Journal of Physiotherapy

Journal of Physiotherapy

Volume 67, Issue 4, October 2021, Pages 263-270
Journal of Physiotherapy

Research
Advice and education provide small short-term improvements in pain and disability in people with non-specific spinal pain: a systematic review

https://doi.org/10.1016/j.jphys.2021.08.014Get rights and content
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Abstract

Questions

What is the effect of advice/education compared with placebo or no advice/education on pain and disability in people with non-specific spinal pain? To what extent do characteristics of the patients, trial or intervention modify the estimate of the treatment effects?

Design

A systematic review with meta-analyses of randomised controlled trials.

Participants

Adults with non-specific back and/or neck pain with or without radiating leg/arm pain of any duration were included. Trials recruiting pregnant women or surgical patients in the immediate postoperative phase were ineligible.

Intervention

Advice or education.

Outcome measures

The primary outcomes were self-reported pain and disability, and the secondary outcome was adverse events. The following potential effect modifiers were examined: risk of bias, duration of pain, location of pain, intensity of intervention and mode of intervention.

Results

Twenty-seven trials involving 7,006 participants were included. Eighteen of the included trials were assessed as being at low risk of bias (≥ 6 on the PEDro scale). There was low-quality evidence that advice had a small effect on pain (MD −8.2, 95% CI −12.5 to −3.9, n = 2,241) and moderate-quality evidence that advice had a small effect on disability (MD −4.5, 95% CI −7.9 to −1.0, n = 2,579) compared with no advice or placebo advice in the short-term. None of the items that were assessed modified the treatment effects.

Conclusion

Advice provides short-term improvements in pain and disability in non-specific spinal pain, but the effects are small and may be insufficient as the sole treatment for patients with spinal pain.

Registration

PROSPERO CRD42020162008.

Key words

Back pain
Neck pain
Advice
Education
Meta-analysis

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Footnotes: a Comprehensive Meta-Analysis software Version 3.3.070, Biostat, Englewood, NJ, USA.

eAddenda: Table 1, Figures 3, 5 and 7, and Appendices 1, 2, 3, 4 and 5 can be found online at https://doi.org/10.1016/j.jphys.2021.08.014

Ethics approval: Not applicable.

Competing interests: Flexeze provided heat wraps at no cost for the SHaPED trial, which has CM as an investigator. CM’s expenses have been covered, or partially covered, by professional associations hosting conferences where he has been an invited speaker. Flexeze provided heat wraps at no cost for a pilot trial in which CAS is an investigator. No other authors have competing interests to declare.

Source(s) of support: No specific funding was received for this study. CM and CL are funded by research fellowships from the National Health and Medical Research Foundation, Australia.