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Identifying potential moderators for response to treatment in low back pain : a systematic review
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Gurung, Tara, Ellard, David R., Mistry, Dipesh, Patel, Shilpa and Underwood, Martin (2015) Identifying potential moderators for response to treatment in low back pain : a systematic review. Physiotherapy, 101 (3). pp. 243-251. doi:10.1016/j.physio.2015.01.006 ISSN 0031-9406.
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Official URL: http://dx.doi.org/10.1016/j.physio.2015.01.006
Abstract
Background:
Identifying which patients with non-specific low back pain are likely to gain the greatest benefit from different treatments is an important research priority. Few studies are large enough to produce data on sub-group effects from different treatments. Data from existing large studies may help identify potential moderators to use in future individual patient data meta-analyses.
Objective:
To systematically review papers of therapist delivered interventions for low back pain to identify potential moderators to inform an individual patient data meta-analysis.
Data sources:
We searched MEDLINE, EMBASE, Web of Science and Citation Index and Cochrane Register of Controlled Trials (CENTRALhttp://www.cochrane.org/editorial-and-publishing-policy-resource/cochrane-central-register-controlled-trials-central) for relevant papers.
Data extraction and data synthesis:
We screened for randomised controlled trials with ≥500 or more participants, and cohort studies of ≥1000 or more participants. We examined all publications related to these studies for any reported moderator analyses. Two reviewers independently did risk of bias assessment of main results and quality assessment of any moderator analyses.
Results:
We included four randomised trials (n=7208). Potential moderators with strong evidence (p<0.05) in one or more studies were age, employment status and type, back pain status, narcotic medication use, treatment expectations and education. Potential moderators with weaker evidence (0.05<p≤0.20) included gender, psychological distress, pain/disability and quality of life.
Conclusion:
There are insufficient robust data on moderators to be useful in clinical practice. This review has identified some important potential moderators of treatment effect worthy of testing in future confirmatory analyses.
Item Type: | Journal Article | ||||
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Subjects: | R Medicine > RM Therapeutics. Pharmacology | ||||
Divisions: | Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School > Clinical Trials Unit Faculty of Science, Engineering and Medicine > Medicine > Warwick Medical School |
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Library of Congress Subject Headings (LCSH): | Backache -- Treatment | ||||
Journal or Publication Title: | Physiotherapy | ||||
Publisher: | Elsevier Science Ltd. | ||||
ISSN: | 0031-9406 | ||||
Official Date: | 25 January 2015 | ||||
Dates: |
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Volume: | 101 | ||||
Number: | 3 | ||||
Number of Pages: | 9 | ||||
Page Range: | pp. 243-251 | ||||
DOI: | 10.1016/j.physio.2015.01.006 | ||||
Status: | Peer Reviewed | ||||
Publication Status: | Published | ||||
Access rights to Published version: | Restricted or Subscription Access | ||||
Date of first compliant deposit: | 19 February 2016 | ||||
Date of first compliant Open Access: | 22 February 2016 | ||||
Funder: | National Institute for Health Research (Great Britain) (NIHR), Birmingham Science City, Advantage West Midlands (AWM) | ||||
Grant number: | RP-PG-0608-10076 (NIHR) |
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