Table 2
Characteristics of included RCTs (n 70)
Age, mean
(y)
Female
(%)
Author and country
Setting
Treatment
Albaladejo et al Spain [w20]
Primary care
Arribas et al Spain[w21]
National health centres
Bendix et al, Denmark[w22]
General practice
51
51
53
39
39
40
43
68
63
72
64
64
66
69
Bronfort et al, USA[w23]
College outpatient clinic
Bronfort et al USA[w24]
Physical therapy clinic
Browder et al USA[w25]
Physical therapy clinics
41
40
41
45
45
46
40
38
Burton et al, UK[w26]
General practice
Cambron et al, USA[w27]
Chiropractic clinic + hospital clinic +
General population
Education & physiotherapy
Education
Usual GP care
GDS physical therapy
Electrotherapy
Functional restoration (PT + OT + Psychological)
Outpatient intensive physical training: Aerobics + strengthening exercises +
fitness machines
Spinal manipulation & trunk strengthening exercise
NSAID & Trunk strengthening exercise
Spinal manipulation & Stretching exercise
Supervised exercises
Chiropractic
Home exercises
Extension orientated exercises
Strengthening exercises
The Back Book + usual care (GP & osteopathic care)
The traditional Handy Hints & usual care (GP & osteopathic care)
Chiropractic flexion distraction procedure
42
54
44
39
57
66
58
31
32
11
12
34
Cecchi et al Italy[w28]
Rehabilitation department
Chan et al Hong Kong[w29]
Physiotherapy
Chang et al Taiwan[w30]
General population
Active trunk exercise program
Spinal manipulation
Individual physiotherapy
Back school
Aerobic training
Usual physiotherapy
Piroxicam sachet
41
58
61
58
47
46
34
41
69
61
70
79
77
30
Duration of Sample size
back pain,
of trial
mean (weeks)
arms
100
139
109
78
67
48
51
156
104
120
249
250
250
9
9
54
63
71
52
51
100
100
101
26
22
83
79
123
112
70
70
70
24
22
23
Chok et al, Singapore[w31]
Physiotherapy + Orthopaedic clinics +
A/E
Costa et al Australia[w32]
Physical therapy clinics
Constant et al, France[w33]
Critchley et al UK[w34]
Di Cesare et al Italy[w35]
Djavid et al Iran[w36]
Dufour et al Denmark[w37]
Dundar et al Turkey[w38]
Fritz et al USA[w39]
Frost et al, UK[w40]
Geisser et al, USA[w41]
George et al, USA[w42]
Glasov et al Australia[w43]
Glomsrod et al, Norway[w44]
Goldby et al, UK[w45]
Piroxicam tablets
Physical therapy (endurance exercise at the PT department) + back hot pack
Back hot pack (Home)
Exercise
Detuned diathermy and detuned USS
General practice
Spa therapy & usual GP care
Waiting list group & usual GP care
Individual physiotherapy
Physiotherapy department
Spinal stabilisation
Pain management
Trigger point mesotherapy
Physical therapy clinics
Acupuncture point mesotherapy
Low level laser (LLL)
Occupational clinic
LLL + exercise
Placebo LLL + exercise
Group based multidisciplinary therapy
Rheumatology clinics
Individual therapist assisted exercises
Aquatic exercise
Physical therapy clinics
Land based exercise
Traction plus EOT
Physical therapy clinics
Extension orientated therapy (EOT)
Physiotherapy
Routine physiotherapy & advice book
Advice from physiotherapist & advice book
University spinal programme
Manual therapy & Specific exercise (self corrections, stretching, strengthening)
Sham Manual therapy & Specific exercise
Manual Therapy & Non-specific exercise
Sham Manual Therapy & non-specific exercise
Physical therapy
Standard care physical therapy
Fear-avoidance based physical therapy
Laser acupuncture
General population
Sham laser
Physicians clinics and General population Active back school (Lectures and back exercises)
Usual medical care
General practice + hospital physicians
Spinal stabilisation & Attending the back school
34
38
26
20
4
34
55
53
29
58
62
4
335
328
45
44
44
53
53
40
38
36
41
41
35
35
42
41
42
40
39
39
37
46
37
40
58
49
41
39
43
59
71
62
55
55
56
37
17
57
56
47
48
55
58
58
47
67
56
80
61
53
62
95
62
65
57
68
275
346
348
22
21
118
110
106
514
540
284
370
370
284
4
4
19
38
28
77
77
63
63
71
72
69
29
33
20
21
20
142
144
32
33
31
33
144
142
26
25
24
25
32
34
45
45
37
35
84
Hay et al, UK[w46]
General practice
Heymans et al, Netherlands[w47] Occupational healthcare
Hseih et al, USA[w48]
General population
Hurley et al, UK[w49]
Physiotherapy + General practice + self
referral
Hurwitz et al, USA[w50]
Managed care facility
Hurwitz et al, USA[w51]
Network of healthcare
Jellema et al, Netherlands[w52]
General practice
Kaapa H, Finland[w53]
Occupational healthcare
Kankaanpaa et al, Finland[w54]
Occupational healthcare
Kapitza et al Germany[w55]
General population
Manual therapy & Attending the back school
Education (Booklet: Back in action) & Attending the back school
A brief programme of pain management (general fitness and exercise at clinic
and home, explanation about pain mechanisms, distress, encouragement of
positive coping strategies, overcoming fear of “hurt=harm”, and implementation
of a graded return to usual activities)
Physiotherapy including manual therapy techniques
Usual Dutch occupational physician care
Low intensity back school
High intensity back school
Joint manipulation & myofascial therapy
Joint manipulation
Myofascial therapy
Back school
Manipulation therapy (Passively move intervertebral joint within or beyond its
range)
Interferential therapy (Electrical stimulation)
Manipulation & interferential therapy
41
42
40
70
68
50
89
40
201
41
41
41
40
48
47
49
48
40
55
17
22
23
33
33
33
40
57
35
35
35
12
12
12
11
8
201
103
98
98
52
48
51
48
80
40
41
62
60
8
8
80
80
Chiropractic care only
Chiropractic care & physical modalities (Heat/cold, USS)
Medical care (excluding physical treatment) only
Medical care & physical modalities (Heat/cold, USS)
Chiropractic care only
Chiropractic care & physical modalities (Heat/cold, USS)
Minimal intervention strategy (Assessing psychosocial risks, providing
information on back pain and treatments & advice on self care)
Usual GP care
Multidisciplinary rehabilitation: guided, group programme. : CBT, relaxation,
back school education & physical therapy
Individual physiotherapy
Active rehabilitation: guided exercises in a dept + behavioural support
Passive treatment: which they considered as minor to the active arm, e.g.
massage and thermal treatment
Contingent biofeedback
Non-contingent biofeedback (placebo)
52
54
49
49
52
53
43
49
58
47
54
49
58
48
2
169
172
170
170
340
340
143
42
46
47
100
2
72
171
59
47
40
39
100
34
33
63
61
30
24
53
54
67
62
655
800
21
21
Karjalainen et al 2003 & 2004,
Finlands[w56, w57]
General practice
Kennedy et al UK[w58]
Primary care
Kerr et al, UK[w59]
General practice
Kovacs et al Spain[w60]
Nursing home consulters
Kuukkanen et al, Finland[w61]
Occupational healthcare
Leclaire et al, Canada[w62]
Private physiatrist clinic
Lindstrom et al, Sweden[w63]
Occupational healthcare
Linton et al, Sweden[w64]
General practice + general population
Luijsterburg et al
Netherlands[w65]
Primary care
Machado et al Brazil[w66]
Physiotherapy
Mannion et al 1999& 2001,
Finland[w67,w68]
General population
Maul et al, Switzerland[w69]
Occupational healthcare
Mehling et al, USA[w70]
General practice
Moseley L, Australia[w71]
Physiotherapy + General practice
Mini-intervention (Specific back exercises, reduce patient concerns & encourage
physical activity)
Mini-intervention & worksite visit
Usual GP care
Acupuncture +back book
Sham acupuncture + back book
Acupuncture
Placebo TENS (non-functioning)
Back book education
Back guide education
Pamphlet with cardiovascular health advice
Intensive training: intensive progressive exercises guided at the gym + home
exercises
Home exercise only: same as intensive, but unguided
Control: usual activities, no trial exercises
Standard care (rest, analgesics, physio) & Swedish back school
Standard care (rest, analgesics, physio)
Swedish back school & workplace visit + graded exercise (CBT approach)
Usual care: rest& analgesics & physical treatment
Back pain pamphlet
Comprehensive information package
CBT intervention
Physical therpay + GP care
Usual GP care
Psychotherapy
Exercise
Modern active individual physiotherapy: strengthening, coordination and
aerobics exercises, instructions on ergonomic principles + home exercises
Muscle reconditioning on training devices (small groups)
Low impact aerobic/stretching (groups)
Back school & exercise
Back school
Breath therapy
Physical therapy: soft tissue mobilisation, joint mobilisation and exercises
Physiotherapy
44
59
56
44
43
47
45
43
43
80
81
80
57
60
46
58
50
65
66
63
64
62
51
57
24
24
30
30
233
199
241
29
86
73
45
44
44
42
48
54
43
41
24
38
71
74
70
57
43
45
42
46
40
81
59
61
356
206
520
45
44
38
39
50
49
43
54
55
504
676
70
58
64
51
57
32
32
29
28
82
86
51
52
70
66
107
67
68
16
17
46
47
44
97
86
16
12
29
Niemisto et al 2003& 2005,
Finland[w72, w73]
Nordeman et al, Sweden[w74]
Paatelma et al Finland[w75]
Peloso et al, USA[w76]
Rantonen et al Finland[w77]
Rasmussen-Barr et al
Sweden[w78]
General population
Usual GP care
Manipulation, exercise & physician consultation
38
37
54
55
37
39
41
44
44
44
58
58
44
45
44
37
53
63
50
42
29
35
64
61
35
28
32
50
312
Advice and walking
Stabilizing training (Individual) (Cognitive + stabilisation of spinal muscles)
Manual treatment (Individual) (Other muscles exercises, no manipulation)
Isodynamic lumbar extension
40
39
37
50
50
70
78
44
572
Vibration exercise (On a machine with a vibrating platform)
Traditional chiropractic bone setting
Physical therapy
Coordination of primary healthcare program
Usual GP care
Back school
Physical therapy
Mensediesk exercise group intervention
54
41
42
37
38
47
51
40
52
45
43
33
23
75
78
53
754
30
32
676
30
33
28
54
56
75
75
34
Waiting list group
Graded activity (Physiotherapy + OT)
40
39
49
5
578
9
35
67
Usual OT care
Medical exercise therapy (MET)
Conventional physiotherapy (CP)
37
42
43
8
52
48
8
67
71
67
Physician consultation only
General practice + physical therapy dept Early access to physio (Individualised, exercise, advice, group education)
Waiting list control
Orthopaedic manual therapy
Occupational clinic
McKenzie technique
Advice only
Outpatients
Tramadol & Acetamenophen combination tablets 375/325 2 PRN
Placebo tablets 2 PRN
Physical therapy
Occupational clinic
Exercise
Back book education
Graded exercises
Physiotherapy
Rasmussen-Barr et al,
Sweden[w79]
Physiotherapy
Rittweger et al, Germany[w80]
General population
Ritvanen et al, Finland[w81]
General population
Rossignol et al, Canada[w82]
Workers compensation board
Sahin et al Turkey[w83]
Physical therapy clinics
Soukup et al, Norway[w84]
General practice + general population +
referrals
Staal et al & Hlobil et al,
Netherlands[w85, w86]
Occupational healthcare
Torstensen et al, Norway[w87]
Social security offices
312
676
520
728
468
603
28
102
102
32
28
45
52
37
167
169
43
43
40
36
35
24
23
30
Tsui et al, Hong Kong[w88]
Physiotherapy
Turner et al, USA[w89]
General practice + physicians + general
population
Unsgaard-Tondel et al Norway
Primary care
van der Roer et al Netherlands
Physiotherapy
Wand et al, UK
General practice + A/E patients
Werners et al, Germany
General practice
Yelland et al, Australia
General practice
Self exercise
Electro-acupuncture & back exercise
Electrical heat acupuncture + back exercise
Back exercise only
Relaxation training (group)
Cognitive therapy (group)
Cognitive therapy & Relaxation training (group)
Waiting list control
Low load exercise
high load sling exercise
General exercise
Intensive protocol training
Guidelines based physiotherapy
Assess & Advice & Physiotherapy
Assess & Advice & wait
Interferential therapy: electrotherapy, to stimulate muscles fibres
Motorised lumbar traction & massage
Glucose lignocaine injection
Exercise (Alternating: flexion and extension of spine and hips)
Saline injection
Normal activity
40
40
39
41
41
43
36
42
42
34
35
38
39
52
49
50
51
51
76
71
62
81
64
65
55
48
44
55
43
49
59
55
56
58
39
54
50
312
468
312
54
47
770
718
759
733
70
14
14
14
24
23
25
30
36
36
37
60
54
43
51
68
72
28
26
27
29