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Non-Pharmacological Interventions for Chronic Low Back Pain: What Works Best? A Network Meta-Analysis

35 Pages Posted: 2 Oct 2018

See all articles by Rongzhong Huang

Rongzhong Huang

Kunming University of Science and Technology, First People’s Hospital of YunNan Province, Department of Geriatrics

Yu Cao

Kunming University of Science and Technology

Jie Ning

Kunming University of Science and Technology

Hongrong Li

Kunming University of Science and Technology, First People’s Hospital of YunNan Province, Department of Cardiothoracic Surgery

Sanrong Wang

Chongqing Medical University

Zengdong Meng

Kunming University of Science and Technology - First People's Hospital of Yunnan Province

Yu Xu

Chongqing Medical University

Lihong Jiang

Kunming University of Science and Technology, First People’s Hospital of YunNan Province, Department of Cardiothoracic Surgery; Kunming University of Science and Technology, First People’s Hospital of YunNan Province, Department of Geriatrics

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Abstract

Background: Several non-pharmacological strategies are widely-used in patients with chronic low back pain. However, which of these strategies is more effective remain undetermined. We conducted this network meta-analysis to assess and compare the effectiveness of various non-pharmacological strategies for managing chronic low back pain.

Methods: We searched Medline, Scopus, Web of Science, Embase and Cochrane-Central through February 2018. We included randomized trials that enrolled >100 patients and compared different non-pharmacological interventions to each other or standard care. A network meta-analysis with frequentist approach was performed using R software. We used the P-score to rank the efficacy of treatments and the net-split function to assess the consistency between direct and indirect evidence. The main outcomes included visual analogue scale (VAS) and Rolland-Morris Disability Questionnaire (RMDQ). The outcomes were analyzes as mean difference (MD) with 95% confidence interval (CI).

Findings: Seventy-seven trials randomizing 14850 patients into nine treatment groups were included. For VAS, massage (MD=-4.51, 95%CI [-7.76, -1.26]) and spinal manipulation (MD=-2.11, 95%CI [-3.63, -0.60]) were associated with significant reductions than standard care. In terms of RMDQ, massage (MD=-2.12, 95%CI [-3.73, -0.50]) and yoga (MD=-1.84, 95%CI [-3.45, -0.22]) were associated with significant reductions than standard care. Moreover, massage was associated with a significant reduction in healthcare utilization at 12 months (MD=-0.90, 95%CI [-1.78, -0.02]) than acupuncture. The P-score ranking indicated that massage ranked the highest in terms of reducing VAS (P-score=0.94), RMDQ (P-score=0.92) and Oswestry disability scale (P-score=0.76). Spinal manipulation (P-score=0.79) ranked the highest in reducing health care utilization at 12 months, while exercise (P-score= 0.76) ranked the highest in reducing sick leaves' duration.

Interpretation: Our network meta-analysis showed significantly higher efficacy for most assessed non-pharmacological strategies than standard care, with message achieving the highest rank in reducing back pain and associated disability.

Funding Statement: This work was supported by the National Natural Science Foundation of China (grant nos.31300137).

Declaration of Interests: The authors state: "None to declare."

Ethics Approval Statement: All steps of this network meta-analysis were performed following the guidelines of the PRISMA checklist.

Keywords: Exercise; Massage; Network Meta-Analysis; Non-Pharmacological; Spinal Manipulation

Suggested Citation

Huang, Rongzhong and Cao, Yu and Ning, Jie and Li, Hongrong and Wang, Sanrong and Meng, Zengdong and Xu, Yu and Jiang, Lihong, Non-Pharmacological Interventions for Chronic Low Back Pain: What Works Best? A Network Meta-Analysis (January 9, 2018). Available at SSRN: https://ssrn.com/abstract=3244928 or http://dx.doi.org/10.2139/ssrn.3244928

Rongzhong Huang

Kunming University of Science and Technology, First People’s Hospital of YunNan Province, Department of Geriatrics

China

Yu Cao

Kunming University of Science and Technology

Kunming Yunnan China
Kunming, Yunnan
China

Jie Ning

Kunming University of Science and Technology

Kunming Yunnan China
Kunming, Yunnan
China

Hongrong Li

Kunming University of Science and Technology, First People’s Hospital of YunNan Province, Department of Cardiothoracic Surgery

China

Sanrong Wang

Chongqing Medical University

China

Zengdong Meng

Kunming University of Science and Technology - First People's Hospital of Yunnan Province

Kunming
China

Yu Xu

Chongqing Medical University

China

Lihong Jiang (Contact Author)

Kunming University of Science and Technology, First People’s Hospital of YunNan Province, Department of Cardiothoracic Surgery ( email )

China

Kunming University of Science and Technology, First People’s Hospital of YunNan Province, Department of Geriatrics ( email )

China

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