The effectiveness of physiotherapy functional restoration for post-acute low back pain: A systematic review
Manual Therapy , 07/23/2012
Richards MC et al. – Moderate to high quality evidence was found of small effects favouring physiotherapy functional restoration (PFR) compared with advice. Preliminary evidence suggested PFR is not different to other treatment types. Further high quality research is required replicating existing trial protocols.Methods
- Electronic databases searched include: MEDLINE, EMBASE, CINAHL, PsycINFO, PEDro and Cochrane CENTRAL.
- Randomised controlled trials of physiotherapy treatment for post–acute LBP combining exercise and cognitive–behavioural intervention compared with other intervention, no intervention or placebo.
- Two authors independently extracted data.
- Risk of bias was assessed using the PEDro scale and overall quality of the body of evidence was assessed using GRADE (Grading of Recommendations, Assessment, Development and Evaluation).
- Treatment effect sizes and 95% confidence intervals were calculated for pain, function and sick leave.
- Sixteen trials were included.
- Heterogeneity prevented meta–analysis for most comparisons.
- Meta–analyses showed moderate to high quality evidence of significant but small effects favouring PFR compared with advice for intermediate term function and intermediate and long term pain.
- There was however low to moderate quality evidence that PFR was no more effective than a range of other treatment types.
- Heterogeneous trials frequently contributed to very low quality evidence.