Is the combination of exercise therapy and health education more effective than usual medical care in the prevention of non-specific back pain? A systematic review with meta-analysis

BACKGROUND: Clinical practice guidelines emphasize the importance of the prevention and treatment of non-specific back pain through exercise therapy and health education. However, it has not yet been confirmed that the combination of exercise plus education is more effective than usual medical care. OBJECTIVE: The aim of this study was to determine if the combination of exercise plus education is more effective for the prevention of non-specific back pain than usual medical care. MATERIALS AND METHODS: A systematic search in PubMed, Scopus, Web of Science and Medline was conducted with the terms Back Pain, Neck Pain, Musculoskeletal Pain, Exercise, Exercise Therapy, Health Education, Cognitive Behavioral Therapy, Primary Prevention, Secondary Prevention and Clinical Trial. The inclusion criteria were: articles published from 2016 to 2021, the intervention included exercise and education, and the sample consisted of non-specific back pain patients. RESULTS: A total of 4 randomized controlled trials were selected (average PEDro score 6.5 points). The meta-analysis showed statistically significant differences in the pain intensity, standardized mean differences was found to be −0.75 (95% CI = −1.41 to −0.08; p = 0.03); and in disability, standardized mean differences was found to be −0.24 (95% CI = −0.38 to −0.1; p = 0.001). CONCLUSIONS: Interventions combining exercise and education seem to have a greater preventive effect on non-specific back pain than usual medical care. KEY MESSAGES: Exercise therapy and health education combination prevent better non-specific back pain than usual care. Combining exercise with educational interventions has a higher improvement on disability and kinesophobia than usual care.