OBJECTIVE: This systematic review aimed to identify and synthesize the objective and subjective criteria currently used to guide the progression of therapeutic exercise during the rehabilitation of adults with nonspecific low back pain (NSLBP). A secondary objective was to determine whether the use of those progression criteria enhances the effectiveness of exercise interventions compared to protocols without specific criteria.
METHODS: A comprehensive search was performed across three electronic databases and supplemented by a manual reference screening. Eligible studies were randomized controlled trials (RCTs) including adults (>18 years) with NSLBP where at least one group received therapeutic exercise with defined progression criteria. Study selection and full-text screening were followed by risk of bias assessment using the Cochrane Risk of Bias 2 tool.
RESULTS: A total of 47 RCTs met the inclusion criteria. Due to the heterogeneity of included studies, a qualitative synthesis was conducted. Progression criteria were found to be both subjective and objective. Overall, intervention groups using predefined progression criteria showed greater short- and medium-term improvements than controls. However, only a subset of low-risk-of-bias studies confirmed these effects, and long-term benefits were rarely reported.
CONCLUSION: Exercise progression based on specific criteria appears to offer promising benefits, particularly in the short-term reduction of pain and improvement in function. However, limitations persist regarding the direct applicability of these findings to clinical practice. Future research should aim to further standardize methodologies and establish measurable, clearly defined progression criteria for exercise-based interventions in patients with NSLBP.
| Discipline Area | Score |
|---|---|
| Physician |  |
| Rehab Clinician (OT/PT) | |
Rehab Clinician (OT/PT) rater
The diagnostic heterogeneity attached to NSLBP let alone the uncertainty in clinical meaning and whether that applies to acute, subacute, or persistent episodes of pain appear not useful basis upon which to formulate a rational informed approach to an endemic and poorly managed societal problem. It seems worth pointing out that no patient (or reasoning, ethical, and informed clinician) would accept a diagnosis of nonspecific abdominal pain or nonspecific chest pain without attempting a systematic and reasonable investigation to discern potential underlying pathology, its absence or a linked psychological state. I would anticipate no less in the analysis of "low back pain." Little wonder that the frequent use of this meaningless diagnosis dooms its many sufferers to mediocre, frequently uninformed or worse, and ill-informed treatment.
Rehab Clinician (OT/PT) rater
The authors examined the comparative effectiveness between exercise-based interventions with and without defined progression exercise protocols for patients with nonspecific LBP (NSLBP) complaints. As a physical therapist specializing in the management of patients with NSLBP, the article was helpful only for highlighting the importance of an active vs passive approach. Unfortunately, I found the study’s aims and findings myopic in scope. The authors did not consider nor discuss the wealth of previously published evidence supporting cognitive functional therapies as an optimal multimodal management method for achieving best patient outcomes. The authors also did not stratify their results/recommendation by symptom acuity (e.g., chronic vs acute low back symptoms). Translating the authors' results into everyday clinical practice is lacking.
, McMaster University