The effectiveness of physiotherapy functional restoration for post-acute low back pain: A systematic review
Abstract
Background The effectiveness of multidisciplinary treatment for post-acute (>6 weeks) low back pain (LBP) has been established. Physiotherapists have sufficient training to conduct less intensive functional restoration. The effectiveness of physiotherapy functional restoration (PFR) has not been evaluated using current systematic review methodology.Objectives To determine the effects of PFR for post-acute LBP.Data sources Electronic databases searched include: MEDLINE, EMBASE, CINAHL, PsycINFO, PEDro and Cochrane CENTRAL. TRIAL ELIGIBILITY CRITERIA: Randomised controlled trials of physiotherapy treatment for post-acute LBP combining exercise and cognitive-behavioural intervention compared with other intervention, no intervention or placebo. TRIAL APPRAISAL AND SYNTHESIS METHODS: Two authors independently extracted data. Risk of bias was assessed using the PEDro scale and overall quality of the body of evidence was assessed using GRADE (Grading of Recommendations, Assessment, Development and Evaluation). Treatment effect sizes and 95% confidence intervals were calculated for pain, function and sick leave.Results Sixteen trials were included. Heterogeneity prevented meta-analysis for most comparisons. Meta-analyses showed moderate to high quality evidence of significant but small effects favouring PFR compared with advice for intermediate term function and intermediate and long term pain. There was however low to moderate quality evidence that PFR was no more effective than a range of other treatment types. Heterogeneous trials frequently contributed to very low quality evidence.Conclusions Moderate to high quality evidence was found of small effects favouring PFR compared with advice. Preliminary evidence suggested PFR is not different to other treatment types. Further high quality research is required replicating existing trial protocols.
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Many UK hospitals struggle to provide multidisciplinary pain rehabilitation programmes due to high cost and difficulties accessing clinical psychologists working in chronic pain.
“many UK hospitals struggle to provide such programmes due to the high cost and difficulties in accessing clinical psychologists working in chronic pain. 8,9”
From Introducing acceptance and commitment therapy to a physiotherapy-led pain rehabilitation programme: An action research study (2016) · cites this paper as [9]
There is moderate to high-quality evidence of small effects for physiotherapy-led functional restoration programmes.
“There is moderate to high-quality evidence of small effects for physiotherapy-led functional restoration programmes. 9”
From Introducing acceptance and commitment therapy to a physiotherapy-led pain rehabilitation programme: An action research study (2016) · cites this paper as [9]
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Rehabilitation of Acute and Subacute Low Back and Neck Pain in the Work-Injured Patient
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Chenot, J.-F., Greitemann, B., Kladny, B., Petzke, F., Pfingsten, M., & Schorr, S. G. (2017) · Deutsches Ärzteblatt international · doi:10.3238/arztebl.2017.0883 · Cited by 282 · see citing works
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“Walking is a promising, safe, and patient-preferred method for improving physical function in populations with chronic pain, particularly when it is gradually and strategically increased (ie, quota-based pacing regardless of symptoms) [22,26-32].”
- Authors
- Richards, M. C., Ford, J. J., Slater, S. L., Hahne, A. J., Surkitt, L. D., Davidson, M., & McMeeken, J. M.
- Affiliations
- La Trobe University (AU)
- The University of Melbourne (AU)
- Venue
- Manual Therapy
- Publisher
- Elsevier BV
- Published
- 2013-02
- Volume
- 18
- Issue
- 1
- Pages
- 4-25
- ISSN
- 1356-689X (ISSN-L)
- OpenAlex
- W2080812660
- Cited by
- 24
- References
- 102
- Citations by year
- 2024: 1 · 2023: 1 · 2022: 2 · 2020: 2 · 2019: 2 · 2018: 2 · 2017: 2 · 2016: 5 · 2015: 2 · 2014: 2 · 2013: 2 · 2012: 1
- FWCI
- 0.26
- Type
- journal article
- Language
- en
- Open access
- closed
- Locations
- Manual Therapy (publishedVersion)
- PubMed (publishedVersion)
- Topics
- Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
- Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Medical Practices and Rehabilitation
- Health Sciences › Medicine › Pathology and Forensic Medicine › Spine and Intervertebral Disc Pathology
- Keywords
- physiotherapy, functional restoration, exercise therapy, cognitive-behavioural intervention, multidisciplinary treatment, pain, functions, sick leave, treatment effectiveness
- MeSH terms
- Humans, Randomized Controlled Trials as Topic, Low Back Pain, Physical Therapy Modalities
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.
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.
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