Comparative Effectiveness of Personalised Exercise Therapies Alone or Combined With Psychological Interventions for Chronic Non-Specific Low Back Pain: A Systematic Review With Network Meta-Analysis

OBJECTIVE: To estimate the comparative effectiveness of tailored exercise therapies in people with non-specific chronic low back pain. DESIGN: Systematic review with network meta-analysis. LITERATURE SEARCH: We searched PubMed, Cochrane Library, EMBASE, CINAHL, Web of Science, and Google Scholar from inception to 27 August 2024. ELIGIBILITY CRITERIA FOR SELECTING STUDIES: Randomised controlled trials (RCTs) studying the effects of any type of tailored exercise therapies in persons with chronic, non-specific low back pain. Outcomes of interest were pain intensity and disability. Usual care was the standard comparator; effect sizes were calculated as Hedges’ g. DATA SYNTHESIS: We used the R package netmeta to conduct network meta-analyses. Network plotting and P-scores summarised the intervention hierarchy; usual care acted as the main comparator. Risk of bias was assessed using the Cochrane risk of bias tool (ROB 2.0). The certainty of evidence was evaluated using the CINeMA (Confidence in Network Meta-Analysis) tool. RESULTS: We included 58 randomised trials (n = 10,510 participants) with 29 different treatment or control categories. Risk of bias for pain intensity and disability was high. Cognitive functional therapy alone (SMD Disability = −0.89 [95% confidence interval = −1.11 to −0.66]; SMD Pain = −0.71 [-0.97 to −0.45]) or combined with biofeedback (SMD Disability = −1.00 [-1.36 to −0.64]) were, with moderate certainty evidence, the most effective treatments for pain intensity (k= 49 RCTs) and disability (k= 45) reduction when compared to care as usual. CONCLUSION: In comparison to usual care, only cognitive functional therapy standalone or with biofeedback likely result in a large disability reduction.