Best Evidence Rehab for Chronic Low Back Pain

Malfliet A et al. Best Evidence Rehabilitation for Chronic Pain Part 3: Low Back Pain. J. Clin Med: 2019
  • Goal of paper is to to endorse consistent best practice, reduce unwarranted variation, and diminish use of low-value interventions in CLBP care
  • Of the inactive techniques investigated: ultrasound, kinesiotape, pain neuroscience education (PNE)TENS, massage, and spinal manipulative therapy (SMT), only PNE and SMT are recommended.
  • However, both PNE and SMT should only be considered if in conjunction with active therapies such as exercise. PNE can help reduce kinesiophobia in the short term and help adapt beliefs and expectations. SMT has shown to help improvements in pain and function in the short term (1 month), but not long term( 6-12 months).
  • The following four treatments are NOT recommended due to lack of evidence or conflicting evidence: back schools, sensory discrimination training, proprioceptive exercises, and sling exercises
  • All exercise modalities (aerobic, strength/resistance, coordination, motor control, and pilates) can effectively reduce pain and disability compared to minimal, passive therapies, or no intervention. However, when compared to one another, there is no difference found between different exercise modalities.
  • When compared to education or other active exercises, walking improves pain, disability, quality of life, and fear avoidance to a similar extent. Walking is not recommended as a stand-alone, but due to its low cost and easy accessibility, it can be a valuable home-based addition to other active therapies.
  • All the International guidelines (NICE, Dutch physiotherapy) recommend exercise and also found that no exercise modality was superior to another in patients with CLPB.
  • All the guidelines also agree to NOT recommend TENS, IFC, and ultrasound as well as traction, laser, taping, lumbar support, orthotics, and massage.