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MSK Pain – Reduces work absence

Evidence Summary (Updated 2022)
A Cochrane review concluded that physical conditioning interventions have a small positive effect on reducing sick leave in those with chronic low back pain at 12 months follow up (23). There was no effect in those with acute low back pain. In those with non-specific low back pain, there is good evidence of a moderate reduction in work disability with exercise interventions versus usual care, with long-term work disability reduced by 34% (24). However, the authors were unable to determine which of the different exercise interventions were most effective, and there was no significant effect observed in the short or medium term.

Quality of Evidence
Grade B – moderate quality

Strength of recommendation
Grade 1 – strong recommendation.

Conclusion
Long-term work absence in those with chronic low back pain is not uncommon, and physical activity interventions, ideally with biopsychosocial components, are likely to benefit many.

References

  1. Hayden J, van Tulder MW, Malmivaara A, Koes BW. Exercise therapy for treatment of non-specific low back pain. Cochrane database Syst Rev [Internet]. 2005 Jul 20 [cited 2022 Aug 18];(3). Available from: https://pubmed.ncbi.nlm.nih.gov/16034851/
  2. Geneen LJ, Moore RA, Clarke C, Martin D, Colvin LA, Smith BH. Physical activity and exercise for chronic pain in adults: An overview of Cochrane Reviews. Cochrane Database Syst Rev [Internet]. 2017 Apr 24 [cited 2022 Aug 18];2017(4). Available from: https://pubmed.ncbi.nlm.nih.gov/28087891/
  3. Hayden JA, Ellis J, Ogilvie R, Malmivaara A, van Tulder MW. Exercise therapy for chronic low back pain. Vol. 2021, Cochrane Database of Systematic Reviews. John Wiley and Sons Ltd; 2021.
  4. Hayden JA, Wilson MN, Stewart S, Cartwright JL, Smith AO, Riley RD, et al. Exercise treatment effect modifiers in persistent low back pain: an individual participant data meta-analysis of 3514 participants from 27 randomised controlled trials. Br J Sports Med [Internet]. 2020 Nov 1 [cited 2022 Aug 18];54(21):1277–8. Available from: https://pubmed.ncbi.nlm.nih.gov/31780447/
  5. Vadalà G, Russo F, De Salvatore S, Cortina G, Albo E, Papalia R, et al. Physical Activity for the Treatment of Chronic Low Back Pain in Elderly Patients: A Systematic Review. J Clin Med [Internet]. 2020 Apr 1 [cited 2022 Jul 6];9(4). Available from: https://pubmed.ncbi.nlm.nih.gov/32260488/
  6. Clael S, Campos LF, Correia KL, de Lucena JMS, Gentil P, Durigan JL, et al. Exercise interventions can improve muscle strength, endurance, and electrical activity of lumbar extensors in individuals with non-specific low back pain: a systematic review with meta-analysis. Sci Rep [Internet]. 2021 Dec 1 [cited 2022 Jul 7];11(1). Available from: https://pubmed.ncbi.nlm.nih.gov/34413400/
  7. Zhu F, Zhang M, Wang D, Hong Q, Zeng C, Chen W. Yoga compared to non-exercise or physical therapy exercise on pain, disability, and quality of life for patients with chronic low back pain: A systematic review and meta-analysis of randomized controlled trials. PLoS One [Internet]. 2020 Sep 1 [cited 2022 Jul 6];15(9). Available from: https://pubmed.ncbi.nlm.nih.gov/32870936/
  8. Zou L, Zhang Y, Yang L, Loprinzi PD, Yeung AS, Kong J, et al. Are Mindful Exercises Safe and Beneficial for Treating Chronic Lower Back Pain? A Systematic Review and Meta-Analysis of Randomized Controlled Trials. J Clin Med [Internet]. 2019 May 1 [cited 2022 Jul 7];8(5). Available from: https://pubmed.ncbi.nlm.nih.gov/31072005/
  9. Kamper SJ, Apeldoorn AT, Chiarotto A, Smeets RJEM, Ostelo RWJG, Guzman J, et al. Multidisciplinary biopsychosocial rehabilitation for chronic low back pain. Cochrane database Syst Rev [Internet]. 2014 Sep 2 [cited 2022 Aug 18];2014(9). Available from: https://pubmed.ncbi.nlm.nih.gov/25180773/
  10. Parreira P, Heymans MW, van Tulder MW, Esmail R, Koes BW, Poquet N, et al. Back Schools for chronic non-specific low back pain. Cochrane database Syst Rev [Internet]. 2017 Aug 3 [cited 2022 Aug 18];8(8). Available from: https://pubmed.ncbi.nlm.nih.gov/28770974/
  11. Poquet N, Lin CWC, Heymans MW, van Tulder MW, Esmail R, Koes BW, et al. Back schools for acute and subacute non-specific low-back pain. Cochrane database Syst Rev [Internet]. 2016 Apr 26 [cited 2022 Aug 18];4(4). Available from: https://pubmed.ncbi.nlm.nih.gov/27113258/
  12. De Campos TF, Maher CG, Fuller JT, Steffens D, Attwell S, Hancock MJ. Prevention strategies to reduce future impact of low back pain: a systematic review and meta-analysis. Br J Sports Med [Internet]. 2021 May 1 [cited 2022 Jul 7];55(9):468–76. Available from: https://pubmed.ncbi.nlm.nih.gov/32646887/
  13. Bigos SJ, Holland J, Holland C, Webster JS, Battie M, Malmgren JA. High-quality controlled trials on preventing episodes of back problems: systematic literature review in working-age adults. 2009 Feb 1 [cited 2022 Aug 18];9(2):147–68. Available from: http://www.thespinejournalonline.com/article/S1529943008014307/fulltext
  14. Shiri R, Falah-Hassani K. Does leisure time physical activity protect against low back pain? Systematic review and meta-analysis of 36 prospective cohort studies. Br J Sports Med [Internet]. 2017 Oct 1 [cited 2022 Aug 18];51(19):1410–8. Available from: https://pubmed.ncbi.nlm.nih.gov/28615218/
  15. Steffens D, Maher CG, Pereira LSM, Stevens ML, Oliveira VC, Chapple M, et al. Prevention of Low Back Pain: A Systematic Review and Meta-analysis. JAMA Intern Med [Internet]. 2016 Feb 1 [cited 2022 Aug 18];176(2):199–208. Available from: https://pubmed.ncbi.nlm.nih.gov/26752509/
  16. Owen PJ, Miller CT, Mundell NL, Verswijveren SJJM, Tagliaferri SD, Brisby H, et al. Which specific modes of exercise training are most effective for treating low back pain? Network meta-analysis. 2020 Nov 1 [cited 2022 Mar 7];54(21):1279–87. Available from: https://pubmed.ncbi.nlm.nih.gov/31666220/
  17. Lawford BJ, Walters J, Ferrar K. Does walking improve disability status, function, or quality of life in adults with chronic low back pain? A systematic review. Clin Rehabil [Internet]. 2016 Jun 1 [cited 2022 Aug 18];30(6):523–36. Available from: https://pubmed.ncbi.nlm.nih.gov/26088673/
  18. Wang XQ, Zheng JJ, Yu ZW, Bi X, Lou SJ, Liu J, et al. A meta-analysis of core stability exercise versus general exercise for chronic low back pain. PLoS One [Internet]. 2012 Dec 17 [cited 2022 Aug 18];7(12). Available from: https://pubmed.ncbi.nlm.nih.gov/23284879/
  19. Kristensen J, Franklyn-Miller A. Resistance training in musculoskeletal rehabilitation: a systematic review. Br J Sports Med [Internet]. 2012 Aug [cited 2022 Aug 18];46(10):719–26. Available from: https://pubmed.ncbi.nlm.nih.gov/21791457/
  20. Macedo LG, Maher CG, Latimer J, McAuley JH. Motor control exercise for persistent, nonspecific low back pain: a systematic review. Phys Ther [Internet]. 2009 Jan [cited 2022 Aug 18];89(1):9–25. Available from: https://pubmed.ncbi.nlm.nih.gov/19056854/
  21. Denham-Jones L, Gaskell L, Spence N, Pigott T. A systematic review of the effectiveness of Pilates on pain, disability, physical function, and quality of life in older adults with chronic musculoskeletal conditions. Musculoskeletal Care [Internet]. 2021 May 24 [cited 2022 Jan 5]; Available from: http://www.ncbi.nlm.nih.gov/pubmed/34028164
  22. National Institute for Health and Care Excellence. Low Back Pain and Sciatica in Over 16s: Assessment and Management. 2016 [cited 2022 Aug 18];(November):0–816. Available from: https://pubmed.ncbi.nlm.nih.gov/27929617/
  23. Schaafsma FG, Whelan K, van der Beek AJ, van der Es-Lambeek LC, Ojajärvi A, Verbeek JH. Physical conditioning as part of a return to work strategy to reduce sickness absence for workers with back pain. Cochrane database Syst Rev [Internet]. 2013 Aug 30 [cited 2022 Aug 18];2013(8). Available from: https://pubmed.ncbi.nlm.nih.gov/23990391/
  24. Oesch P, Kool J, Hagen KB, Bachmann S. Effectiveness of exercise on work disability in patients with non-acute non-specific low back pain: Systematic review and meta-analysis of randomised controlled trials. J Rehabil Med [Internet]. 2010 Mar [cited 2022 Aug 18];42(3):193–205. Available from: https://pubmed.ncbi.nlm.nih.gov/20411212/

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