Systematic Review to Inform a World Health Organization (WHO) Clinical Practice Guideline: Benefits and Harms of Structured and Standardized Education or Advice for Chronic Primary low back pain in Adults

Danielle Southerst, Cesar A. Hincapié*, Hainan Yu, Leslie Verville, André Bussières, Douglas P. Gross, Paulo Pereira, Silvano Mior, Andrea C. Tricco, Christine Cedraschi, Ginny Brunton, Margareta Nordin, Jessica J. Wong, Gaelan Connell, Heather M. Shearer, Astrid DeSouza, Javier Muñoz Laguna, Joyce G.B. Lee, Daphne To, Rahim LaljiKent Stuber, Martha Funabashi, Léonie Hofstetter, Danny Myrtos, Andrew Romanelli, Brett Guist, James J. Young, Sophia da Silva-Oolup, Maja Stupar, Dan Wang, Kent Murnaghan, Carol Cancelliere*

*Kontaktforfatter

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

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Abstract

Purpose: Evaluate benefits and harms of education/advice for chronic primary low back pain (CPLBP) in adults to inform a World Health Organization (WHO) standard clinical guideline. Methods: Electronic databases were searched for randomized controlled trials (RCTs) assessing education/advice compared with placebo/sham, usual care, or no intervention (including comparison interventions where the attributable effect of education/advice could be isolated). We conducted meta-analyses and graded the certainty of evidence. Results: We screened 2514 citations and 86 full text RCTs and included 15 RCTs. Most outcomes were assessed 3 to 6 months post-intervention. Compared with no intervention, education/advice improved pain (10 RCTs, MD = -1.1, 95% CI -1.63 to -0.56), function (10 RCTs, SMD = -0.51, 95% CI -0.89 to -0.12), physical health-related quality of life (HRQoL) (2 RCTs, MD = 24.27, 95% CI 12.93 to 35.61), fear avoidance (5 RCTs, SMD = -1.4, 95% CI -2.51 to -0.29), depression (1 RCT; MD = 2.10, 95% CI 1.05 to 3.15), and self-efficacy (1 RCT; MD = 4.4, 95% CI 2.77 to 6.03). Education/advice conferred less benefit than sham Kinesio taping for improving fear avoidance regarding physical activity (1 RCT, MD = 5.41, 95% CI 0.28 to 10.54). Compared with usual care, education/advice improved pain (1 RCT, MD = -2.10, 95% CI -3.13 to -1.07) and function (1 RCT, MD = -7.80, 95% CI -14.28 to -1.32). There was little or no difference between education/advice and comparisons for other outcomes. For all outcomes, the certainty of evidence was very low. Conclusion: Education/advice in adults with CPLBP was associated with improvements in pain, function, HRQoL, and psychological outcomes, but with very low certainty.

OriginalsprogEngelsk
TidsskriftJournal of Occupational Rehabilitation
Vol/bind33
Udgave nummer4
Sider (fra-til)625–635
ISSN1053-0487
DOI
StatusUdgivet - dec. 2023

Bibliografisk note

Funding Information:
All team members provided DOI forms to WHO for evaluation at inception. CC, LV, DS, HY, GC, JJW, HMS report funding from the Canadian Chiropractic Guideline Initiative. ACT is funded by a Tier 2 Canada Research Chair in Knowledge Synthesis. JJW is funded by a Banting Postdoctoral Fellowship from the Canadian Institutes of Health Research (CIHR). CAH reports grants to the University of Zurich from the Foundation for the Education of Chiropractors in Switzerland, the Swiss National Science Foundation (SNSF), and the European Centre for Chiropractic Research Excellence (ECCRE) outside the submitted work. SM reports grants from the Canadian Chiropractic Association, Canadian Chiropractic Research Foundation, and Canadian Institute of Health Research outside of submitted work. JJW reports grants from the Canadian Institutes of Health Research (CIHR) and Canadian Chiropractic Research Foundation (paid to university), and travel reimbursement for research meetings from the Chiropractic Academy of Research Leadership outside the submitted work. JML reports a grant from the European Cooperation in Science and Technology (COST) outside the submitted work. AB reports grants from the Canadian Chiropractic Association, Canadian Chiropractic Research Foundation, and Health Canada outside the submitted work. JJY is funded by an Arthritis Society Canada Postdoctoral Training Fellowship, Canadian Institutes of Health Research Fellowship, and grant from the Danish Foundation for Chiropractic Research and Post-graduate Education, all outside the submitted work.

Funding Information:
Open access funding provided by University of Zurich. This work was funded by the World Health Organization (Switzerland/Ageing and Health Unit).

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