Individualized exercise in chronic non-specific low back pain: a systematic review with meta-analysis on the effects of exercise alone or in combination with psychological interventions on pain and disability

ABSTRACT This systematic review with meta-analysis and meta-regression investigated the effects of individualized exercise interventions consisting with or without combined psychological intervention on pain intensity and disability in patients with chronic non-specific low-back-pain. Databases were searched up to 31 January 2022 and we selected randomized controlled trials involving adults with chronic non-specific low-back-pain being treated with individualized/personalized/stratified exercise interventions with or without psychological treatment compared to any control. Fifty-eight studies (n = 10084) were included. At short-term follow-up (12 weeks), low-certainty evidence for pain intensity (SMD -0.28 [95%CI -0.42 to -0.14]) and very low-certainty evidence for disability (−0.17 [-0.31 to -0.02]) indicates effects of individualized versus active exercises, and very low-certainty evidence for pain intensity (−0.40; [-0.58 to -0.22])), but not (low-certainty evidence) for disability (−0.18; [-0.22 to 0.01]) compared to passive controls. At long-term follow-up (1 year), moderate-certainty evidence for pain intensity (−0.14 [-0.22 to -0.07]) and disability (−0.20 [-0.30 to -0.10]) indicates effects versus passive controls. Sensitivity analyses indicates that the effects on pain, but not on disability (always short-term and versus active treatments) were robust. Pain reduction caused by individualized exercise treatments in combination with psychological interventions (in particular behavioural-cognitive therapies) (−0.28 [-0.42 to -0.14], low certainty) is of clinical importance. Certainty of evidence was downgraded mainly due to evidence of risk of bias, publication bias and inconsistency that could not be explained. Individualized exercise can be recommended from a clinical point of view to treat pain and disability in chronic non-specific low-back-pain. Sub-group analysis suggests a combination of individualized exercise (especially motor-control based treatments) with behavioural therapy interventions to booster effects. Certainty of evidence was moderate for long-term follow-up. PROSPERO registration CRD42021247331