REVIEW ARTICLE (META-ANALYSIS)
Region-specific Exercises vs General Exercises in the Management of Spinal and Peripheral Musculoskeletal Disorders: A Systematic Review With Meta-analyses of Randomized Controlled Trials

https://doi.org/10.1016/j.apmr.2021.01.093Get rights and content

Abstract

Objective

To compare the efficacy of region-specific exercises to general exercises approaches for adults with spinal or peripheral musculoskeletal disorders (MSKDs).

Data Sources

Electronic searches were conducted up to April 2020 in Medline, Embase, Cochrane Central Register of Controlled Trials, and Cumulative Index to Nursing and Allied Health.

Study Selection

Randomized control trials (RCTs) on the efficacy of region-specific exercises compared to general exercises approaches for adults with various MSKDs.

Data Extraction

Mean differences and standardized mean differences were calculated using random-effects inverse variance modeling. Eighteen RCTs (n=1719) were included. Cohorts were composed of participants with chronic neck (n=313) or low back disorders (n=1096) and knee osteoarthritis (OA) (n=310).

Data Synthesis

Based on low-quality evidence in the short-term and very low-quality in the mid- and long-term, there were no statistically significant differences between region-specific and general exercises in terms of pain and disability reductions for adults with spinal disorders or knee OA. Secondary analyses for pain reduction in the short-term for neck or low back disorders did not report any statistically significant differences according to very low- to low-quality of evidence.

Conclusions

The difference in treatment effect remains uncertain between region-specific and general exercises approaches. Based on very low- to low-quality evidence, there appear to have no differences between both types of exercise approaches for pain reduction or disability for adults with spinal disorders. Future trials may change the current conclusions. More evidence is needed for region-specific exercises compared to general exercises for other peripheral MSKDs including knee OA.

Section snippets

Methods

The study protocol is available online on PROSPERO: registration number is CRD42019145180.

Results

From the 11,352 potentially relevant articles identified through title and abstract review, 18 RCTs met the eligibility criteria after full-text review (fig 1). Characteristics of included studies are presented in table 1.7,31, 32, 33, 34, 35, 36, 37, 38, 39, 40, 41, 42, 43, 44, 45, 46, 47, 48, 49

Discussion

The aim of this systematic review was to assess the efficacy of region-specific exercises compared with general exercise approaches for adults with various MSKDs. Eighteen RCTs were included with 16 trials pooled in different meta-analyses, with most of cohorts composed of participants with persistent or chronic neck or LBP; only 2 RCTs investigated the efficacy of region-specific exercises compared with general exercises for knee OA. One RCT was considered at a low risk of bias,39 and 1 was

Conclusions

Based on very low- to moderate-quality evidence, there are no clinically important differences between region-specific and general exercises regarding pain-, disability-, or health-related quality of life in the short-, mid-, or long-term follow-ups for adults with chronic low back or neck disorders. Evidence is lacking regarding region-specific exercises compared with general exercises for peripheral disorders. Addition of new trials to these analyses may change the current conclusions.

Suppliers

  • a.

    RoB 2; The Cochrane Collaboration.

  • b.

    RevMan 5.3; The Cochrane Collaboration.

References (62)

  • GH Guyatt et al.

    GRADE guidelines 6. Rating the quality of evidence–imprecision

    J Clin Epidemiol

    (2011)
  • A Demirel et al.

    Stabilization exercise versus yoga exercise in non-specific low back pain: pain, disability, quality of life, performance: a randomized controlled trial

    Complement Ther Clin Pract

    (2019)
  • ML Ferreira et al.

    Comparison of general exercise, motor control exercise and spinal manipulative therapy for chronic low back pain: a randomized trial

    Pain

    (2007)
  • R Lauche et al.

    The effects of tai chi and neck exercises in the treatment of chronic nonspecific neck pain: a randomized controlled trial

    J Pain

    (2016)
  • P von Trott et al.

    Qigong and exercise therapy for elderly patients with chronic neck pain (QIBANE): a randomized controlled study

    J Pain

    (2009)
  • KM Naugle et al.

    A meta-analytic review of the hypoalgesic effects of exercise

    J Pain

    (2012)
  • KL Bennell et al.

    A review of the clinical evidence for exercise in osteoarthritis of the hip and knee

    J Sci Med Sport

    (2011)
  • AR Gross et al.

    Exercises for mechanical neck disorders: a Cochrane review update

    Man Ther

    (2016)
  • Global, regional, and national incidence, prevalence, and years lived with disability for 354 diseases and injuries for 195 countries and territories, 1990-2017: a systematic analysis for the Global Burden of Disease Study 2017

    Lancet

    (2018)
  • AD Woolf et al.

    Burden of major musculoskeletal conditions

    Bull World Health Organ

    (2003)
  • I Lin et al.

    What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review

    Br J Sports Med

    (2020)
  • JA Hayden et al.

    Exercise therapy for treatment of non-specific low back pain

    Cochrane Database Syst Rev

    (2005)
  • LL Andersen et al.

    Effect of two contrasting types of physical exercise on chronic neck muscle pain

    Arthritis Rheum

    (2008)
  • OO Babatunde et al.

    Effective treatment options for musculoskeletal pain in primary care: a systematic overview of current evidence

    PLoS One

    (2017)
  • BE Smith et al.

    Musculoskeletal pain and exercise-challenging existing paradigms and introducing new

    Br J Sports Med

    (2019)
  • LV Lima et al.

    Does exercise increase or decrease pain? Central mechanisms underlying these two phenomena

    J Physiol

    (2017)
  • P Oesch et al.

    Effectiveness of exercise on work disability in patients with non-acute non-specific low back pain: systematic review and meta-analysis of randomised controlled trials

    J Rehabil Med

    (2010)
  • LJ Geneen et al.

    Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews

    Cochrane Database Syst Rev

    (2017)
  • PJ Owen et al.

    Which specific modes of exercise training are most effective for treating low back pain? Network meta-analysis

    Br J Sports Med

    (2020)
  • A Hall et al.

    Effectiveness of tai chi for chronic musculoskeletal pain conditions: updated systematic review and meta-analysis

    Phys Ther

    (2017)
  • OT Lam et al.

    Effectiveness of the McKenzie Method of Mechanical Diagnosis and Therapy for treating low back pain: literature review with meta-analysis

    J Orthop Sports Phys Ther

    (2018)
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      Moreover, a systematic review of 100 randomly selected studies, highlighted the poor reporting quality of exercise interventions for LBP [32]. A recent systematic review (18 RCTs, 1719 participants) that compared the efficacy of region-specific exercises to general exercise in adults with musculoskeletal disorders found no differences between the approaches in terms of pain reduction and disability [13]. Nevertheless, a network meta-analysis of 89 studies including 5578 participants with CLBP compared the efficacy of different modes of exercise training on pain, trunk muscle strength, physical function and mental health [14].

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      Therefore, chronic LBP and sleep disturbance have significant healthcare costs and impair workforce capability. There are several pharmacological and non-pharmacological treatments shown to be effective in chronic LBP management [21–26]. Healthcare guidelines recommend non-pharmacological interventions such as exercise therapy and psychosocial interventions as first-line treatment options [27].

    Supported by Dr Desmeules’ Canadian Institutes of Health Research Program New Investigator Salary and Research Award in Clinical Rehabilitation (award no. 201609NCR-375311-130299).

    Disclosures: none

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