10 RCTs of manual therapy versus placebo (n=1,527);
9 RCTs of manual therapy versus physiotherapy (n=1,458);
4 RCTs of manual therapy versus other treatments (n=606);
2 RCTs of mechanical therapy (n=359);
8 RCTs of exercise programmes (n=1476);
2 RCTs of back school (n=379); and
1 RCT of bed rest (n=192).
15 RCTs of manual and conventional physiotherapy (n=2,841);
9 RCTs of physical exercise (n=1,952);
8 RCTs of back school (n=1,752);
4 RCTs of operant conditioning therapy (n=828);
8 RCTs of behavioural or cognitive therapy (n=1,945);
1 RCTs of couple therapy (n=250);
5 RCTs of antidepressants (n=787);
8 RCTs of transcutaneous electrical nerve stimulation (n=2,099); and
7 RCTs of injections or laser treatment (n=1,856).
Therapies used in the management of acute LBP.
There is no conclusive evidence of the effectiveness of manual therapies, whether in comparison to placebo or other types of interventions. A few trials suggest that manual therapy is more effective in patients with radiating pain, and subacute or recurrent exacerbation of pain, than conventional physiotherapy.
The benefit of physiotherapy is not clear as compared with placebo. Recent trials suggest that adequate reassurance and advice coupled with the early resumption of normal activity may be more effective than physiotherapy interventions.
Bed rest appears to have a deleterious effect on recovery and return to work.
Therapies used in the management of chronic LBP.
The evidence on the effectiveness of manipulation and conventional physiotherapy for patients with chronic LBP is conflicting. Some evidence suggests that manipulation and conventional physiotherapy may offer comparable long-term therapeutic benefits, compared to placebo groups.
Limited evidence suggests that physical reconditioning can improve chronic LBP sufferers' levels of functioning and pain report.
Back school appears to have little useful effect on knowledge or pain perception and disability.
Relaxation and cognitive behavioural techniques improve short- and long-term pain perception. The effectiveness of operant conditioning and cognitive therapy in relieving either pain or disability is uncertain.
Multidisciplinary treatment has been insufficiently evaluated.