Effectiveness of exercise-based, neuromuscular, and multidisciplinary interventions for subacute low back pain: a systematic review

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Introduction Treatments for low back pain (LBP), such as exercise, neuromuscular electrical stimulation (NMES) and multidisciplinary programs, have been proposed, but their effectiveness is uncertain. This review evaluates the exercise-based interventions, NMES, multidisciplinary programs, and their impact on physical performance, pain relief, disability reduction, and muscle endurance in managing subacute LBP. Methods This systematic review includes randomised controlled trials (RCTs), cohort studies, and clinical trials evaluating interventions for subacute LBP. A comprehensive literature search was conducted in EMBASE, MEDLINE, Cochrane Library, CINAHL, Scopus, and WOS (from inception until 20 July 2025). The study focused on factors such as participant age, study design, sample size, interventions, functional disability, muscle endurance, and quality of life, and the instruments used to assess them were the ODI (Oswestry Disability Index), RMDQ (Roland-Morris Disability Questionnaire), NPRS (Numeric Pain Rating Scale), and endurance tests. Risk of bias was assessed using Cochrane RoB2, and study quality was evaluated with the PEDro scale and QUIPS tools, by Fleiss-Kappa and Cohen’s Kappa. Results NMES combined with exercise significantly improves muscle strength and endurance (effect size: 0.5–0.9, p = 0.002–0.006). Coordinated care has a 70% recovery rate compared to 50% with normal care (d = 0.5). Structured exercise programs showed significant reductions in pain and disability, with the highest SRM (standardised response mean = 2.85). Supervised interventions demonstrated superior outcomes to non-supervised care (Cohen’s d of 0.65 (RMQ), 0.47 (ODI) and 0.43 (VAS) pain). Conclusions Key findings indicate that NMES combined with exercise significantly improves muscle strength, pain reduction, and disability scores.