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Oliveira CB, Franco MR, Maher CG, et al. Physical Activity-Based Interventions Using Electronic Feedback May Be Ineffective in Reducing Pain and Disability in Patients With Chronic Musculoskeletal Pain: A Systematic Review With Meta-Analysis. Arch Phys Med Rehabil. 2018 Sep;99(9):1900-1912. doi: 10.1016/j.apmr.2017.10.013. Epub 2017 Nov 6. (Systematic review)
Abstract

OBJECTIVE: To investigate the effectiveness of physical activity-based interventions using electronic feedback in reducing pain and disability compared to minimal or no interventions in patients with chronic musculoskeletal pain.

DATA SOURCES: The following electronic databases were searched: EMBASE, MEDLINE, Cochrane Central Register of Controlled Trials, PsycINFO, Cumulative Index to Nursing and Allied Health Literature, SPORTDiscus, Web of Science, Physiotherapy Evidence Database, and main clinical trial registers.

STUDY SELECTION: Randomized controlled trials investigating the effect of physical activity interventions using electronic feedback (eg, physical activity monitors) on pain and disability compared to minimal or no interventions in adults with chronic musculoskeletal pain were considered eligible.

DATA EXTRACTION: Pooled effects were calculated using the standardized mean difference (SMD), and the Grading of Recommendations Assessment, Development and Evaluation system was used to assess the overall quality of the evidence.

DATA SYNTHESIS: Four published randomized controlled trials and 4 registered unpublished randomized controlled trials were included. At short-term follow-up, pooled estimations showed no significant differences in pain (2 trials: n=116; SMD=-.50; 95% confidence interval, -1.91 to 0.91) and disability (2 trials: n=116; SMD=-.81; 95% confidence interval, -2.34 to 0.73) between physical activity-based interventions and minimal interventions. Similarly, nonsignificant results were found at intermediate-term follow-up. According to Grading of Recommendations Assessment, Development and Evaluation, the overall quality of the evidence was considered to be of low quality.

CONCLUSIONS: Our findings suggest that physical activity-based interventions using electronic feedback may be ineffective in reducing pain and disability compared to minimal interventions in patients with chronic musculoskeletal pain. Clinicians should be cautious when implementing this intervention in patients with chronic musculoskeletal pain.

Ratings
Discipline Area Score
Rehab Clinician (OT/PT) 5 / 7
Physician 5 / 7
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Comments from MORE raters

Physician rater

This is a strong review and provides an useful update that will help change my response to patients.

Rehab Clinician (OT/PT) rater

There are useful information insights from a review in keeping with current thinking.

Rehab Clinician (OT/PT) rater

The title of this study was misleading. I do not see how heart rate can be considered electronic feedback of physical activity. Plus, 'chronic conditions' involved 3 studies with fibromyalgia and 1 study with low back pain; I do not think results should be extrapolated to all MSK chronic conditions. I do not see what video games and apps were excluded - surely people can monitor their heart rate while using these? It was not clear how many, or what types, of apps were excluded. This may have biased the results of the study. Physical activity per se does not appear to have been measured - only physiological measures such as heart rate. The results of this study cannot be used clinically, as they are far too restricted and based on too few studies. It would be far more relevant to simply assess performance of individual patients.
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