interventions are widely recommended for patients with low back pain (LBP), but
a meta-analysis by Australian researchers suggests that its effects on pain and
disability are likely to be small and are supported by only moderate-quality
evidence, says a Medscape Medical News article.
The researchers included randomized controlled trials evaluating
self-management for nonspecific LBP and assessing pain and disability in their
review. They pooled data when studies were similar enough and divided analyses
into short-term (less than 6 months after randomization) and long-term (at
least 12 months after randomization) outcomes.
They found 13 original trials that met inclusion criteria. Efficacy of
self-management (including shared responsibility for a plan of care,
self-monitoring, and management of signs and symptoms) was compared with
efficacy of minimal intervention and with other interventions such as massage,
acupuncture, yoga, and exercise.
"The improvement [in pain and disability] was less than what is
generally considered worthwhile by patients," said lead author Vincinius
C. Oliveira. Specifically, the short-term improvement was -3.2 points on a
100-point scale for pain and -2.3 points for disability. According to the
authors, effect sizes of 20% to 30% are needed for patients to consider
Dawn Carnes, DO, director of the National Council for Osteopathic Research
and senior research fellow at the London School of Medicine and Dentistry in
the United Kingdom, told Medscape that
she was surprised by the strength of the authors' conclusion because small
changes in large populations (such as LBP) do make a difference at a population
Carnes also voiced concerned about the review's inclusion criteria. She
said, "[The authors] included all types of [LBP], including chronic. Why
would you expect pain to improve in a chronic pain population, where drugs
don't even work for these people? Similarly, disability is unlikely to change
in chronic patients, especially those with permanent bony or physiological
The researchers told Medscape that
they "were surprised by lack of definition criteria for self-management.
The study raised questions that our group is currently working on such as
consensus on what self-management for [LBP] is among experts, including
clinicians and researchers."
In comparing self-management with minimal intervention, the authors found
"moderate-quality evidence that self-management interventions have small
but statistically significant effects, compared to minimal interventions, on
pain and disability for LBP."
In addition, they found only low-quality evidence that self-management is
not better than massage, acupuncture, yoga, and exercise in reducing pain or
disability in LBP.
The study was published online October 27
and in the November print issue of Arthritis Care & Research.
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