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The cochrane review of advice to stay active as a single treatment for low back pain and sciatica.
Spine (Phila Pa 1976). 2002 Aug 15; 27(16):1736-41.S

Abstract

STUDY DESIGN

A systematic review was conducted within the Cochrane Collaboration Back Review Group.

OBJECTIVES

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

SUMMARY OF BACKGROUND DATA

Low back pain is a common reason for consulting a health care provider, and advice on daily activities constitutes an important part in the primary care management of low back pain.

METHODS

All randomized studies available in systematic searches (electronic databases, contact with authors, reference lists) were included. Two reviewers independently selected trials for inclusion, assessed the validity of the included trials, and extracted data. Investigators were contacted to obtain missing information.

RESULTS

Four trials, with a total of 491 patients, were included. In all the trials, advice to stay active was compared with advice for bed rest. Two trials were assessed as having a low risk of bias, and two as having a moderate to high risk of bias. The results were heterogeneous. The results from one high-quality trial of patients with acute, simple low back pain found small differences in functional status (weighted mean difference on a 0 to 100 scale, 6.0; 95% CI, 1.5-10.5) and length of sick leave (weighted mean difference, 3.4 days; 95% CI, 1.6-5.2) in favor of staying active, as compared with advice to stay in bed 2 days. The other high-quality trial compared advice to stay active with advice to rest in bed 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 advice to engage in exercises for patients with acute, simple low back pain, and found improvement in functional status and reduced sick leave in favor of advice to stay active.

CONCLUSION

The best available evidence suggests that advice to stay active alone has little beneficial effect 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. Because there is no considerable difference between advice to stay active and advice for bed rest, and there are potential harmful effects of prolonged bed rest, 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

National Agency for Health and Social Welfare, Oslo, Norway. k.b.hagen@labmed.uio.noNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Comparative Study
Journal Article
Research Support, Non-U.S. Gov't
Review
Systematic Review

Language

eng

PubMed ID

12195064

Citation

Hagen, Kåre B., et al. "The Cochrane Review of Advice to Stay Active as a Single Treatment for Low Back Pain and Sciatica." Spine, vol. 27, no. 16, 2002, pp. 1736-41.
Hagen KB, Hilde G, Jamtvedt G, et al. The cochrane review of advice to stay active as a single treatment for low back pain and sciatica. Spine. 2002;27(16):1736-41.
Hagen, K. B., Hilde, G., Jamtvedt, G., & Winnem, M. F. (2002). The cochrane review of advice to stay active as a single treatment for low back pain and sciatica. Spine, 27(16), 1736-41.
Hagen KB, et al. The Cochrane Review of Advice to Stay Active as a Single Treatment for Low Back Pain and Sciatica. Spine. 2002 Aug 15;27(16):1736-41. PubMed PMID: 12195064.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - The cochrane review of advice to stay active as a single treatment for low back pain and sciatica. AU - Hagen,Kåre B, AU - Hilde,Gunvor, AU - Jamtvedt,Gro, AU - Winnem,Michael F, PY - 2002/8/27/pubmed PY - 2002/10/31/medline PY - 2002/8/27/entrez SP - 1736 EP - 41 JF - Spine JO - Spine VL - 27 IS - 16 N2 - STUDY DESIGN: A systematic review was conducted within the Cochrane Collaboration Back Review Group. OBJECTIVES: To assess the effects of advice to stay active as a single treatment for patients with acute low back pain or sciatica. SUMMARY OF BACKGROUND DATA: Low back pain is a common reason for consulting a health care provider, and advice on daily activities constitutes an important part in the primary care management of low back pain. METHODS: All randomized studies available in systematic searches (electronic databases, contact with authors, reference lists) were included. Two reviewers independently selected trials for inclusion, assessed the validity of the included trials, and extracted data. Investigators were contacted to obtain missing information. RESULTS: Four trials, with a total of 491 patients, were included. In all the trials, advice to stay active was compared with advice for bed rest. Two trials were assessed as having a low risk of bias, and two as having a moderate to high risk of bias. The results were heterogeneous. The results from one high-quality trial of patients with acute, simple low back pain found small differences in functional status (weighted mean difference on a 0 to 100 scale, 6.0; 95% CI, 1.5-10.5) and length of sick leave (weighted mean difference, 3.4 days; 95% CI, 1.6-5.2) in favor of staying active, as compared with advice to stay in bed 2 days. The other high-quality trial compared advice to stay active with advice to rest in bed 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 advice to engage in exercises for patients with acute, simple low back pain, and found improvement in functional status and reduced sick leave in favor of advice to stay active. CONCLUSION: The best available evidence suggests that advice to stay active alone has little beneficial effect 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. Because there is no considerable difference between advice to stay active and advice for bed rest, and there are potential harmful effects of prolonged bed rest, it is reasonable to advise people with acute low back pain and sciatica to stay active. These conclusions are based on single trials. SN - 1528-1159 UR - https://www.unboundmedicine.com/medline/citation/12195064/The_cochrane_review_of_advice_to_stay_active_as_a_single_treatment_for_low_back_pain_and_sciatica_ L2 - http://dx.doi.org/10.1097/00007632-200208150-00010 DB - PRIME DP - Unbound Medicine ER -