Late-breaking Poster Sydney Spinal Symposium 2023

Non-pharmacological and non-surgical treatments for low back pain in adults: an overview of Cochrane Reviews   (#38)

Rodrigo Rizzo 1 2 , Aidan Cashin 1 2 , Benedict Wand 3 , Neil O'Connell 4 , Michael Ferraro 1 2 , Saurab Sharma 1 2 , Hopin Lee 5 , Edel O'Hagan 1 2 , Christopher Maher 6 , Andrea Furlan 7 , Maurits W van Tulder 8 , James McAuley 1 2
  1. University of New South Wales, Sydneyy, NSW, Australia
  2. Centre for Pain IMPACT , Neuroscience Research Australia, Sydney, NSW, Australia
  3. School of Health Sciences and Physiotherapy, The University of Notre Dame Australia, Fremantle, Australia
  4. Department of Health Sciences, Centre for Health and Wellbeing Across the Lifecourse, Brunel University London, Uxbridge, London, UK
  5. Nuffield Department of Orthopaedics, Rheumatology and Musculoskeletal Sciences (NDORMS), University of Oxford, Oxford , UK
  6. Sydney Musculoskeletal Health, The University of Sydney, Sydney, NSW, Australia
  7. Institute for Work & Health, Toronto, Canada
  8. Department of Human Movement Sciences, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, Amsterdam, Netherlands

Clinical guidelines recommend non-pharmacological and non-surgical interventions for managing low back pain (LBP). We aimed to summarise the evidence from Cochrane reviews on the efficacy and safety of non-pharmacological and non-surgical interventions for adults with non-specific LBP. We searched randomised controlled trials in the Cochrane Database (up to 15 April 2023). We assessed the quality of the reviews and the certainty of the evidence (AMSTAR-2/GRADE). We included 31 Cochrane reviews of 644 trials that randomised 97,183 adults. There is high confidence in the findings of 19 reviews. The effects were classified into small (less than 10 points on a 0-100 scale or 0.2-0.5 SMD), medium: (>10-20 points on a 0-100 scale or >0.5-0.8 SMD), large effect (≥20 points on a 0-100 scale or ≥0.8 SMD). The best available evidence had moderate certainty. Acute/subacute LBP: Compared to placebo, there is no difference in function in the short term for spinal manipulation. Chronic LBP: Acupuncture: Compared to sham, it provides a small improvement in function in the short term. Compared to no treatment, it provides a medium reduction in pain intensity in the short term and a small improvement in function in the short term. Compared to usual care, it provides a small improvement in function in the short term. Exercise: Compared to no treatment/usual care, it provides a small to medium reduction in pain intensity in the short term and a small improvement in function in the short term.Manual therapies: Compared to sham traction, there is no difference in pain intensity in the short term for traction. Multidisciplinary: Compared to usual care, it provides a medium reduction in pain intensity in the short term and a small improvement in function in the short term. Psychological: Compared to usual care, it reduces pain intensity in the short term, but there is no evidence of it on function in the short term. There is only low certainty evidence that non-pharmacological interventions may not be associated with serious adverse events. In the absence of high-certainty evidence, providers should prioritise 'effective/low risks' interventions with moderate certainty evidence for people with low back pain.