Fifteen studies were included in the review (1,695 participants) comprising six RCTs on functional restoration or back rehabilitation, five lumbar spine stabilisation programmes, and four fitness programmes (one study was a follow-up of an included study in the same set). Total quality scores ranged from 4 to 8 (mean score 6). Trial sizes ranged from 41 to 349 participants (median 80).
Functional restoration or back care rehabilitation programmes (where reported, control groups included surgical lumbar spinal fusion and a passive control treatment group): Two studies looked at full-time functional restoration programmes. Both studies found improvement in pain scores. Four studies looked at part-time active rehabilitation programmes with interventions based on functional capacity. Participants attended structured sessions one to two times a week for one to two hours duration. An improvement in pain and functional scores was found in three studies in favour of exercise programmes. In two of these studies improvements were found to be maintained at one year follow-up.
Lumbar stabilisation exercise programmes: All five trials ran programmes over an eight to 10 week period. Comparison interventions included manual therapy, education with active participation in a back school programme, general exercise programmes (including walking, swimming and gym) and no intervention. Two studies found a significant improvement in pain scores in favour of the spinal stabilisation group compared to the comparator and two studies found no between group differences, although both intervention and comparator groups were reported to demonstrate significant effects. One study found a significant improvement in pain intensity in the stabilisation group over the course of treatment. No statistically significant improvement was found for the comparator group.
Other exercise programmes: One study found a significant improvement on the Oswestry disability scale (ODS), pain and self-efficacy reports for the exercise programme compared to a back education programme. Improvements were still observed at two year follow-up. Significant improvements in function were found for hydrotherapy compared to controls but no statistically significant between group differences were found for outcome measures of pain, light touch, reflexes, strength and active movements of the lumbar spine. No statistically significant between group differences were found when yoga was compared with a self-care book.