Effects of exercise/physical activity on fear of movement in people with spine-related pain: protocol for a systematic review and meta-analysis

INTRODUCTION: Low back pain and neck pain are leading causes of disability. Although several studies have examined the effect of exercise on fear of movement in people with spine-related pain, the overall evidence supporting the beneficial effect of different forms of exercise on fear of movement remains unknown. This systematic review will determine the strength of evidence for the effect of exercise/physical activity on fear of movement in people with non-specific spine-related pain. METHODS/ANALYSIS: This review protocol was developed following the Preferred Reporting Items for Systematic Reviews and Meta-Analysis Protocols. The review will include randomised controlled trials and non-randomised studies that recruited adults (≥18 years) with chronic non-specific spine-related pain and where a validated measure of fear of movement/kinesiophobia such as the Tampa Scale of Kinesiophobia (TSK) and the Fear Avoidance Behaviour Questionnaire (FABQ) or any other validated measures to ascertain fear of movement/kinesiophobia was employed. Bibliographic databases include MEDLINE, PsycINFO, EMBASE, CINAHL, ZETOC, Web of Science, PubMed and Google Scholar as well as key journals/grey literature will be searched from inception to 31 January 2022. Only articles published in English will be considered eligible. Two independent reviewers will search, screen studies, extract data and assess risk of bias. Preintervention and postintervention mean and SD with 95% CI of the outcome data (TSK or FABQ) will be extracted or estimated where possible. If possible, study results will be pooled into a meta-analysis. A narrative synthesis of the results will be presented if heterogeneity is high. The overall quality of evidence and risk of bias will be assessed using the Grading of Recommendations Assessment, Development and Evaluation and Risk Of Bias in Non-randomised Studies of Interventions guidelines. ETHICS AND DISSEMINATION: This systematic review does not require ethical approval as existing data will be used. The results will be disseminated through a peer-reviewed journal and via national and international conferences. PROSPERO REGISTRATION NUMBER: CRD42021295755.