Therapeutic Exercise is Effective in Reducing the Intensity of Nonspecific Low Back Pain in Children and Adolescents: A Systematic Review and Network Meta-analysis

Abstract

Objective

To compare the different physiotherapy treatments and determine the most effective treatment to reduce the nonspecific low back pain (NSLBP) intensity in children and adolescents.

Data Sources

Eight databases (Cochrane Library, MEDLINE, PEDro, Web of Science, LILACS, IBECS, PsycINFO, and SCOPUS), and 2 health-specialized journals (BMJ and Spine) were searched from inception to May 2023, with no language restriction.

Study Selection

Individuals aged 6-18 years with NSLBP were selected, and physical therapy treatments were considered. Studies were required to be controlled clinical trials with pretest and posttest evaluations, and to report pain intensity.

Data Extraction

Data extraction and risk of bias assessment were performed independently by 2 reviewers.

Data Synthesis

A meta-analysis of 11 controlled trials with 827 participants found that physiotherapy treatments effectively reduced NSLBP intensity on posttest measurement (d₊=0.75; 95% confidence interval [CI], 0.30-1.20) and 6-month follow-up (d₊=0.35; 95% CI, −0.72 to 1.40). Network meta-analysis showed both therapeutic exercise (d₊=1.11; 95% CI, 0.48-1.74) and a combination of therapeutic exercise and manual therapy (d₊=1.45; 95% CI, 0.40-2.49) were effective compared to no treatment. There were no significant differences between therapeutic exercise and the combination of therapeutic exercise and manual therapy.

Conclusions

Physical exercise has proven to be the most effective treatment for addressing the intensity of NSLBP in children and adolescents. While combining it with manual therapy may yield even better results, it is crucial to emphasize that physical exercise should serve as the cornerstone in the physiotherapeutic approach to managing NSLBP intensity in this age group.