
Preprints with The Lancet is part of SSRN´s First Look, a place where journals identify content of interest prior to publication. Authors have opted in at submission to The Lancet family of journals to post their preprints on Preprints with The Lancet. The usual SSRN checks and a Lancet-specific check for appropriateness and transparency have been applied. Preprints available here are not Lancet publications or necessarily under review with a Lancet journal. These preprints are early stage research papers that have not been peer-reviewed. The findings should not be used for clinical or public health decision making and should not be presented to a lay audience without highlighting that they are preliminary and have not been peer-reviewed. For more information on this collaboration, see the comments published in The Lancet about the trial period, and our decision to make this a permanent offering, or visit The Lancet´s FAQ page, and for any feedback please contact preprints@lancet.com.
Non-Pharmacological Interventions for Chronic Low Back Pain: What Works Best? A Network Meta-Analysis
35 Pages Posted: 2 Oct 2018
More...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: Suggested Citation