The treatment effect of exercise programmes for chronic low back pain

Rationale This paper summarizes evidence of long‐term effectiveness of physiotherapy exercise therapy for chronic low back pain (LBP). Methods A literature search was undertaken for experimental studies (2001–2007), which reported any post‐intervention (follow‐up) outcomes. Studies were critically appraised using the PEDro instrument. Comparative statistics were calculated, relative to the type of follow‐up outcome data. Results Fifteen moderate quality trials were included [mean PEDro score 7.7, SD 1.3 (range 5–10)]. Nine trials reported pain scales, and six reported LBP reoccurrence. Trials which reported on pain scales at 6‐month follow‐up found significant differences in favour of exercise [standardized mean differences −0.57, 95%CI −0.75 to −0.39 (555 participants)]. At 12‐month follow‐up, a small pain scale benefit from exercise persisted [standardized mean differences −0.25, 95%CI −0.44 to 0.06 (434 participants)]. There was unconvincing evidence of exercise effectiveness on pain scales after this time. Three of the four trials which reported dichotomous outcomes at 6‐month follow‐up demonstrated large clinical benefits of exercise (relative risk reduction of reoccurrence 45–246%, absolute risk reduction of reoccurrence 36–42 for every 100 patients; and number needed to treat approximating 3, to prevent one patient suffering a LBP recurrence). The effect of exercise on LBP reoccurrence was variably reported beyond 6 months. Conclusion Exercise programmes are effective for chronic LBP up to 6 months after treatment cessation, evidenced by pain score reduction and reoccurrence rates. The way in which follow‐up data are reported assists clinical interpretation of research findings.