Introduction
Low back pain (LBP) is the leading cause of disability both in Canada and worldwide. Graded activity incorporates exercise with a biopsychosocial model of pain, using principles of cognitive behavioural therapy, and has recently received increasing attention. The number of studies on graded activity for LBP has increased in recent years. Therefore, this Cochrane systematic review aims to assess the benefits and harms of graded activity compared to placebo, sham or no-trial treatment on functional limitation and pain in adults with chronic non-specific low back pain.
Methods
This Cochrane systematic review is part of an overarching Network Review, which aims to update the Cochrane review ‘Exercise therapy for chronic low back pain’ Hayden 2021. This collaborative review model aims to foster greater collaboration among LBP researchers while adhering to robust, standard systematic review methods. The electronic search was conducted the electronic search on Cochrane CENTRAL, MEDLINE, and Embase on November 18, 2021. We included only randomized controlled trials (RCTs), which looked at the effectiveness of graded activity on adults with chronic non-specific low back pain compared to placebo/sham/attention control or no-trial treatment (i.e., no specific treatment provided by the trial, waiting list, to usual care) on functional limitation and pain intensity. No restrictions were placed on the date or language of publication. Study selection, data extraction, and risk of bias assessment were conducted by pairs of independent reviewers. The Cochrane Risk of Bias tool 1 was used to assess the quality of the included studies. The GRADE approach was used to evaluate the certainty of the current evidence.
Results
Our electronic search identified 47,307 records, from which 26,043 duplicate recordings were excluded. 1,396 full-texts were assessed, and three trials (six recordings) were included in this review. We found very low certainty evidence (downgraded due to risk of bias, inconsistency, and imprecision) of no difference between graded activity intervention and no trial treatment on pain intensity and functional limitation in the short term. There is also low certainty evidence (downgraded due to risk of bias, inconsistency, and imprecision) of a small effect favouring the graded activity intervention compared to no trial treatment on functional limitation at moderate-term.
Discussion
More high-quality studies are needed to compare graded activity to placebo or no-trial intervention for adults with chronic non-specific LBP.Additionally, qualitative studies focused on understanding the lived experiences of adults with chronic non-specific LBP who have received a graded activity intervention need to be conducted.