Exercise is certainly the best treatment for non-specific low back pain, but which setting is best suited to implement the exercise plan?
Home is the most accessible place to exercise for most people, but is it the most effective way to improve outcomes for people with nonspecific low back pain?
Develop your understanding of back pain
A new systematic review published in the International Journal of Environmental Research and Public Health has attempted to answer this question.
The aim of the systematic review was to assess the effect of home exercises on pain intensity and functional restrictions in low back pain.
Methods
The question at the center of this systematic review is broad and therefore the search strategy reflects this. The following keywords were searched in four databases (Pubmed, Cochrane Library, Embase and ScienceDirect):
Back pain AND (sport or physical) AND at home
The search was not limited to a date range or language and only animal testing was excluded. The full search strategy for each database is fully available.
To be included in this review article, five inclusion criteria had to be met.
Be an RCT
Participants had to be 16 years or older
Studies have unspecific low back pain
Evaluate at least one of the outcome measures – pain intensity, functional limitation and measures before and after training
The treatment had to include home exercises
Two authors reviewed and reviewed the articles for inclusion and all disagreements were resolved by a third author. The quality of the articles included was assessed using the SIGN guidelines.
Overall, the included studies within the review had good methodological quality with an average score of 75% (40-90), whereby the most frequent source of bias was a lack of blinding in the assessment.
Results and clinical implications
From an initial search result of 24,699 articles, 33 remained after screening, removal of duplicates and application of the inclusion criteria. 10 of them focused exclusively on home exercises, while 23 comprised home exercises and a different setting. A total of 9,588 participants with an average age of 49.3 years were included in the review .
26 of the 33 studies used strength-based training and 24 of them were combined with stretching. Education played a role in half of the exercise programs, as did aerobic exercise. Postural exercises, relaxation and yoga were also included in some of the studies, but were much rarer.
Brief summary of HEP for NSLBP
Exercise at home is effective in relieving pain and improving physical limitations
Exercising only at home was just as effective as at home and in combination with a different setting
Fully supervised training seems to be the most effective way of reducing pain intensity
Standardized exercise plans achieve the best results
On average, the training units took place 5 times a week for 11.4 weeks and lasted 63 minutes. But not all studies reported the information. Training programs were also not completely standardized in a third of the studies.
Overall, it appears that home training reduces pain intensity and improves functional limitations for patients with non-specific low back pain. The effect size was similar for those who trained exclusively at home or in combination with another setting.
When comparing the different methods of performing exercises at home, it appears that fully supervised exercises are most effective for relieving pain and relieving physical limitations, but this is slightly better than partially supervised exercises. Not surprisingly, standardized protocols give the best results.
In summary, home exercises improve pain intensity and function in people who live with unspecific low back pain. Supervised training with a standardized program is most effective. Insufficient data are available to draw reliable conclusions about the duration and frequency of training.
