Comparing the effects of home exercise programmes and supervised exercise therapy on functional disability in adults with chronic non-specific low back pain. A Systematic Review of Randomised Controlled Trials

Background:

Low back pain is the highest contributor to years lived with disability. Many patients experience symptoms lasting over 12 weeks, often without a specific pathology. It remains unclear whether one type of exercise is superior for treating chronic non-specific low back pain (CNSLBP), and few trials have explored whether the exercise setting influences outcomes.

Objective:

To compare the effects of home exercise programmes (HEP) and supervised exercise therapy (SE) on functional disability in adults with CNSLBP.

Method:

MEDLINE, Embase and PEDro were searched for randomised controlled trials (RCTs) evaluating adults (18–65 years) with CNSLBP lasting more than 12 weeks. Trials had to compare SE and HEP effects on functional disability. Databases were searched from inception to January 17^th, 2023. Quality was assessed with Cochrane Risk of Bias 2.0 tool (RoB2). A narrative synthesis was conducted.

Results:

Database search resulted in 2310 hits. 119 were screened in full text, and seven RCTs were included in this review. Most trials were of low quality, scoring either “high risk” or “some concerns” on RoB2. SE was more effective than HEP in four trials, with Cohen’s d effect sizes ranging from near-medium to very large ($d=0.43$ to 1.12) and statistical significance varying from non-significant (i.e. $>$ 0.05) to strong (i.e. $<$ 0.01).

Conclusions:

There is some evidence that supervised exercise may be more effective than home exercise for improving functional disability in adults with CNSLBP. However, the quality of the trials was low. Higher quality trials are needed to establish definitive conclusions.