physical activity and exercise for chronic pain in adults > How the intervention might work
What the sources say
- Not checked yetcites Harvard 2013
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Two overview authors (LG, CC) independently carried out searches and selected reviews for inclusion.Disagreements were resolved through discussion, and a third overview author (RAM) acted as arbitrator where necessary.”
§ Physical activity and exercise for chronic pain in adults > Data collection and analysis
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“resistance exercise, or other forms of strength training, can improve the person's capacity to support bone and cartilage through improved musculature supporting movement around a joint, with potential to relieve stiffness (Mayer 2008) and bringing about some pain relief.”
§ Physical activity and exercise for chronic pain in adults > How the intervention might work
What the sources say
- Not checked yetcites Mayer 2008 source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“For this reason we have also been unable to include a 'Summary of findings' table as planned and stated in the protocol.”
§ Physical activity and exercise for chronic pain in adults > Data synthesis
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Two overview authors (independently carried out assessment of methodological quality (LG, CC), and extracted data (LG, RAM).Any disagreements were resolved through discussion, or involving a third overview author if necessary (DM).”
§ Physical activity and exercise for chronic pain in adults > Data collection and analysis
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“If physical activity and exercise interventions are shown to effectively and safely reduce pain intensity or frequency (or both), they are likely to be a preferable alternative or adjunct therapy to pharmacological/surgical treatments for chronic pain.”
§ Physical activity and exercise for chronic pain in adults > Why it is important to do this overview
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim.
- Rests on an assumption: Exercise is likely to have minimal adverse effects compared with pharmaceutical and surgical interventions in adults with chronic pain.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Two overview authors (LG, RAM) independently extracted data from the included review using a standardised data extraction form and checked for agreement prior to entry into Microsoft Excel for Windows.”
§ Physical activity and exercise for chronic pain in adults > Data extraction and management
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“importantly, exercise caused no actual harm, with most adverse events being increased soreness or muscle pain, which reportedly subsided after several weeks of the intervention.”
§ Physical activity and exercise for chronic pain in adults > Summary of main results
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“This is often the desired outcome (post-intervention) of many drug therapies for pain, and it may therefore be difficult to show a clinically significant improvement in these people.”
§ Physical activity and exercise for chronic pain in adults > Summary of main results
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
- The authors state this as an assumption: The majority of the included population had mild-to-moderate pain severity, assumed because of the lack of exact baseline group data.
In the paper
“This suggests the majority of participants reviewed had mild-tomoderate pain (only one review reported a mean of severe pain (aquatic exercise for fibromyalgia, Bidonde 2014) at the commencement of each intervention (less than 30/100 mild pain, 30/ 100 to 60/100 moderate pain, more than 60/100 severe pain; Collins 1997), though labelling the majority as having only mildto-moderate pain should be”
§ Physical activity and exercise for chronic pain in adults > Reported baseline pain score
What the sources say
- Not checked yetcites Collins 1997 source
Strength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes? Load-bearing: unclear✓ Based: passesIt may state two separate claims as one.
- The authors state this as an assumption: Control group baseline and earliest control group scores can serve as approximate baseline measures for intervention groups.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“However, the original review authors highlighted the low to very low quality of the evidence as many studies had high or unclear risk of bias across multiple domains (van der Heijden 2015).”
§ Physical activity and exercise for chronic pain in adults > Treatment effect
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The evidence in this overview suggests that the broad spectrum of physical activity and exercise interventions assessed here (aerobic, strength, flexibility, range of motion, and core or balance training programmes, as well as yoga, Pilates, and tai chi) are potentially beneficial, though the evidence for benefit is low quality and inconsistent.”
§ Physical activity and exercise for chronic pain in adults > Implications for practice
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The evidence showed variable results, though in some reviews there was a clinical and statistical benefit in pain relief and physical function (based on low quality evidence).”
§ Physical activity and exercise for chronic pain in adults > For policy makers
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“it was concluded that nonsubjective physical assessment should be performed where possible (Perruchoud 2014)”
§ Physical activity and exercise for chronic pain in adults > Quality of the evidence
What the sources say
- Not checked yetcites Perruchoud 2014 source
Strength:hedged· not yet calibratedTests✓ Asserted: passes✗ Checkable: fails✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. It may be too vague to check against evidence. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Appropriate conclusions based on available data.”
§ Physical activity and exercise for chronic pain in adults > A D D I T I O N A L T A B L E S
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“It is widely accepted that there is a delay in muscular hypertrophy as a result of exercise, and initial gains within the first few weeks of any training programme will be as a result of neural factors (Enoka 1997)”
§ Physical activity and exercise for chronic pain in adults > Interventions
What the sources say
- Not checked yetcites Enoka 1997 source
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“previous publications have referred to the higher quality grading (high AMSTAR score) in Cochrane Reviews due to the basic criteria necessary for publication at any stage (protocol or full review) suggesting they may be the most reliable source of evidence (O'Connell 2013).”
§ Physical activity and exercise for chronic pain in adults > Potential biases in the overview process
What the sources say
- Not checked yetcites O'Connell 2013 source
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✗ Asserted: fails✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The authors may not put it forward as true. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Likewise, each review team will have included studies that did not use their chosen outcome measures as the primary measure, and that were therefore powered according to a different primary outcome.”
§ Physical activity and exercise for chronic pain in adults > Quality of the evidence
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“However, it can be argued that those people are more likely to be assigned medical or surgical interventions than physical activity and exercise alone (where available), and as a group they may be less able to engage in exercise, and may therefore be more difficult to recruit into exercise-only studies.”
§ Physical activity and exercise for chronic pain in adults > Overall completeness and applicability of evidence
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✗ Based: failsProbably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds. It may state two separate claims as one.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“Review authors should not have commented on lack of adverse events as this was not reported in the included study.The comment on lack of adverse events contravened present Cochrane guidance”
§ Physical activity and exercise for chronic pain in adults > A D D I T I O N A L T A B L E S
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
The paper states this without a source or data behind it here, so there is nothing to check it against. The quote shows it is in the paper.
In the paper
“The AMSTAR tool is useful in assessing the reporting of a systematic review, though it does not inform us of the actual undertaking or conduct of the review process.”
§ Physical activity and exercise for chronic pain in adults > Quality of the evidence
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“This overview has only used one study of the six included as it alone included a control group, for which we could not extract data as the control comparison was not used in the analysis by the review authors”
§ Physical activity and exercise for chronic pain in adults > A D D I T I O N A L T A B L E S
What the sources say
- Not checked yetcites Regnaux 2015 source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Studies often rely on the self-report of participants as to the actual physical activity and exercise being undertaken, which can lead to a greater risk of bias, and reduced study quality”
§ Physical activity and exercise for chronic pain in adults > Quality of the evidence
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
In the paper
“There was no subgroup analysis to differentiate between acute, subacute, and chronic pain made it difficult to extract appropriate data for this review (one included study had subacute back pain (> 6 weeks), all others were chronic back pain (> 12 weeks)) but results are presented altogether as chronic pain”
§ Physical activity and exercise for chronic pain in adults > A D D I T I O N A L T A B L E S
What the sources say
- Not checked yetcites Yamato 2015 source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“However, no mention of quality/risk of bias of studies in conclusion despite low/unclear quality score in results and discussion sections”
§ Physical activity and exercise for chronic pain in adults > A D D I T I O N A L T A B L E S
What the sources say
- Not checked yetcites Cramp 2013 source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
In the paper
“No subgroup analysis to differentiate between acute, subacute, and chronic pain made it difficult to extract appropriate data for this review”
§ Physical activity and exercise for chronic pain in adults > A D D I T I O N A L T A B L E S
What the sources say
- Not checked yetcites van der Heijden 2015 source
Strength:plain· not yet calibratedCausal:direct· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it. It may state two separate claims as one.
In the paper
“No conclusions about effect on pain (insufficient data).”
§ Physical activity and exercise for chronic pain in adults > A D D I T I O N A L T A B L E S
What the sources say
- Not checked yetcites Cramp 2013 source
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
None of the sources cited for this claim have been checked yet.
In the paper
“It has been previously suggested that for 20% to 25% of participants undertaking an exercise programme there is little to no favourable response (Timmons 2014), while a small percentage (5% to 10%) have adverse events (Bouchard 2012).”
§ Physical activity and exercise for chronic pain in adults > Population/participants/sample
What the sources say
- Not checked yetcites Timmons 2014
- Not checked yetcites Bouchard 2012 source
Load-bearingStrength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“There is some evidence of improved physical function and a variable effect on both psychological function and quality of life.”
§ Physical activity and exercise for chronic pain in adults > A U T H O R S ' C O N C L U S I O N S
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Appropriate conclusions based on available data.”
§ Physical activity and exercise for chronic pain in adults > A D D I T I O N A L T A B L E S
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
What the paper did — it cites no source for this, so there is none to check. The quote shows it is in the paper.
In the paper
“In assessing the quality of the evidence, we employed the AM-STAR tool to examine the reviews, extracted data on risk of bias to examine the available primary evidence, and evaluated the au-thors' conclusions to ensure that they were appropriate based on the available data.”
§ Physical activity and exercise for chronic pain in adults > Quality of the evidence
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesProbably not a substantial claim. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Physical activity and exercise may improve pain severity as well as physical function and quality of life.”
§ Physical activity and exercise for chronic pain in adults > Implications for practice
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The evidence suggests that physical activity or exercise is an acceptable intervention in people with chronic pain, with minimal negative adverse effects.”
§ Physical activity and exercise for chronic pain in adults > For policy makers
Load-bearingStrength:hedged· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“However, results are inconsistent and the evidence is low quality (tier three).”
§ Physical activity and exercise for chronic pain in adults > A U T H O R S ' C O N C L U S I O N S
Load-bearingStrength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“The pain in these cases can occur secondary to other symptoms such as fatigue, muscle stiffness, difficulty sleeping, and depression, all of which could separately (and more effectively) be influenced by the intervention.”
§ Physical activity and exercise for chronic pain in adults > Overall completeness and applicability of evidence
Strength:hedged· not yet calibratedCausal:conditional· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✗ Based: failsProbably not a substantial claim. The paper’s conclusions may not depend on it. The paper may give no reason why it holds. It may state two separate claims as one.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“Appropriate conclusions based on available data.”
§ Physical activity and exercise for chronic pain in adults > A D D I T I O N A L T A B L E S
Strength:plain· not yet calibratedTests✓ Asserted: passes✓ Checkable: passes✗ Load-bearing: fails✓ Based: passesProbably not a substantial claim. The paper’s conclusions may not depend on it.
A conclusion the paper draws from its own results — it cites no other source for it, so there is none to check. The quote shows it is in the paper.
In the paper
“this may lead to underestimating possible adverse events from an intervention, or overestimating its safety.”
§ Physical activity and exercise for chronic pain in adults > Overall completeness and applicability of evidence
Tests✓ Asserted: passes✓ Checkable: passes✓ Load-bearing: passes✓ Based: passesIt may state two separate claims as one.
The paper relies on this without support.
Exercise is likely to have minimal adverse effects compared with pharmaceutical and surgical interventions in adults with chronic pain.
“It is likely to be associated with minimal adverse effects, such as interactions with medication and potential for abuse in adults with chronic pain, when compared to pharmaceutical and surgical interventions.”
The paper relies on this without support.
Cochrane reviews are properly conducted.
“Additional quantitative analyses were not required, since we only considered results from properly conducted (Cochrane) reviews.”
The paper relies on this without support.
Physical activity and exercise can be adapted for an individual and can be self-directed.
“Physical activity and exercise can be adapted for an individual, and is something people can do to help themselves.”
The paper relies on this without support.
Blinding participants and personnel to exercise or physical activity allocation is very difficult.
“With any exercise or physical activity intervention it is very difficult to blind both participants and personnel to the allocation, though some studies included in reviews attempted to by offering sham exercise.”
The authors state this as an assumption.
Control group baseline and earliest control group scores can serve as approximate baseline measures for intervention groups.
“but we were able to use control group baseline and earliest control group scores as assumed or approximate baseline measures for the intervention groups in nine reviews”
The paper relies on this without support.
Regardless of aetiology, the impact of chronic pain is broadly similar across many conditions.
“Regardless of aetiology, the impact of chronic pain is broadly similar across many conditions.”
The authors state this as an assumption.
The majority of the included population had mild-to-moderate pain severity, assumed because of the lack of exact baseline group data.
“The majority of the included population had an assumed mild-to-moderate pain severity score (assumed only due to lack of exact group data at baseline).”
Claims other papers make about this one
Each is checked against this paper’s own text: does it say what the citing paper says it does?
The cited source says what the claim attributes to it.
In the citing paper
“Exercise is increasingly being recommended to manage a range of chronic pain conditions (Geneen et al., 2017), including primary dysmenorrhea (Armour et al., 2019a) and endometriosis (Awad et al., 2017; Mira et al., 2018).”
From Self-management strategies to consider to combat endometriosis symptoms during the COVID-19 pandemic (2020) · cites this paper as Geneen et al., 2017
Experimental — accuracy not yet measuredThe cited source says what the claim attributes to it.
In the citing paper
“However, an overview of systematic reviews has reported the quality of the evidence supporting exercise and physical activity to be poor (Geneen et al., 2017), and the duration of follow-up in the majority of included studies was insufficient to assess the longterm effects of the interventions.”
From Exercise combined with Acceptance and Commitment Therapy for chronic pain: One-year follow-up from a randomized controlled trial (2024) · cites this paper as Geneen et al., 2017
The cited source says what the claim attributes to it.
In the citing paper
“Exercise interven tions and PA (eg, aerobic experience, strength training, and yoga) have also been examined, and a small-tomedium effect has been found for outcomes including pain severity and quality of life (QoL), although incon sistency in findings was also noted. 18”
From The Effectiveness of Interventions for Improving Chronic Pain Symptoms Among People With Mental Illness: A Systematic Review (2024) · cites this paper as [18]
Self-check
Percentages, sums and reported differences re-computed from the paper’s own numbers.
Each contradiction between two passages listed here was confirmed by an independent check.
The review-group count does not match the list
MinorThe text says the 21 reviews came from five Cochrane Review groups, but the ensuing list names seven distinct groups.
“The 21 included reviews were published by five different Cochrane Review groups”
“11 from the Cochrane Musculoskeletal Group (Bartels 2007;Bidonde 2014;Busch 2007;Busch 2013;Cramp 2013;Fransen 2014;Fransen 2015;Han 2004; Hurkmans 2009; Regnaux 2015; Silva 2010); four from the Cochrane Neck and Back Group previously the Cochrane Back Group) (Gross 2015a; Hayden 2005; Saragiotto 2016; Yamato 2015); two from the Cochrane Peripheral Vascular Diseases Group”
The attrition-bias summary conflicts with its reported percentage
MinorThe quality discussion says fewer than half of studies were at low risk for attrition and reporting biases. The results instead put low risk of attrition bias at about 55%, although the reporting-bias figure is below half.
“the trials did not consistently and adequately report potential attrition and reporting biases, with less than half of studies within these reviews at low risk of bias.”
“About 55% (144/264) of the studies included in these reviews showed low risk of bias.”
One AMSTAR row exceeds the eleven-item total
MinorThe Hayden 2005 row reports 10 yes and 2 no answers. Those counts sum to 12, although the tool has only 11 criteria.
Reported 11 · recomputed 12
“Hay- den 2005 Y Y Y Y Y N Y Y Y Y Y 10 2 -”
A psychological-function estimate lies outside its confidence interval
MinorThe reported SMD of 0.16 is above the reported 95% confidence interval's upper bound of 0.032. The midpoint of the printed bounds is 0.021, not 0.16.
Reported 0.16 · recomputed 0.021
“Bartels 2007 -4 studies SMD 0.16 (95% CI 0.01 to 0.032)”
Withdrawal-group denominators exceed the stated sample
MinorThe Bidonde 2014 withdrawal row gives group denominators of 252 and 232, totalling 484, while stating that the eight studies had 472 participants.
Reported 472 · recomputed 484
“Bidonde 2014 (fibromyalgia) 8 studies, n = 472 151 (imputed from reported 38/252) 129 (imputed from reported 30/232)”
Citations
Cites
9 retracted
Transcutaneous electrical nerve stimulation (TENS) for chronic pain
Nnoaham, K. E., & Kumbang, J. (2008) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd003222.pub2 · Cited by 264
RetractedExercise therapy for patellofemoral pain syndrome
Heintjes, E. M., Berger, M. Y., Bierma‐Zeinstra, S., Bernsen, R. M. D., Verhaar, J. A. N., & Koes, B. W. (2003) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd003472 · Cited by 202
RetractedNon-invasive physical treatments for chronic/recurrent headache
Brønfort, G., Haas, M., Evans, R., Goldsmith, C. H., Assendelft, W. J., & Bouter, L. M. (2014) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd001878.pub3 · Cited by 169
RetractedInterventions for treating chronic pelvic pain in women
Stones, W., Cheong, Y. C., Howard, F. M., & Singh, S. (2003) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd000387 · Cited by 165
RetractedPsychosocial interventions for the management of chronic orofacial pain
Aggarwal, V. R., Lovell, K., Peters, S., Javidi, H., Joughin, A., & Goldthorpe, J. (2011) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd008456.pub2 · Cited by 126
RetractedPhysical medicine modalities for mechanical neck disorders
Gross, A., Aker, P. D., Goldsmith, C. H., & Peloso, P. M. J. (1998) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd000961 · Cited by 83
RetractedBrown, J., & Brown, S. (2010) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd004142.pub2 · Cited by 82
RetractedPhysical therapy for the management of patients with temporomandibular disorders and related pain
Craane, B., De Laat, A., Dijkstra, P. U., Stappaerts, K., & Stegenga, B. (2006) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd005621 · Cited by 14
RetractedSpinal rehabilitative exercise and manual treatment for the prevention of migraine attacks in adults
Brønfort, G., Evans, R., Goldsmith, C. H., Haas, M., Leininger, B. D., Levin, M., Schmitt, J., & Westrom, K. K. (2015) · Cochrane Database of Systematic Reviews · doi:10.1002/14651858.cd011848 · Cited by 7
RetractedStatistical Power Analysis for the Behavioral Sciences
Muller, K. E., & Cohen, J. (1989) · Technometrics · doi:10.2307/1270020 · Cited by 99,603
Flagged first, then by citations
Research works printed but not linked: 8
- Gross, 2012, Patient education for neck pain, Cochrane Database of Systematic Reviews, 10.1002/14651858.cd005106.pub4 · DOI
- Merskey H Bogduk N Part III: Pain terms: a current list with definitions and notes on usage Classification of Chronic Pain 2nd Edition Seattle IASP Task Force on Taxonomy, IASP Press
- Mooney, 2006, Clinical management of chronic, disabling low back syndromes
- Moore, 2008, Managing potential publication bias, 15
- Moore RA Derry S Taylor RS Straube S Phillips CJ The costs and consequences of adequately managed chronic non-cancer pain and chronic neuropathic pain Pain Practice 2014 79 94 · DOI
- The Nordic Cochrane Centre, Cochrane Review Manager (RevMan) 2014
- 2013, Management of chronic pain. SIGN publication no. 136
- Timmon, 2014, Do we have a valid public health strategy for exercise prescription?, Sport and Exercise Scientist, 39, 26
Cited by
Sorted by citations
Items 101–200 of 730
Patel, K., Eley, K. A., Cascarini, L., Watt-Smith, S., Larkin, M., Lloyd, T., Maddocks, C., McLaren, E., Stovell, R., & McMillan, R. (2023) · Oral Surgery Oral Medicine Oral Pathology and Oral Radiology · doi:10.1016/j.oooo.2023.02.001 · Cited by 31
McClure, P. W., Tevald, M. A., Zarzycki, R., Kantak, S. S., Malloy, P. J., Day, K. V., Shah, K. M., Miller, A., & Mangione, K. K. (2021) · Physical Therapy · doi:10.1093/ptj/pzab024 · Cited by 31
Borges, P. D. A., Koerich, M. H. A. D. L., Wengerkievicz, K. C., & Knabben, R. J. (2023) · Physis Revista de Saúde Coletiva · doi:10.1590/s0103-7331202333019 · Cited by 30
Moore, A., Bidonde, J., Fisher, E., Häuser, W., Bell, R. F., Perrot, S., Makri, S., & Straube, S. (2024) · Rheumatology · doi:10.1093/rheumatology/keae707 · Cited by 30
Hao, Z., Zhang, X., & Chen, P. (2022) · Brain Sciences · doi:10.3390/brainsci12060698 · Cited by 34
Wood, L., Foster, N. E., Lewis, M., & Bishop, A. (2020) · Journal of Pain · doi:10.1016/j.jpain.2020.04.002 · Cited by 30
Lunny, C., Reid, E. K., Neelakant, T., Chen, A., Zhang, J. H., Shinger, G., Stevens, A., Tasnim, S., Sadeghipouya, S., Adams, S., et al. (2021) · Research Synthesis Methods · doi:10.1002/jrsm.1542 · Cited by 29
Saltan, A., & Ankaralı, H. Ç. (2020) · Perspectives In Psychiatric Care · doi:10.1111/ppc.12547 · Cited by 28
Okabe, D., Tsuji, T., Hanazato, M., Miyaguni, Y., Asada, N., & Kondo, K. (2019) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph16234598 · Cited by 28
Núñez‐Cortés, R., Salazar‐Méndez, J., & Nijs, J. (2025) · Journal of Functional Morphology and Kinesiology · doi:10.3390/jfmk10020183 · Cited by 27
Carrascosa, M. D. C., Navas, A., Artigues, C., Ortas, S., Portells, E., Soler, A., Bennasar‐Veny, M., & Leiva, A. (2021) · Midwifery · doi:10.1016/j.midw.2021.103105 · Cited by 36
A Brief Survey of the COVID-19 Pandemic's Impact on the Chronic Pain Experience
Chatkoff, D. K., Leonard, M. T., Najdi, R. R., Cruga, B. N., Forsythe, A., Bourgeau, C., & Easton, H. (2021) · Pain Management Nursing · doi:10.1016/j.pmn.2021.10.003 · Cited by 27
Valencia, L. P., He, Y., & Wippert, P. (2024) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-024-07289-1 · Cited by 26
Sörös, P., & Bantel, C. (2019) · Pain · doi:10.1097/j.pain.0000000000001756 · Cited by 27
Schneider, C. R., Freeman, A. L. J., Spiegelhalter, D. J., & van der Linden, S. (2021) · PLoS ONE · doi:10.1371/journal.pone.0259048 · Cited by 28
Chen, F., Chi, J., Niu, F., Gao, Q., Mei, F., Zhao, L., Hu, K., Zhao, B. Q., & Ma, B. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.01.024 · Cited by 28
Rhim, H. C., Tenforde, A. S., Mohr, L., Hollander, K., Vogt, L., Groneberg, D. A., & Wilke, J. (2022) · BMJ Open · doi:10.1136/bmjopen-2021-059525 · Cited by 26
Vægter, H. B., Kinnunen, M. I., Verbrugghe, J., Cunningham, C., Meeus, M., Armijo-Olivo, S. L., Bandholm, T., Fullen, B. M., Wittink, H. M., Morlion, B. J., et al. (2024) · European Journal of Pain · doi:10.1002/ejp.2278 · Cited by 25
Abdel-Salam, D. M., Almuhaisen, A. S., Alsubiti, R. A., Aldhuwayhi, N. F., Almotairi, F. S., Alzayed, S. M., & Bakri, F. F. (2019) · Journal of Public Health · doi:10.1007/s10389-019-01127-8 · Cited by 25
Multimodal Chronic Pain Therapy for Adults via Smartphone: Randomized Controlled Clinical Trial
Morcillo-Muñoz, Y., Sánchez-Guarnido, A. J., Calzón-Fernández, S., & Baena-Parejo, I. (2022) · Journal of Medical Internet Research · doi:10.2196/36114 · Cited by 25
What decreases low back pain? A qualitative study of patient perspectives
Setchell, J., Costa, N., Ferreira, M. L., & Hodges, P. W. (2019) · Scandinavian Journal of Pain · doi:10.1515/sjpain-2019-0018 · Cited by 25
Treatment targets of exercise for persistent non-specific low back pain: a consensus study
Wood, L., Bishop, A., Lewis, M., Smeets, R. J. E. M., Bronfort, G., Hayden, J. A., & Foster, N. E. (2021) · Physiotherapy · doi:10.1016/j.physio.2021.03.005 · Cited by 24
Ouellet, P., Lafrance, S., Pizzi, A., Roy, J., Lewis, J. S., Christiansen, D. H., Dubois, B., Langevin, P., & Desmeules, F. (2021) · Archives of Physical Medicine and Rehabilitation · doi:10.1016/j.apmr.2021.01.093 · Cited by 24
Skelton, D. A., & Mavroeidi, A. (2018) · Journal of Frailty Sarcopenia and Falls · doi:10.22540/jfsf-03-085 · Cited by 24
Lumbar Paravertebral Muscle Pain Management Using Kinesitherapy and Electrotherapeutic Modalities
Silişteanu, S. C., Antonescu, E., DUICA, L. C., Totan, M., Cucu, A. I., & Costea, A. I. (2024) · Healthcare · doi:10.3390/healthcare12080853 · Cited by 23
Nøst, T. H., Steinsbekk, A., Bratås, O., & Grønning, K. (2018) · BMJ Open · doi:10.1136/bmjopen-2018-023017 · Cited by 23
Verbrugghe, J., Agten, A., Stevens, S., Vandenabeele, F., Roussel, N. A., Verbunt, J., Goossens, N., & Timmermans, A. A. A. (2023) · Brazilian Journal of Physical Therapy · doi:10.1016/j.bjpt.2023.100496 · Cited by 26
Palmer, K. L., Shivgulam, M. E., Champod, A. S., Wilson, B. C., O'Brien, M. W., & Bray, N. W. (2023) · Neurobiology of Pain · doi:10.1016/j.ynpai.2023.100129 · Cited by 23
Kheirinejad, S., Visuri, A., Suryanarayana, S. A., & Hosio, S. J. (2023) · Heliyon · doi:10.1016/j.heliyon.2023.e16586 · Cited by 24
de Zoete, R. M. J. (2023) · Journal of Clinical Medicine · doi:10.3390/jcm12227108 · Cited by 29
Greenley, R. N., Naftaly, J. P., Walker, R. J., Kappelman, M. D., Martin, C. F., & Schneider, K. L. (2018) · Inflammatory Bowel Diseases · doi:10.1093/ibd/izx057 · Cited by 23
Iversen, V. V., Vasseljen, O., Mork, P. J., & Fimland, M. S. (2018) · Journal of Rehabilitation Medicine · doi:10.2340/16501977-2370 · Cited by 23
Walking increases pain tolerance in humans: an experimental cross-over study
Hviid, J.-C. T., Thorlund, J. B., & Vægter, H. B. (2019) · Scandinavian Journal of Pain · doi:10.1515/sjpain-2019-0070 · Cited by 23
Neumann, I. L., de Oliveira, D. A., de BARROS, E. L., Santos, G. D. S., de Oliveira, L. S., Duarte, Â. L. B. P., Marques, C. D. L., Dantas, A. T., Dantas, D. D. S., de Siqueira, G. R., et al. (2021) · European Journal of Physical and Rehabilitation Medicine · doi:10.23736/s1973-9087.21.06520-5 · Cited by 23
Falls in older and senile patients. Clinical giudelines
Ткачева, О. Н., Kotovskaya, Y. V., Milto, A. S., Рунихина, Н. К., Frolova, E. V., Naumov, A. V., Dudinskaya, Е. N., Matchekhina, L. V., Vorobyeva, N. M., Розанов, А. В., et al. (2021) · Russian Journal of Geriatric Medicine · doi:10.37586/2686-8636-2-2021-148-174 · Cited by 23
Fernandez, M., Moore, C., Eklund, A., Swain, M. S., de Luca, K. E., Sibbritt, D. W., Adams, J., & Peng, W. (2019) · Complementary Therapies in Medicine · doi:10.1016/j.ctim.2019.06.012 · Cited by 22
Carmona‐Torres, J. M., Cobo‐Cuenca, A. I., Pozuelo‐Carrascosa, D. P., Román, P. Á. L., MONTILLA, J. A. P., & Laredo‐Aguilera, J. A. (2021) · International Journal of Environmental Research and Public Health · doi:10.3390/ijerph18031100 · Cited by 22
Alessandro de, S. I. R. E., Lippi, L., Curci, C., Calafiore, D., Cisari, C., Ammendolia, A., & Invernizzi, M. (2021) · Applied Sciences · doi:10.3390/app11104338 · Cited by 22
García-Correa, H. R., Montoya, L. J. S., Daza-Arana, J. E., & Ordoñez‐Mora, L. T. (2021) · Journal of Physical Activity and Health · doi:10.1123/jpah.2020-0806 · Cited by 22
Comachio, J., Ferreira, M. L., Mork, P. J., Holtermann, A., Ho, E. K., Wang, D. X. M., Lan, Q., Stamatakis, E., Beckenkamp, P. R., & Ferreira, P. H. (2024) · Journal of science and medicine in sport · doi:10.1016/j.jsams.2024.01.003 · Cited by 22
Predictors of anxiety and depression 2 years following treatment in uveal melanoma survivors
Brown, S. L., Hope‐Stone, L., Heimann, H., Damato, B. E., & Salmon, P. (2018) · Psycho-Oncology · doi:10.1002/pon.4715 · Cited by 22
Sit, R. W. S., Choi, S. Y. K., Wang, B., Chan, D. C. C., Zhang, D., Yip, B. H. K., & Wong, S. Y. S. (2020) · British Journal of General Practice · doi:10.3399/bjgp20x714053 · Cited by 21
Muscle-brain communication in pain: The key role of myokines
Wang, Y., Wu, Z., Wang, D., Huang, C., Xu, J., Liu, C., & Yang, C. (2021) · Brain Research Bulletin · doi:10.1016/j.brainresbull.2021.11.017 · Cited by 21
Blanchard, A., Nguyen, S. M., Devanne, M., Simonnet, M., Goff-Pronost, M. L., & Rémy‐Néris, O. (2022) · BioMed Research International · doi:10.1155/2022/5667223 · Cited by 21
Arena, R. A., MYERS, J. N., Kaminsky, L. A., Williams, M. A., Sabbahi, A., Popović, D., Axtell, R. S., Faghy, M. A., Hills, A. P., Olivares, S. L. O., et al. (2021) · Current Problems in Cardiology · doi:10.1016/j.cpcardiol.2021.100823 · Cited by 21
Exercise and Physical Activity for Older Adults
Avers, D. (2019) · Elsevier eBooks · doi:10.1016/b978-0-323-60912-8.00008-7 · Cited by 21
Impact of isometric and concentric resistance exercise on pain and fatigue in fibromyalgia
Berardi, G., Senefeld, J. W., Hunter, S. K., & Bement, M. H. (2021) · European Journal of Applied Physiology · doi:10.1007/s00421-021-04600-z · Cited by 20
Falskog, F., Landsem, A. M., Meland, E., Bjorvatn, B., Hjelle, O. P., & Mildestvedt, T. (2021) · Scandinavian Journal of Primary Health Care · doi:10.1080/02813432.2021.1910670 · Cited by 21
Fukuda, T. Y., de Aquino, L. M., Pereira, P., Ayres, I., Feio, A. F., de Jesus, F. L. A., & Neto, M. G. (2021) · Brazilian Journal of Physical Therapy · doi:10.1016/j.bjpt.2021.10.005 · Cited by 20
Physical exercise, depression, and anxiety in 2190 affective disorder subjects
D'Angelantonio, M., Collins, J. L., Manchia, M., Baldessarini, R. J., & Tondo, L. (2022) · Journal of Affective Disorders · doi:10.1016/j.jad.2022.04.079 · Cited by 20
Jia, Y., Yao, Y., Zhuo, L., Chen, X., Yan, C., Ji, Y., Tao, J., & Zhu, Y. (2022) · Frontiers in Neurology · doi:10.3389/fneur.2022.862078 · Cited by 21
Bae, K., Lamoury, G., Carroll, S., Morgia, M., Lim, S. H.-S., Baron-Hay, S. E., Shin, I., Park, S.-J., & Oh, B. (2022) · Critical Reviews in Oncology/Hematology · doi:10.1016/j.critrevonc.2022.103898 · Cited by 21
AGA Clinical Practice Update on Pain Management in Inflammatory Bowel Disease: Commentary
Keefer, L., Hashash, J. G., Szigethy, E., & Mayer, E. A. (2024) · Gastroenterology · doi:10.1053/j.gastro.2024.03.034 · Cited by 20
Heredia‐Rizo, A. M., Petersen, K. K., Arendt‐Nielsen, L., & Madeleine, P. (2019) · Pain Medicine · doi:10.1093/pm/pnz360 · Cited by 20
Perturbation‐based exercise for prevention of low‐back pain in adolescent athletes
Arampatzis, A., Laube, G., Schroll, A., Frank, J., Böhm, S., & Mersmann, F. (2020) · Translational Sports Medicine · doi:10.1002/tsm2.191 · Cited by 20
Tobore, T. O. (2021) · Advances in Redox Research · doi:10.1016/j.arres.2021.100003 · Cited by 20
Guo, X., Li, L., Yan, Z., Li, Y., Peng, Z., Yang, Y., Zhang, Y., Schmitz, C., & Feng, Z. (2021) · Journal of Orthopaedic Surgery and Research · doi:10.1186/s13018-021-02848-x · Cited by 20
Ma, R., Romano, E., Ashworth, M., Smith, T. O., Vancampfort, D., Scott, W., Gaughran, F., Stewart, R., & Stubbs, B. (2024) · The Journal of Pain · doi:10.1016/j.jpain.2023.11.004 · Cited by 19
Pain Management of Amazon Indigenous Peoples: A Community-Based Study
de Moraes, E. B., Fabbro, D. R. D., de Oliveira, L. B., & Leão, E. R. (2021) · Journal of Pain Research · doi:10.2147/jpr.s298219 · Cited by 19
Perception of musculoskeletal pain in the state of confinement: associated factors
Carpintero-Rubio, C., Torres-Chica, B., Guadrón-Romero, M. A., Visiers‐Jiménez, L., & Peña-Otero, D. (2021) · Revista Latino-Americana de Enfermagem · doi:10.1590/1518-8345.4894.3454 · Cited by 19
Skogberg, O., Karlsson, L., Börsbo, B., Arendt‐Nielsen, L., Graven‐Nielsen, T., Gerdle, B. U. C., Bäckryd, E., & Lemming, D. (2022) · Journal of Rehabilitation Medicine · doi:10.2340/jrm.v54.241 · Cited by 19
Manderlier, A., de Fooz, M., Patris, S., & Berquin, A. D. (2022) · Annals of Physical and Rehabilitation Medicine · doi:10.1016/j.rehab.2022.101660 · Cited by 19
Sleep quality and anxiety levels among university students
Silva, D. N., Lima, A. O., dos Santos, L. A., Barreto, D. M., & Pithon, K. R. (2022) · O Mundo da Saúde · doi:10.15343/0104-7809.202246247254 · Cited by 19
Becher, B., Lozano-López, C., de Castro‐Carletti, E. M., Hoffmann, M., Becher, C., Mesa-Jiménez, J. A., Fernández‐de‐las‐Peñas, C., & Armijo-Olivo, S. L. (2023) · Musculoskeletal Science and Practice · doi:10.1016/j.msksp.2023.102822 · Cited by 19
de Azambuja, G., Hortscht, U., Hoheisel, U., Oliveira, M. C. G., Mense, S., & Treede, R. (2018) · European Journal of Pain · doi:10.1002/ejp.1230 · Cited by 19
Eisele‐Metzger, A., Schagg, D., & Göhner, W. (2019) · Musculoskeletal Science and Practice · doi:10.1016/j.msksp.2019.102104 · Cited by 19
Development of a mind body program for obese knee osteoarthritis patients with comorbid depression
Jacobs, C. A., Mace, R. A., Greenberg, J., Popok, P., Reichman, M., Lattermann, C. M., Burris, J. L., Macklin, E. A., & Vranceanu, A. (2021) · Contemporary Clinical Trials Communications · doi:10.1016/j.conctc.2021.100720 · Cited by 20
O’Neill, A., O’Sullivan, K., & McCreesh, K. M. (2021) · European Journal of Pain · doi:10.1002/ejp.1759 · Cited by 19
Pragmatic but flawed: the NICE guideline on chronic pain
Eccleston, C., Aldington, D. J., Moore, A., & Williams, A. C. D. C. (2021) · The Lancet · doi:10.1016/s0140-6736(21)01058-8 · Cited by 19
Wang, X.-N., Yue, J., Guo, S., Rahmatulla, A., Li, S.-S., Liu, Y., & Chen, Y. (2025) · International journal of pharmaceutics · doi:10.1016/j.ijpharm.2025.125206 · Cited by 24
Evaluation of the effect of cooling strategies on recovery after surgical intervention
Engelhard, D., Hofer, P., & Annaheim, S. (2019) · BMJ Open Sport & Exercise Medicine · doi:10.1136/bmjsem-2019-000527 · Cited by 18
Nielsen, S. S., Skou, S. T., Larsen, A. E., Søndergaard, J., & Christensen, J. R. (2022) · Scandinavian Journal of Pain · doi:10.1515/sjpain-2021-0062 · Cited by 17
Tai, L. A., Tsai, L. Y., Lin, C.-H., & Chiu, Y. (2024) · BMC Psychiatry · doi:10.1186/s12888-023-05273-y · Cited by 18
Chang, M. C. (2020) · Cureus · doi:10.7759/cureus.9934 · Cited by 19
Training health professionals to provide physical activity counselling
Coombes, J. S., Williams, A. D., & Radford, J. C. (2020) · Progress in Cardiovascular Diseases · doi:10.1016/j.pcad.2020.12.005 · Cited by 17
Wippert, P., Niederer, D., Drießlein, D., Beck, H., Banzer, W. E., Schneider, C., Schiltenwolf, M., & Mayer, F. (2021) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2021.629474 · Cited by 17
Davydov, D. M., Shahabi, L., & Naliboff, B. D. (2019) · Neurogastroenterology & Motility · doi:10.1111/nmo.13710 · Cited by 17
The brain and behavioral correlates of motor-related analgesia (MRA)
Holmes, S. A., Kim, A., & Borsook, D. (2020) · Neurobiology of Disease · doi:10.1016/j.nbd.2020.105158 · Cited by 17
Chronic neck pain and postural rehabilitation: A literature review
Alagingi, N. K. (2022) · Journal of Bodywork and Movement Therapies · doi:10.1016/j.jbmt.2022.04.017 · Cited by 16
Bartley, E. J., Makhoul, M., Palit, S., Robinson, M. E., & Fillingim, R. B. (2022) · Pain Medicine · doi:10.1093/pm/pnac156 · Cited by 16
Greenwalt, D., Phillips, S. A., Ozemek, C., Arena, R. A., & Sabbahi, A. (2023) · Current Problems in Cardiology · doi:10.1016/j.cpcardiol.2023.101871 · Cited by 18
Calafiore, D., Marotta, N., Longo, U. G., Vecchio, M. M., Zito, R., Lippi, L., Ferraro, F., Invernizzi, M., Ammendolia, A., & Alessandro de, S. I. R. E. (2025) · Journal of Back and Musculoskeletal Rehabilitation · doi:10.1177/10538127241304110 · Cited by 16
Norheim, K. L., Samani, A., Bønløkke, J. H., Omland, Ø., & Madeleine, P. (2019) · Scandinavian Journal of Public Health · doi:10.1177/1403494819839533 · Cited by 16
Bertin, C., Delage, N., Rolland, B., Pennel, L., Fatseas, M., Trouvin, A., Delorme, J., Chenaf, C., & Authier, N. (2020) · Neuroscience & Biobehavioral Reviews · doi:10.1016/j.neubiorev.2020.12.015 · Cited by 17
Morcillo-Muñoz, Y., Castellano, M. H. J., Exposito, F. J. D., Sánchez-Guarnido, A. J., Alcantara, M. G., & Baena-Parejo, M. I. (2021) · Clinics and Practice · doi:10.3390/clinpract11030072 · Cited by 19
Comprehensive pain management as a frontline treatment to address the opioid crisis
Hobelmann, J. G., & Huhn, A. S. (2021) · Brain and Behavior · doi:10.1002/brb3.2369 · Cited by 16
Kennedy, M., O’Mahony, B., Roche, S., McGowan, M. A., Singleton, E., Ryan, K. M., Connell, N. O., Pipe, S. W., Lavin, M., Donnell, J. S. O., et al. (2022) · European Journal Of Haematology · doi:10.1111/ejh.13763 · Cited by 16
Minakawa, Y., Miyazaki, S., Waki, H., Yoshida, N., Iimura, K., & Itoh, K. (2022) · Journal of Acupuncture and Meridian Studies · doi:10.51507/j.jams.2022.15.2.143 · Cited by 16
Hochheim, M., Ramm, P., Wunderlich, M., & Amelung, V. E. (2022) · BMC Musculoskeletal Disorders · doi:10.1186/s12891-022-05806-8 · Cited by 16
Self‐Management Therapies for Temporomandibular Disorders—Evidence From Systematic Reviews
Bijelic, T., Michelotti, A., Bucci, R., Sorbo, D. D., Ekberg, E., & Häggman‐Henrikson, B. (2025) · Journal of Oral Rehabilitation · doi:10.1111/joor.70074 · Cited by 15
Emergency department pain management in older patients
Tyler, K. R., Hullick, C., Newton, B. A., Adams, C. B., & Arendts, G. (2020) · Emergency Medicine Australasia · doi:10.1111/1742-6723.13562 · Cited by 15
Ames, M. E., Robillard, C. L., Ryan, J. E. H., Merrin, G. J., & Turner, B. J. (2023) · Mental health and physical activity · doi:10.1016/j.mhpa.2023.100513 · Cited by 15
Courtney, R. E., Schadegg, M. J., Bolton, R. E., Smith, S., & Harden, S. M. (2023) · Pain Management Nursing · doi:10.1016/j.pmn.2023.09.010 · Cited by 15
González-Álvarez, M. E., Riquelme-Aguado, V., Rossettini, G., Fernández‐Carnero, J., & Villafañe, J. H. (2024) · Life · doi:10.3390/life15010040 · Cited by 15
Therapeutic Recommendations for the Management of Older Adult Patients with Sjögren’s Syndrome
Retamozo, S., Baldini, C., Bootsma, H., Vita, S. D., Dörner, T., Fisher, B. A., Gottenberg, J., Hernández‐Molina, G., Kocher, A., Kostov, B., et al. (2021) · Drugs & Aging · doi:10.1007/s40266-021-00838-6 · Cited by 15
Blake, H., Somerset, S., & Greaves, S. (2021) · Healthcare · doi:10.3390/healthcare10010056 · Cited by 15
Booth, G., Howarth, A., Stubbs, B., & USSHER, M. H. (2021) · Journal of Pain · doi:10.1016/j.jpain.2021.11.004 · Cited by 16
Nagaki, K., Fujioka, S., Sasai, H., Yamaguchi, Y., & Tsuboi, Y. (2022) · Healthcare · doi:10.3390/healthcare10040749 · Cited by 14
Shanbehzadeh, S., ShahAli, S., Hides, J. A., Ebrahimi-Takamjani, I., & Rasouli, O. (2022) · Journal of Manipulative and Physiological Therapeutics · doi:10.1016/j.jmpt.2022.06.003 · Cited by 17
Yokota, H., Edama, M., Kawanabe, Y., Hirabayashi, R., Sekikne, C., Akuzawa, H., Ishigaki, T., Otsuru, N., Saito, K., Kojima, S., et al. (2024) · European Journal of Neuroscience · doi:10.1111/ejn.16305 · Cited by 14
Metadata
- Authors
- Geneen, L. J., Moore, R. A., Clarke, C., Martin, D., Colvin, L. A., & Smith, B. H.
- Affiliations
- University of Dundee (GB)
- Teesside University (GB)
- Western General Hospital (GB)
- Venue
- Cochrane Database of Systematic Reviews
- Publisher
- John Wiley & Sons, Ltd
- Published
- 2017-01-14
- Volume
- 1
- Pages
- CD011279-CD011279
- ISSN
- 1361-6137 (ISSN-L)
- PMC
- PMC6469540
- OpenAlex
- W2962729479
- Cited by
- 719
- References
- 136
- Citations by year
- 2026: 55 · 2025: 117 · 2024: 94 · 2023: 92 · 2022: 89 · 2021: 92 · 2020: 75 · 2019: 64 · 2018: 33 · 2017: 7
- Type
- reference entry
- Language
- en
- Update notices
- new_version (2017-04-24)
- Open access
- bronze
- doi.org
- Locations
- Cochrane Database of Systematic Reviews (publishedVersion)
- PubMed Central (publishedVersion)
- PubMed (publishedVersion)
- Discovery Research Portal (University of Dundee) (publishedVersion, other-oa)
- Teesside University Research Portal (Teesside University) (submittedVersion, other-oa)
- Funders
- McMaster University
- National Institute of Academic Anaesthesia
- National Institute for Health and Care Research
- National Institute for Academic Anaesthesia
- Royal College of Anaesthetists
- National Institutes of Health
- Medical Research Council
- Topics
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
- Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Physical Activity and Health
- Health Sciences › Medicine › Physiology (medical) › Pain Mechanisms and Treatments
- Keywords
- physical activity, exercise intervention, pain intensity, physical function, quality of life, health care utilization, adverse effects, rheumatoid arthritis, osteoarthritis, fibromyalgia, low back pain, neck pain, whiplash injury, sciatica, post-stroke pain, cancer pain, spinal cord injury, stroke rehabilitation, exercise adherence, exercise safety
- MeSH terms
- Adult, Exercise Therapy, Humans, Pain Measurement, Patient Compliance, Quality of Life, Review Literature as Topic, Exercise, Randomized Controlled Trials as Topic, Exercise Movement Techniques, Chronic Pain, Myalgia
About these checks
Registry, retraction, Cites and statistics results are computed, not judged, with one exception: a printed reference that no index lists is read once by a model before it counts as a citation error. Claims are extracted by a model and kept only when their quote appears verbatim in the text; each cited source is then checked, with a model’s help, for whether it says what the claim relies on. Those verdicts can be wrong — read the claim’s quote and the cited source before relying on one.
A language model drew the claims from the paper on 2026-09-28, under version 3 of the claim definition (model deepseek-v4.1-flash, prompt extract-v3).
A second model labelled each claim on 2026-09-28 (model jev-1.13-20260917, definition revision gold-guideline-v0.2).
Statistics and arithmetic are recomputed, not judged.
Confidence bands are shown only for fields calibrated on our annotated test set. None is calibrated yet, so no band is shown.
What counts as a claim ›How we measure confidence ›How we check this ›
Are you an author, or do you see a problem with this page? Request a review
