Exercise reduces sick leave in patients with non-acute non-specific low back pain: a meta-analysis
Jan Kool A1, Rob de Bie A4, Peter Oesch A3, Otto Knüsel A2, Piet van den Brandt A4, Stefan Bachmann A2
A1 Research Department Rehabilitation Centre Valens Switzerland
A2 Department of Rheumatology Rehabilitation Centre Valens Switzerland
A3 Work Rehabilitation Rehabilitation Centre Valens Switzerland
A4 Department of Epidemiology Maastricht University The Netherlands
Objectives: To investigate whether exercise alone or as a part of a multidisciplinary treatment reduces sick leave in patients with non-specific non-acute low back pain. Methods: A meta-analysis of randomized controlled trials was performed. A qualitative analysis of the sick leave results was performed applying pre-defined levels of evidence. In studies comparing exercise with usual care, pooled effect sizes were computed. Results: Fourteen trials were identified allowing 22 comparisons between treatments. The qualitative and the quantitative analysis showed strong evidence that exercise reduces sick days during the first follow-up year, the effect size (95% confidence interval) was -0.24 ( -0.36, -0.11). In a subgroup of studies on the treatment of severely disabled patients (>90 sick days under usual care) the effect size was -0.30 (-0.42, -0.17). The effect size of the number of patients receiving a disability allowance was small and not significant. Conclusion: The reviewed trials provide strong evidence that exercise significantly reduces sick days during the first follow-up year.
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