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Advice to stay active as a single treatment for low back pain and sciatica.

Abstract

BACKGROUND

Low back pain is one of the most common conditions managed in primary care. Restricted activity, rest, and symptomatic analgesics are the most commonly prescribed treatment for low back pain and sciatica.

OBJECTIVES

To assess the effects of advice to stay active as single treatment for patients with low back pain.

SEARCH STRATEGY

Computerised searches in MEDLINE, EMBASE, Sport, The Cochrane Controlled Trials Register, Musculoskeletal Group's Trials Register and Scisearch, and scanning of reference lists from relevant articles were undertaken. Relevant studies were also traced by contacting authors. Date of the most recent searches: December 1998.

SELECTION CRITERIA

We included all randomised trials or quasi-randomised trials where the study population consisted of adult patients with low back pain or sciatica, in which one comparison group was advised to stay active. The main outcomes of interest were pain, functional status, recovery and return to work.

DATA COLLECTION AND ANALYSIS

Two reviewers independently selected trials for inclusion, assessed the validity of included trials and extracted data. Investigators were contacted to collect missing data or for clarification when needed.

MAIN RESULTS

Four trials, with a total of 491 patients, were included. Advice to stay active was compared to advice to rest in bed in all trials. Two trials were assessed to have low risk of bias and two to have moderate to high risk of bias. The results were heterogeneous. Results from one high quality trial of patients with acute simple LBP found small differences in functional status [Weighted Mean Difference (on a 0-100 scale) 6.0 (95% CI: 1.5, 10.5)] and length of sick leave [WMD 3.4 days (95% CI: 1.6, 5.2)] in favour of staying active compared to advice to stay in bed for two days. The other high quality trial compared advice to stay active with advice to rest in bed for 14 days for patients with sciatic syndrome, and found no differences between the groups. One of the high quality trials also compared advice to stay active with exercises for patients with acute simple LBP, and found improvement in functional status and reduction in sick leave in favour of advice to stay active.

REVIEWER'S CONCLUSIONS

The best available evidence suggests that advice to stay active alone has small beneficial effects for patients with acute simple low back pain, and little or no effect for patients with sciatica. There is no evidence that advice to stay active is harmful for either acute low back pain or sciatica. If there is no major difference between advice to stay active and advice to rest in bed, and there is potential harmful effects of prolonged bed rest, then it is reasonable to advise people with acute low back pain and sciatica to stay active. These conclusions are based on single trials.

Authors+Show Affiliations

Health Services Research Unit, National Institute of Public Health, P.O. Box 4404 Torshov, N-0403 Oslo, Norway. k.b.hagen@labmed.uio.noNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Review
Systematic Review

Language

eng

PubMed ID

12076492

Citation

Hilde, G, et al. "Advice to Stay Active as a Single Treatment for Low Back Pain and Sciatica." The Cochrane Database of Systematic Reviews, 2002, p. CD003632.
Hilde G, Hagen KB, Jamtvedt G, et al. Advice to stay active as a single treatment for low back pain and sciatica. Cochrane Database Syst Rev. 2002.
Hilde, G., Hagen, K. B., Jamtvedt, G., & Winnem, M. (2002). Advice to stay active as a single treatment for low back pain and sciatica. The Cochrane Database of Systematic Reviews, (2), CD003632.
Hilde G, et al. Advice to Stay Active as a Single Treatment for Low Back Pain and Sciatica. Cochrane Database Syst Rev. 2002;(2)CD003632. PubMed PMID: 12076492.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Advice to stay active as a single treatment for low back pain and sciatica. AU - Hilde,G, AU - Hagen,K B, AU - Jamtvedt,G, AU - Winnem,M, PY - 2002/6/22/pubmed PY - 2002/8/10/medline PY - 2002/6/22/entrez SP - CD003632 EP - CD003632 JF - The Cochrane database of systematic reviews JO - Cochrane Database Syst Rev IS - 2 N2 - BACKGROUND: Low back pain is one of the most common conditions managed in primary care. Restricted activity, rest, and symptomatic analgesics are the most commonly prescribed treatment for low back pain and sciatica. OBJECTIVES: To assess the effects of advice to stay active as single treatment for patients with low back pain. SEARCH STRATEGY: Computerised searches in MEDLINE, EMBASE, Sport, The Cochrane Controlled Trials Register, Musculoskeletal Group's Trials Register and Scisearch, and scanning of reference lists from relevant articles were undertaken. Relevant studies were also traced by contacting authors. Date of the most recent searches: December 1998. SELECTION CRITERIA: We included all randomised trials or quasi-randomised trials where the study population consisted of adult patients with low back pain or sciatica, in which one comparison group was advised to stay active. The main outcomes of interest were pain, functional status, recovery and return to work. DATA COLLECTION AND ANALYSIS: Two reviewers independently selected trials for inclusion, assessed the validity of included trials and extracted data. Investigators were contacted to collect missing data or for clarification when needed. MAIN RESULTS: Four trials, with a total of 491 patients, were included. Advice to stay active was compared to advice to rest in bed in all trials. Two trials were assessed to have low risk of bias and two to have moderate to high risk of bias. The results were heterogeneous. Results from one high quality trial of patients with acute simple LBP found small differences in functional status [Weighted Mean Difference (on a 0-100 scale) 6.0 (95% CI: 1.5, 10.5)] and length of sick leave [WMD 3.4 days (95% CI: 1.6, 5.2)] in favour of staying active compared to advice to stay in bed for two days. The other high quality trial compared advice to stay active with advice to rest in bed for 14 days for patients with sciatic syndrome, and found no differences between the groups. One of the high quality trials also compared advice to stay active with exercises for patients with acute simple LBP, and found improvement in functional status and reduction in sick leave in favour of advice to stay active. REVIEWER'S CONCLUSIONS: The best available evidence suggests that advice to stay active alone has small beneficial effects for patients with acute simple low back pain, and little or no effect for patients with sciatica. There is no evidence that advice to stay active is harmful for either acute low back pain or sciatica. If there is no major difference between advice to stay active and advice to rest in bed, and there is potential harmful effects of prolonged bed rest, then it is reasonable to advise people with acute low back pain and sciatica to stay active. These conclusions are based on single trials. SN - 1469-493X UR - https://www.unboundmedicine.com/medline/citation/12076492/Advice_to_stay_active_as_a_single_treatment_for_low_back_pain_and_sciatica_ L2 - https://doi.org/10.1002/14651858.CD003632 DB - PRIME DP - Unbound Medicine ER -