The Effects of Workplace Interventions on Low Back Pain in Workers: A Systematic Review and Meta-Analysis.
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ABSTRACT:
SUBMITTER: Russo F
PROVIDER: S-EPMC8657220 | biostudies-literature |
REPOSITORIES: biostudies-literature
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Project description:Chronic non-specific low back pain (CNSLBP) is a highly prevalent musculoskeletal condition that has a great socioeconomic impact on health systems. Instead of focusing on mechanical causes and direct workload in the development of CNSLBP, genetics, psychosocial environment, lifestyle and quality of life are coming to the forefront in its approach. The main objective was to analyze whether interventions aimed at modifying lifestyle can be effective in improving pain intensity and functional disability in CNSLBP. A search in PubMed, Web of Science, Scopus and SportDiscus databases was performed. Both a univariate and a multivariate network meta-analysis were applied with the difference pre/post-treatment. A total of 20 studies were included for qualitative analysis, of which 16 were randomized clinical trials with a moderate-high methodological quality and were part of the quantitative analysis. The interventions that had the greatest effect in reducing pain intensity were cognitive therapy combined with functional exercise programs, lumbar stabilization exercise and resistance exercise; meanwhile, for functional disability, they were functional exercise programs, aerobic exercise and standard care. In conclusion, a multimodal intervention aimed at changing one's lifestyle that encompasses cognitive, behavioral, and physical aspects seems to be highly effective in improving pain intensity and functional disability caused by CNSLBP; however, it is not yet known if these improvements are maintained in the long term.
| S-EPMC10931043 | biostudies-literature
Project description:Background and objectiveThe current treatments of primary musculoskeletal low back pain (LBP) have a low to moderate efficacy, which might be improved by looking at the contribution of placebo effects. However, the size of true placebo effects in LBP is unknown. Therefore, a systematic review and meta-analysis were executed of randomized controlled trials investigating placebo effects in LBP.Databases and data treatmentThe study protocol was registered in the international prospective register of systematic reviews Prospero (CRD42019148745). A literature search (in PubMed, Embase, The Cochrane Library, CINAHL and PsycINFO) up to 2021 February 16th yielded 2,423 studies. Two independent reviewers assessed eligibility and risk of bias.ResultsEighteen studies were eligible for the systematic review and 5 for the meta-analysis. Fourteen of the 18 studies were clinical treatment studies, and 4 were experimental studies specifically assessing placebo effects. The clinical treatment studies provided varying evidence for placebo effects in chronic LBP but insufficient evidence for acute and subacute LBP. Most experimental studies investigating chronic LBP revealed significant placebo effects. The meta-analysis of 5 treatment studies investigating chronic LBP depicted a significant moderate effect size of placebo for pain intensity (SMD = 0.57) and disability (SMD = 0.52).ConclusionsThis review shows a significant contribution of placebo effects to chronic LBP symptom relief in clinical and experimental conditions. The meta-analysis revealed that placebo effects can influence chronic LBP intensity and disability. However, additional studies are required for more supporting evidence and evidence for placebo effects in acute or subacute LBP.SignificanceThis systematic review and meta-analysis provides evidence of true placebo effects in low back pain (LBP). It shows a significant contribution of placebo effects to chronic LBP symptom relief. The results highlight the importance of patient- and context-related factors in fostering treatment effects in this patient group. New studies could provide insight into the potential value of actively making use of placebo effects in clinical practice.
| S-EPMC8518410 | biostudies-literature
Project description:IntroductionPsychological factors such as fear avoidance beliefs, depression, anxiety, catastrophic thinking and familial and social stress, have been associated with high disability levels in people with chronic low back pain (LBP). Guidelines endorse the integration of psychological interventions in the management of chronic LBP. However, uncertainty surrounds the comparative effectiveness of different psychological approaches. Network meta-analysis (NMA) allows comparison and ranking of numerous competing interventions for a given outcome of interest. Therefore, we will perform a systematic review with a NMA to determine which type of psychological intervention is most effective for adults with chronic non-specific LBP.Methods and analysisWe will search electronic databases (MEDLINE, Embase, PsycINFO, Cochrane Central Register of Controlled Trials, Web of Science, SCOPUS and CINAHL) from inception until 22 August 2019 for randomised controlled trials comparing psychological interventions to any comparison interventions in adults with chronic non-specific LBP. There will be no restriction on language. The primary outcomes will include physical function and pain intensity, and secondary outcomes will include health-related quality of life, fear avoidance, intervention compliance and safety. Risk of bias will be assessed using the Revised Cochrane risk-of-bias tool for randomised trials (RoB 2) tool and confidence in the evidence will be assessed using the Confidence in NMA (CINeMA) framework. We will conduct a random-effects NMA using a frequentist approach to estimate relative effects for all comparisons between treatments and rank treatments according to the mean rank and surface under the cumulative ranking curve values. All analyses will be performed in Stata.Ethics and disseminationNo ethical approval is required. The research will be published in a peer-reviewed journal.Prospero registration numberCRD42019138074.
| S-EPMC7500308 | biostudies-literature
Project description:BackgroundLow back pain (LBP) is a common cause of disability and is ranked as the most burdensome health condition globally. Self-management, including components on increased knowledge, monitoring of symptoms, and physical activity, are consistently recommended in clinical guidelines as cost-effective strategies for LBP management and there is increasing interest in the potential role of digital health.ObjectiveThe study aimed to synthesize and critically appraise published evidence concerning the use of interactive digital interventions to support self-management of LBP. The following specific questions were examined: (1) What are the key components of digital self-management interventions for LBP, including theoretical underpinnings? (2) What outcome measures have been used in randomized trials of digital self-management interventions in LBP and what effect, if any, did the intervention have on these? and (3) What specific characteristics or components, if any, of interventions appear to be associated with beneficial outcomes?MethodsBibliographic databases searched from 2000 to March 2016 included Medline, Embase, CINAHL, PsycINFO, Cochrane Library, DoPHER and TRoPHI, Social Science Citation Index, and Science Citation Index. Reference and citation searching was also undertaken. Search strategy combined the following concepts: (1) back pain, (2) digital intervention, and (3) self-management. Only randomized controlled trial (RCT) protocols or completed RCTs involving adults with LBP published in peer-reviewed journals were included. Two reviewers independently screened titles and abstracts, full-text articles, extracted data, and assessed risk of bias using Cochrane risk of bias tool. An independent third reviewer adjudicated on disagreements. Data were synthesized narratively.ResultsOf the total 7014 references identified, 11 were included, describing 9 studies: 6 completed RCTs and 3 protocols for future RCTs. The completed RCTs included a total of 2706 participants (range of 114-1343 participants per study) and varied considerably in the nature and delivery of the interventions, the duration/definition of LBP, the outcomes measured, and the effectiveness of the interventions. Participants were generally white, middle aged, and in 5 of 6 RCT reports, the majority were female and most reported educational level as time at college or higher. Only one study reported between-group differences in favor of the digital intervention. There was considerable variation in the extent of reporting the characteristics, components, and theories underpinning each intervention. None of the studies showed evidence of harm.ConclusionsThe literature is extremely heterogeneous, making it difficult to understand what might work best, for whom, and in what circumstances. Participants were predominantly female, white, well educated, and middle aged, and thus the wider applicability of digital self-management interventions remains uncertain. No information on cost-effectiveness was reported. The evidence base for interactive digital interventions to support patient self-management of LBP remains weak.
| S-EPMC5466697 | biostudies-literature
Project description:Ethnopharmacological relevanceTibetan traditional medicine CheeZheng Pain-Relieving Plaster (CZPRP) is frequently used as an over-the-counter external analgesic for musculoskeletal pain; however, its evidence for low back pain (LBP) has not been evaluated.Aim of the studyThis study aims to assess the efficacy and safety of CZPRP for both acute, subacute and chronic LBP through a systematic review and meta-analysis of clinical trials.Materials and methodsPubMed, CENTRAL, CNKI, CQVIP, and Wanfang databases were searched through April 20, 2020 for randomized controlled trials of CZPRP for LBP. Eligible comparators were placebo, active treatment, or usual care. Clinical outcomes included pain severity, lower back function score, pain-free rate, and adverse events (AEs). Qualitative evaluations were conducted using the Cochrane risk of bias assessment tools. Quantitative analyses were conducted using a random-effects model.ResultsThis study includes 1674 LBP patients from nine clinical studies. Pooled analyses among subjects with acute LBP show 1) significant pain reductions (mean difference -0.84, 95% confidence interval[CI] -1.31, -0.37) in CZPRP plus diclofenac versus diclofenac, 2) significant improvements in lower back function (standard mean difference -1.50, 95% CI -2.16, -0.85) in CZPRP versus diclofenac, and 3) a higher pain-free rate in CZPRP alone (risk ratio 1.48, 95% CI 1.16, 1.89; I2 = 61%) or CZPRP plus nonsteroidal anti-inflammatory drugs (NSAIDs) (risk ratio 1.66, 95% CI 1.14, 2.40; I2 = 0%) versus NSAIDs. However, in a heterogeneous population with mixed LBP subtypes, there was no significant difference in pain outcomes between CZPRP and diclofenac. Additionally, CZPRP use did not increase AEs compared with no CZPRP (p = 0.40). All nine studies are associated with moderate to high risk of bias.ConclusionsThe use of CZPRP is associated with improved acute LBP outcomes compared to diclofenac. However, due to the moderate to high risk of bias of the studies, future rigorous randomized controlled trials are needed to evaluate the effects of CZPRP for acute and chronic LBP.
| S-EPMC9254726 | biostudies-literature
Project description:BackgroundTrials on sling exercise (SE), commonly performed to manage chronic low back pain (LBP), yield conflicting results. This study aimed to review the effects of SE on chronic LBP.MethodsThe randomized controlled trials comparing SE with other treatments or no treatment, published up to August 2013, were identified by electronic searches. Primary outcomes were pain, function, and return to work. The weighted mean difference (WMD) and 95% confidence interval (CI) were calculated, using a random-effects model.ResultsRisk of bias was rated as high in 9 included trials, where some important quality components such as blinding were absent and sample sizes were generally small. We found no clinically relevant differences in pain or function between SE and other forms of exercise, traditional Chinese medical therapy, or in addition to acupuncture. Based on two trials, SE was more effective than thermomagnetic therapy at reducing pain (short-term: WMD -13.90, 95% CI -22.19 to -5.62; long-term: WMD -26.20, 95% CI -31.32 to -21.08) and improving function (short-term: WMD -10.54, 95% CI -14.32 to -6.75; long-term: WMD -25.75, 95% CI -30.79 to -20.71). In one trial we found statistically significant differences between SE and physical agents combined with drug therapy (meloxicam combined with eperisone hydrochloride) but of borderline clinical relevance for pain (short-term: WMD -15.00, 95% CI -19.64 to -10.36) and function (short-term: WMD -10.00; 95% CI -13.70 to -6.30). There was substantial heterogeneity among the two trials comparing SE and thermomagnetic therapy; both these trials and the trial comparing SE with physical agents combined with drug therapy had serious methodological limitations.InterpretationBased on limited evidence from 2 trials, SE was more effective for LBP than thermomagnetic therapy. Clinically relevant differences in effects between SE and other forms of exercise, physical agents combined with drug therapy, traditional Chinese medical therapy, or in addition to acupuncture could not be found. More high-quality randomized trials on the topic are warranted.
| S-EPMC4053356 | biostudies-literature
Project description:BackgroundLow back pain (LBP) is one of the most common symptoms prompting patients to seek treatment. In China, tuina is a common treatment for LBP, but its effects and safety remain uncertain. This protocol is to provide the methods used to assess the effectiveness and safety of tuina for the treatment of patients with LBP.MethodsWe will search the following databases by electronic methods: MEDLINE, PUBMED, EMBASE, CINAHL, the Chinese Biomedical Literature Database (CBM), the China National Knowledge Infrastructure (CNKI), Wanfang Data (WAN FANG), and VIP Information (VIP). The time limit for retrieving studies is set to be built in and before July 2018 for each database. The therapeutic effects according to the Visual Analog Scale (VAS) will be accepted as the primary outcomes. We will use RevMan V.5.3 software as well to compute the data synthesis carefully when a meta-analysis is allowed.ResultsThis study will provide a high-quality synthesis of current evidence of tuina for the treatment of patients with LBP.ConclusionThe conclusion of our systematic review will provide evidence to judge whether tuina is an effective intervention for patient with LBP.Prospero registration numberPROSPERO CRD 42018096762.
| S-EPMC6113039 | biostudies-literature
Project description:Background: Chronic low back pain (CLBP) is one of the most common musculoskeletal diseases in the elderly, which has a severe impact on the health of the elderly. However, CLBP treatment is very challenging, and more effective treatment methods are needed. Myofascial release may be an effective therapy for the management of chronic musculoskeletal pain. It is widely used clinically to treat CLBP, but its clinical efficacy is still controversial. Objective: This study aims to systematically evaluate the effectiveness of myofascial release for patients with CLBP. Methods: We selected PubMed, Cochrane Library, EMBASE database, and Web of Science database articles published until April 5, 2021. Randomized controlled trials (RCTs) of myofascial release for CLBP were included. Outcome measures included pain, physical function, quality of life, balance function, pain pressure-threshold, trunk mobility, and mental health. For each outcome, Standardized mean differences (SMD) or mean differences (MD) and 95% confidence intervals (CIs) were calculated. Results: Eight RCTs (n = 375) were included based on inclusion and exclusion criteria. The meta-analysis showed that the overall efficacy of myofascial release for CLBP was significant, including two aspects: pain [SMD = -0.37, 95% CI (-0.67, -0.08), I 2 = 46%, P = 0.01] and physical function [SMD = -0.43, 95% CI (-0.75, -0.12), I 2 = 44%, P = 0.007]. However, myofascial release did not significantly improve quality of life [SMD = 0.13, 95% CI (-0.38, 0.64), I 2 = 53%, P = 0.62], balance function [SMD = 0.58, 95% CI (-0.49, 1.64), I 2 = 82%, P = 0.29], pain pressure-threshold [SMD = 0.03,95% CI (-0.75, 0.69), I 2 = 73%, P = 0.93], trunk mobility [SMD = 1.02, 95% CI (-0.09, 2.13), I 2 = 92%, P = 0.07] and mental health [SMD = -0.06, 95% CI (-0.83, 0.71), I 2 = 73%, P = 0.88]. Conclusions: In this study, we systematically reviewed and quantified the efficacy of myofascial release in treating CLBP. The meta-analysis results showed that myofascial release significantly improved pain and physical function in patients with CLBP but had no significant effects on balance function, pain pressure-threshold, trunk mobility, mental health, and quality of life. However, due to the low quality and a small number of included literature, more and more rigorously designed RCTs should be included in the future to verify these conclusions.
| S-EPMC8355621 | biostudies-literature
Project description:The workplace has been identified as a potential location for dietary intervention delivery due to the amount of time spent and the meals eaten in this setting. It is recommended that interventions are tailored to specific occupational groups, and to date, there is limited synthesis of the evidence relating to healthcare workers. This review characterises and evaluates the effectiveness of dietary interventions in healthcare workers to aid the design and implementation of interventions. The MEDLINE database was searched to September 2020. The reference list of an umbrella review was hand searched for additional titles against inclusion criteria. The search included i) population, ii) intervention and iii) work environment. Studies were assessed for risk of bias. Harvest plots and Forest plots were created to display study quality, direction and size of effect of selected primary (energy, fruit and vegetable and fat intake) and secondary outcomes (weight, body mass index, blood pressure and serum cholesterol levels). Thirty-nine articles assessing thirty-four interventions were eligible for inclusion. Intervention types most commonly used were environmental, educational, educational plus behavioural, and behavioural. Due to the heterogeneity in study design and intervention type, results were largely inconclusive. For dietary outcomes, interventions produced small-moderate favorable changes in fruit, vegetable and fat intake. Decreased fat intake was mainly observed in environmental interventions and increases in fruit and vegetable intake were observed when an educational or/and behavioral component was present. Interventions producing weight loss were mostly non-randomised trials involving education and physical activity. Total and low-density lipoprotein cholesterol decreased in interventions involving physical activity. Meta-analyses revealed significant decreases in energy intake, weight, blood pressure, total cholesterol, and LDL cholesterol in non-randomised trials where data were available. Much more research is needed into strategies to promote diet quality improvement in healthcare workers. Statement of significance: It is recommended that workplace dietary interventions are tailored to specific occupational groups. To our knowledge, this is the first review to examine the effects of dietary workplace interventions in healthcare professionals. Small-moderate favourable changes in fruit and vegetable intake can be achieved when an educational or/and behavioural component is included in the intervention. For weight loss, interventions involving nutrition education and physical activity in addition to a dietary component show benefit. In the studies reviewed, a high level of heterogeneity was evident and insufficient information reported to ascertain potential bias.
| S-EPMC8970821 | biostudies-literature
Project description:BackgroundLow back pain (LBP) is the leading cause of worldwide years lost because of disability, with a tremendous economic burden for health care systems. Digital therapeutic care (DTC) programs provide a scalable, universally accessible, and low-cost approach to the multidisciplinary treatment of LBP. Moreover, novel decision support interventions such as personalized feedback messages, push notifications, and data-driven activity recommendations amplify DTC by guiding the user through the program while aiming to increase overall engagement and sustainable behavior change.ObjectiveThis systematic review aims to synthesize recent scientific literature on the impact of DTC apps for people with LBP and outline the implementation of add-on decision support interventions, including their effect on user retention and attrition rates.MethodsWe searched bibliographic databases, including MEDLINE, Cochrane Library, Web of Science, and the Physiotherapy Evidence Database, from March 1, 2016, to October 15, 2020, in accordance with the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines and conducted this review based on related previously published systematic reviews. Besides randomized controlled trials (RCTs), we also included study designs with the evidence level of at least a retrospective comparative study. This enables the consideration of real-world user-generated data and provides information regarding the adoption and effectiveness of DTC apps in a real-life setting. For the appraisal of the risk of bias, we used the Risk of Bias 2 Tool and the Risk of Bias in Non-Randomized Studies of Interventions Tool for the RCTs and nonrandomized trials, respectively. The included studies were narratively synthesized regarding primary and secondary outcome measures, DTC components, applied decision support interventions, user retention, and attrition rates.ResultsWe retrieved 1388 citations, of which 12 studies are included in this review. Of the 12 studies, 6 (50%) were RCTs and 6 (50%) were nonrandomized trials. In all included studies, lower pain levels and increased functionality compared with baseline values were observed in the DTC intervention group. A between-group comparison revealed significant improvements in pain and functionality levels in 67% (4/6) of the RCTs. The study population was mostly homogeneous, with predominantly female, young to middle-aged participants of normal to moderate weight. The methodological quality assessment revealed moderate to high risks of biases, especially in the nonrandomized trials.ConclusionsThis systematic review demonstrates the benefits of DTC for people with LBP. There is also evidence that decision support interventions benefit overall engagement with the app and increase participants' ability to self-manage their recovery process. Finally, including retrospective evaluation studies of real-world user-generated data in future systematic reviews of digital health intervention trials can reveal new insights into the benefits, challenges, and real-life adoption of DTC programs.
| S-EPMC8663573 | biostudies-literature