Article

Exercise programs may vary in terms of duration, frequency, and
dosage; whether they are supervised; and whether they include a home-based
program. Uncritical pooling of heterogeneous exercise trials may result in
misleading conclusions regarding the effects of exercise on chronic low back pain
(CLBP).
The purpose of this study was to establish the effect of
exercise on pain and disability in patients with CLBP, with a major aim of
explaining between-trial heterogeneity. DATA SOURCES: Six databases were searched
up to August 2008 using a computerized search strategy. STUDY SELECTION: Eligible
studies needed to be randomized clinical trials evaluating the effects of
exercise for nonspecific CLBP. Outcomes of interest were pain and disability
measured on a continuous scale. DATA EXTRACTION: Baseline demographic data,
exercise features, and outcome data were extracted from all included trials. DATA
SYNTHESIS: Univariate meta-regressions were conducted to assess the associations
between exercise effect sizes and 8 study-level variables: baseline severity of
symptoms, number of exercise hours and sessions, supervision, individual
tailoring, cognitive-behavioral component, intention-to-treat analysis, and
concealment of allocation. LIMITATIONS: Only study-level characteristics were
included in the meta-regression analyses. Therefore, the implications of the
findings should not be used to differentiate the likelihood of the effect of
exercise based on patient characteristics. CONCLUSIONS: The results show that, in
general, when all types of exercise are analyzed, small but significant
reductions in pain and disability are observed compared with minimal care or no
treatment. Despite many possible sources of heterogeneity in exercise trials,
only dosage was found to be significantly associated with effect sizes.

Langue : ANGLAIS