Exercise Therapy Versus Manual Therapy for the Management of Pain Intensity, Disability, and Physical Function in People With Chronic Low Back Pain: A Systematic Review With Meta-Analysis and Meta-Regression

IF 3.4 2区医学 Q1 ANESTHESIOLOGY

European Journal of Pain Pub Date : 2025-08-01 DOI:10.1002/ejp.70090

Luis González-Gómez, Jose A. Moral-Munoz, Abel Rosales-Tristancho, Alejandro Cuevas-Moreno, Melania Cardellat-González, Álvaro-José Rodríguez-Domínguez

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Abstract

Background and Objective

Guidelines recommend combining physical and psychological programmes for chronic low back pain (CLBP); however, exercise therapy (ET) and manual therapy (MT) are often delivered separately. This systematic review with meta-analysis and meta-regression of randomised controlled trials (RCTs) aimed to compare the efficacy of ET with MT in terms of pain intensity, disability and physical function in people with CLBP.

Databases and Data Treatment

MEDLINE, Web of Science, PEDro, Cochrane Library and Scopus were searched July–August 2024 for RCTs comparing ET with MT in participants aged 18–54 years. Outcomes were extracted for the short-, medium- and long-term follow-up periods. Risk of bias (RoB 2.0 Cochrane Tool) and certainty of evidence (GRADE) were appraised.

Results

Six RCTs (743 patients) were included. Meta-analyses showed, albeit non-clinically relevant, a significant difference for long-term in favour of ET for disability (SMD = −0.25, 95% CI [−0.43, −0.07], p = 0.007). Meta-regression showed that the female–male ratio, treatment duration and mean age explain variability in pain intensity and disability.

Conclusions

ET had a small beneficial effect on long-term disability in people with CLBP. Nevertheless, evidence does not provide conclusive differences between both the treatments overall, influenced by heterogeneity and the number of studies included. Biopsychosocial factors may moderate the differences in outcomes. The GRADE assessment revealed very low certainty across all outcomes, highlighting the lack of high-quality research.

Significance Statement

ET may offer small long-term benefits over MT for disability in people with CLBP. Differences seem to be influenced by sex, age and treatment duration. The choice of ET over MT, or vice versa, as a stand-alone treatment does not appear to be supported by current evidence.

PROSPERO Registration Number

CRD42024569120

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运动疗法与手工疗法对慢性腰痛患者疼痛强度、残疾和身体功能的控制：荟萃分析和荟萃回归的系统综述

背景和目的指南建议结合生理和心理治疗慢性腰痛（CLBP）；然而，运动疗法（ET）和手工疗法（MT）通常是分开进行的。本系统综述采用随机对照试验（RCTs）的荟萃分析和荟萃回归，旨在比较ET和MT在CLBP患者疼痛强度、残疾和身体功能方面的疗效。检索了MEDLINE、Web of Science、PEDro、Cochrane Library和Scopus，检索了18-54岁受试者中比较ET和MT的rct。提取了短期、中期和长期随访期间的结果。评估偏倚风险（RoB 2.0 Cochrane Tool）和证据确定性（GRADE）。结果共纳入6项rct（743例）。荟萃分析显示，尽管无临床相关性，但长期支持ET治疗残疾有显著差异（SMD = - 0.25, 95% CI [- 0.43, - 0.07], p = 0.007）。meta回归显示，男女比例、治疗时间和平均年龄解释了疼痛强度和残疾的变异性。结论：ET对CLBP患者的长期残疾有小的有益作用。然而，受异质性和纳入的研究数量的影响，总体而言，证据并未提供两种治疗之间的结论性差异。生物心理社会因素可能会缓和结果的差异。GRADE评估显示所有结果的确定性都很低，这表明缺乏高质量的研究。对于CLBP患者的残疾，ET可能比MT提供少量的长期益处。差异似乎受到性别、年龄和治疗时间的影响。目前的证据似乎不支持选择ET而不是MT作为一种单独的治疗方法，反之亦然。普洛斯彼罗注册号CRD42024569120

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来源期刊

European Journal of Pain 医学-临床神经学

CiteScore

7.50

自引率

5.60%

发文量

163

审稿时长

4-8 weeks

期刊介绍： European Journal of Pain (EJP) publishes clinical and basic science research papers relevant to all aspects of pain and its management, including specialties such as anaesthesia, dentistry, neurology and neurosurgery, orthopaedics, palliative care, pharmacology, physiology, psychiatry, psychology and rehabilitation; socio-economic aspects of pain are also covered. Regular sections in the journal are as follows: • Editorials and Commentaries • Position Papers and Guidelines • Reviews • Original Articles • Letters • Bookshelf The journal particularly welcomes clinical trials, which are published on an occasional basis. Research articles are published under the following subject headings: • Neurobiology • Neurology • Experimental Pharmacology • Clinical Pharmacology • Psychology • Behavioural Therapy • Epidemiology • Cancer Pain • Acute Pain • Clinical Trials.