STUDY DESIGN: A systematic review and meta-analysis. OBJECTIVE: To evaluate the evidence on comparative effectiveness of advice to stay active versus supervised structured exercise in the management of sciatica. SUMMARY OF BACKGROUND DATA: Conservative management of sciatica usually includes interventions to promote physical activity in the form of advice to stay active or exercise, but there has been no systematic review directly comparing the effectiveness of these two approaches. METHODS: Data Sources included MEDLINE, CINAHL, Embase and PEDro databases. Studies were randomized controlled trials comparing advice with exercise. Two independent reviewers extracted data and assessed methodological quality using the PEDro scale. Pain and disability data were extracted for all time points and converted to a common 0 to 100 scale. Data were pooled with a random effects model for short; intermediate and long-term follow ups. The GRADE approach was used to summarize the strength of evidence. RESULTS: Five trials were included in the meta-analysis, which showed a significant, although small effect favoring exercise over advice for reducing leg pain intensity in the short term (weighted mean difference 11.43 [95%CI, 0.71, 22.16]), but no difference for disability (weighted mean difference 1.45 [95%CI, -2.86, 5.76]). Furthermore, there was no difference at intermediate and long term follow ups between advice and exercise for patient relevant outcomes. CONCLUSION: There is low quality evidence (GRADE) that exercise provides small, superior effects compared with advice to stay active on leg pain in the short term for patients suffering with sciatica. However there is moderate quality evidence showing no difference between advice to stay active and exercise on leg pain and disability status in people with sciatica in the long term.
AD - From: 1The Faculty of Health Science, University of Sydney 2Institute of Sports Science and Clinical Biomechanics and Nordic Institute of Chiropractic and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark 3The George Institute for Global Health, Sydney Medical School, University of Sydney 4The Institute of Bone and Joint Research, Sydney Medical School, University of Sydney. AN - 26165218 BT - Spine DP - NLM ET - 2015/07/15 LA - Eng LB - MSKSTUDY DESIGN: A systematic review and meta-analysis. OBJECTIVE: To evaluate the evidence on comparative effectiveness of advice to stay active versus supervised structured exercise in the management of sciatica. SUMMARY OF BACKGROUND DATA: Conservative management of sciatica usually includes interventions to promote physical activity in the form of advice to stay active or exercise, but there has been no systematic review directly comparing the effectiveness of these two approaches. METHODS: Data Sources included MEDLINE, CINAHL, Embase and PEDro databases. Studies were randomized controlled trials comparing advice with exercise. Two independent reviewers extracted data and assessed methodological quality using the PEDro scale. Pain and disability data were extracted for all time points and converted to a common 0 to 100 scale. Data were pooled with a random effects model for short; intermediate and long-term follow ups. The GRADE approach was used to summarize the strength of evidence. RESULTS: Five trials were included in the meta-analysis, which showed a significant, although small effect favoring exercise over advice for reducing leg pain intensity in the short term (weighted mean difference 11.43 [95%CI, 0.71, 22.16]), but no difference for disability (weighted mean difference 1.45 [95%CI, -2.86, 5.76]). Furthermore, there was no difference at intermediate and long term follow ups between advice and exercise for patient relevant outcomes. CONCLUSION: There is low quality evidence (GRADE) that exercise provides small, superior effects compared with advice to stay active on leg pain in the short term for patients suffering with sciatica. However there is moderate quality evidence showing no difference between advice to stay active and exercise on leg pain and disability status in people with sciatica in the long term.
PY - 2015 SN - 1528-1159 (Electronic)