Efficacy of conservative therapy in older people with nonspecific low back pain: A systematic review with meta-analysis and GRADE recommendations

•Low back pain is prevalent in older people affecting independence and autonomy.•Evidence of conservative therapy for older people with low back pain is scarce.•This review found that exercise has a short-term effect on disability.•Trigger point acupuncture has also short-term effects on disability and pain. This systematic review aimed to investigate the effectiveness of conservative therapy in older people with nonspecific low back pain. Searches were conducted on Medline, Amed, Embase, Cochrane, Psycinfo and Pedro databases up to 2020. Risk of bias were assessed using the 0−10 PEDro scale. Weighted mean differences (WMDs) or mean differences (MDs) with 95 % confidence intervals (CIs) were reported for each conservative therapy, and strength of the current evidence was assessed using the GRADE approach. Eleven original trials were included investigating effects on disability, pain, coping, quality of life, strength, balance, depression, falls, sleep quality, mobility, body mass index, percentage body fat, trunk muscle mass and waist-to-hip ratio. Moderate quality evidence showed short-term effects of trigger point acupuncture on disability (WMD = 5.0 points [95 % CI 3.5–6.4] on a 25-point scale) and pain (WMD = 35.9 points [95 % CI 22.2–49.7] on a 101-point scale), and of exercise on disability (WMD = 1.7 points [95 % CI 0.3–3.0]) when compared with control (placebo, sham, waiting list or no intervention). Moderate quality evidence showed no short-term effect of exercise on coping (95 % CI −5.0 to 14.6). Moreover, evidence for other important outcomes in older people is scarce and we did not find any trial investigating pharmacological therapies. Findings support partially exercise and trigger point acupuncture to improve disability and/or pain. Future trials with appropriate sample sizes are likely to impact on the estimates and need to clarify medium- and long-term effects.