Effectiveness of self-management of low back pain: Systematic review with meta-analysis

Objective To determine the effectiveness of self-management for nonspecific low back pain (LBP). Methods We performed a systematic review searching the Medline, Embase, CINAHL, PsycINFO, LILACS, PEDro, AMED, SPORTDiscus, and Cochrane databases from earliest record to April 2011. Randomized controlled trials evaluating self-management for nonspecific LBP and assessing pain and disability were included. The PEDro scale was used to assess the methodologic quality of included trials. Data were pooled where studies were sufficiently homogenous. Analyses were conducted separately for short- (less than 6 months after randomization) and long-term (at least 12 months after randomization) followup. Six criteria for self-management were used to assess the content of the intervention. Results The search identified 2,325 titles, of which 13 original trials were included. Moderate-quality evidence showed that self-management is effective for improving pain and disability for people with LBP. The weighted mean difference at short-term followup for pain was -3.2 points on a 0-100 scale (95% confidence interval [95% CI] -5.1, -1.3) and for disability was -2.3 points (95% CI -3.7, -1.0). The long-term effects were -4.8 (95% CI -7.1, -2.5) for pain and -2.1 (95% CI -3.6, -0.6) for disability. Conclusion There is moderate-quality evidence that self-management has small effects on pain and disability in people with LBP. These results challenge the endorsement of self-management in treatment guidelines.