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Table 2 Characteristics of included RCTs (n 70)

From: The clinical course of low back pain: a meta-analysis comparing outcomes in randomised clinical trials (RCTs) and observational studies

Author and country Setting Treatment Age, mean (y) Female (%) Duration of back pain, mean (weeks) Sample size of trial arms
Albaladejo et al., Spain [36] Primary care Education & physiotherapy 51 68   100
   Education 51 63   139
   Usual GP care 53 72   109
Arribas et al., Spain [37] National health centres GDS physical therapy 39 64   78
   Electrotherapy 39 64   67
Bendix et al., Denmark [38] General practice Functional restoration (PT + OT + Psychological) 40 66   48
   Outpatient intensive physical training: Aerobics + strengthening exercises + fitness machines 43 69   51
Bronfort et al., USA [39] College outpatient clinic Spinal manipulation & trunk strengthening exercise 41 54 156 71
   NSAID & Trunk strengthening exercise 40 44 104 52
   Spinal manipulation & Stretching exercise 41 39 120 51
Bronfort et al., USA [40] Physical therapy clinic Supervised exercises 45 57 249 100
   Chiropractic 45 66 250 100
   Home exercises 46 58 250 101
Browder et al., USA [41] Physical therapy clinics Extension orientated exercises 40 31 9 26
   Strengthening exercises 38 32 9 22
Burton et al., UK [42] General practice The Back Book + usual care (GP & osteopathic care)   11   83
   The traditional Handy Hints & usual care (GP & osteopathic care)   12   79
Cambron et al., USA [43] Chiropractic clinic + hospital clinic + General population Chiropractic flexion distraction procedure 42 34   123
   Active trunk exercise program 41 41   112
Cecchi et al., Italy [44] Rehabilitation department Spinal manipulation 58 69   70
   Individual physiotherapy 61 61   70
   Back school 58 70   70
Chan et al., Hong Kong [45] Physiotherapy Aerobic training 47 79 54 24
   Usual physiotherapy 46 77 63 22
Chang et al., Taiwan [46] General population Piroxicam sachet 34 30   23
   Piroxicam tablets 34 26   19
Chok et al., Singapore [47] Physiotherapy + Orthopaedic clinics + A/E Physical therapy (endurance exercise at the PT department) + back hot pack 38 20 4 38
   Back hot pack (Home) 34 29 4 28
Costa et al., Australia [48] Physical therapy clinics Exercise 55 58 335 77
   Detuned diathermy and detuned USS 53 62 328 77
Constant et al., France [49] General practice Spa therapy & usual GP care     63
   Waiting list group & usual GP care     63
Critchley et al., UK [50] Physiotherapy department Individual physiotherapy 45 59 275 71
   Spinal stabilisation 44 71 346 72
   Pain management 44 62 348 69
Di Cesare et al., Italy [51] Physical therapy clinics Trigger point mesotherapy 53 55 22 29
   Acupuncture point mesotherapy 53 55 21 33
Djavid et al., Iran [52] Occupational clinic Low level laser (LLL) 40 56 118 20
   LLL + exercise 38 37 110 21
   Placebo LLL + exercise 36 17 106 20
Dufour et al., Denmark [53] Rheumatology clinics Group based multidisciplinary therapy 41 57 514 142
   Individual therapist assisted exercises 41 56 540 144
Dundar et al., Turkey [54] Physical therapy clinics Aquatic exercise 35 47   32
   Land based exercise 35 48   33
Fritz et al., USA [55] Physical therapy clinics Traction plus EOT 42 55   31
   Extension orientated therapy (EOT) 41 58   33
Frost et al., UK [56] Physiotherapy Routine physiotherapy & advice book 42 58   144
   Advice from physiotherapist & advice book 40 47   142
Geisser et al., USA [57] University spinal programme Manual therapy & Specific exercise (self corrections, stretching, strengthening) 39 67 284 26
   Sham Manual therapy & Specific exercise 39 56 370 25
   Manual Therapy & Non-specific exercise 37 80 370 24
   Sham Manual Therapy & non-specific exercise 46 61 284 25
George et al., USA [58] Physical therapy Standard care physical therapy 37 53 4 32
   Fear-avoidance based physical therapy 40 62 4 34
Glasov et al., Australia [59] General population Laser acupuncture 58 95   45
   Sham laser 49 62   45
Glomsrod et al., Norway [60] Physicians clinics and General population Active back school (Lectures and back exercises) 41 65   37
   Usual medical care 39 57   35
Goldby et al., UK [61] General practice + hospital physicians Spinal stabilisation & Attending the back school 43 68   84
   Manual therapy & Attending the back school 41 70   89
   Education (Booklet: Back in action) & Attending the back school 42 68   40
Hay et al., UK [62] General practice A brief programme of pain management (general fitness and exercise at clinic and home, explanation about pain mechanisms, distress, encouragement of positive coping strategies, overcoming fear of “hurt = harm”, and implementation of a graded return to usual activities) 40 50   201
   Physiotherapy including manual therapy techniques 41 55   201
Heymans et al., Netherlands [63] Occupational healthcare Usual Dutch occupational physician care 41 17 35 103
   Low intensity back school 41 22 35 98
   High intensity back school 40 23 35 98
Hseih et al., USA [64] General population Joint manipulation & myofascial therapy 48 33 12 52
   Joint manipulation 47 33 12 48
   Myofascial therapy 49 33 12 51
   Back school 48 40 11 48
Hurley et al., UK [65] Physiotherapy + General practice + self referral Manipulation therapy (Passively move intervertebral joint within or beyond its range) 40 57 8 80
   Interferential therapy (Electrical stimulation) 40 62 8 80
   Manipulation & interferential therapy 41 60 8 80
Hurwitz et al., USA [66] Managed care facility Chiropractic care only 52 49   169
   Chiropractic care & physical modalities (Heat/cold, USS) 54 58   172
   Medical care (excluding physical treatment) only 49 47   170
   Medical care & physical modalities (Heat/cold, USS) 49 54   170
Hurwitz et al., USA [67] Network of healthcare Chiropractic care only 52 49   340
   Chiropractic care & physical modalities (Heat/cold, USS) 53 58   340
Jellema et al., Netherlands [68] General practice Minimal intervention strategy (Assessing psychosocial risks, providing information on back pain and treatments & advice on self care) 43 48 2 143
   Usual GP care 42 47 2 171
Kaapa H., Finland [69] Occupational healthcare Multidisciplinary rehabilitation: guided, group programme. : CBT, relaxation, back school education & physical therapy 46 100 72 59
   Individual physiotherapy 47 100 63 61
Kankaanpaa, Finland [70] Occupational healthcare Active rehabilitation: guided exercises in a dept + behavioural support 40 34   30
   Passive treatment: which they considered as minor to the active arm, e.g. massage and thermal treatment 39 33   24
Kapitza et al., Germany [71] General population Contingent biofeedback 53 67 655 21
   Non-contingent biofeedback (placebo) 54 62 800 21
Karjalainen et al., 2003 & 2004, Finlands [72, 73] General practice Mini-intervention (Specific back exercises, reduce patient concerns & encourage physical activity) 44 59   56
   Mini-intervention & worksite visit 44 57   51
   Usual GP care 43 60   57
Kennedy et al., UK [74] Primary care Acupuncture + back book 47 46   24
   Sham acupuncture + back book 45 58   24
Kerr et al., UK [75] General practice Acupuncture 43 50 86 30
   Placebo TENS (non-functioning) 43 65 73 30
Kovacs et al., Spain [76] Nursing home consulters Back book education 80 66   233
   Back guide education 81 63   199
   Pamphlet with cardiovascular health advice 80 64   241
Kuukkanen et al., Finland [77] Occupational healthcare Intensive training: intensive progressive exercises guided at the gym + home exercises   62   29
   Home exercise only: same as intensive, but unguided   48   29
   Control: usual activities, no trial exercises   54   28
Leclaire et al., Canada [78] Private physiatrist clinic Standard care (rest, analgesics, physio) & Swedish back school 32 43   82
Standard care (rest, analgesics, physio) 32 41   86
Lindstrom et al., Sweden [79] Occupational healthcare Swedish back school & workplace visit + graded exercise (CBT approach)   24   51
   Usual care: rest& analgesics & physical treatment   38   52
Linton et al., Sweden [80] General practice + general population Back pain pamphlet 45 71   70
   Comprehensive information package 44 74   66
   CBT intervention 44 70   107
Luijsterburg et al., Netherlands [81] Primary care Physical therpay + GP care 42 57   67
   Usual GP care 43 40   68
Machado et al., Brazil [82] Physiotherapy Psychotherapy 45 81 356 16
   Exercise 42 59 206 17
Mannion et al., 1999 & 2001, Finland [83, 84] General population Modern active individual physiotherapy: strengthening, coordination and aerobics exercises, instructions on ergonomic principles + home exercises 46 61 520 46
   Muscle reconditioning on training devices (small groups) 45 54 504 47
   Low impact aerobic/stretching (groups) 44 55 676 44
Maul et al., Switzerland [85] Occupational healthcare Back school & exercise 38    97
   Back school 39    86
Mehling et al., USA [86] General practice Breath therapy 50 70 51 16
   Physical therapy: soft tissue mobilisation, joint mobilisation and exercises 49 58 57 12
Moseley L, Australia [87] Physiotherapy + General practice Physiotherapy 43 64   29
   Usual GP care 38 54   28
Niemisto et al., 2003 & 2005, Finland [88, 89] General population Manipulation, exercise & physician consultation 37 55 312 102
   Physician consultation only 37 53 312 102
Nordeman et al., Sweden [90] General practice + physical therapy dept Early access to physio (Individualised, exercise, advice, group education) 39 63   32
   Waiting list control 41 50   28
Paatelma et al., Finland [91] Occupational clinic Orthopaedic manual therapy 44 42   45
   McKenzie technique 44 29   52
   Advice only 44 35   37
Peloso et al., USA [92] Outpatients Tramadol & Acetamenophen combination tablets 375/325 2 PRN 58 64   167
   Placebo tablets 2 PRN 58 61   169
Rantonen et al., Finland [93] Occupational clinic Physical therapy 44 35 676 43
   Exercise 45 28 520 43
   Back book education 44 32 728 40
Rasmussen-Barr et al., Sweden [94] Physiotherapy Graded exercises 37 50 468 36
   Advice and walking 40 50 572 35
Rasmussen-Barr et al., Sweden [95] Physiotherapy Stabilizing training (Individual) (Cognitive + stabilisation of spinal muscles) 39 70   24
Manual treatment (Individual) (Other muscles exercises, no manipulation) 37 78   23
Rittweger et al., Germany [96] General population Isodynamic lumbar extension 50 44 603 30
Vibration exercise (On a machine with a vibrating platform) 54 52 754 30
Ritvanen et al., Finland [97] General population Traditional chiropractic bone setting 41 45   33
   Physical therapy 42 43   28
Rossignol et al., Canada [98] Workers compensation board Coordination of primary healthcare program 37 33   54
Usual GP care 38 23   56
Sahin et al., Turkey [99] Physical therapy clinics Back school 47 75 30 75
   Physical therapy 51 78 32 75
Soukup et al., Norway [100] General practice + general population + referrals Mensediesk exercise group intervention 40 53 676 34
   Waiting list group 40 49 578 35
Staal et al., & Hlobil et al., Netherlands [101, 102] Occupational healthcare Graded activity (Physiotherapy + OT) 39 5 9 67
   Usual OT care 37 8 8 67
Torstensen et al., Norway [103] Social security offices Medical exercise therapy (MET) 42 52   71
Conventional physiotherapy (CP) 43 48   67
Self exercise 40 51   70
Tsui et al., Hong Kong [104] Physiotherapy Electro-acupuncture & back exercise 40 76 39 14
   Electrical heat acupuncture + back exercise 39 71 54 14
   Back exercise only 41 62 50 14
Turner et al., USA [105] General practice + physicians + general population Relaxation training (group)     24
   Cognitive therapy (group)     23
   Cognitive therapy & Relaxation training (group)     25
   Waiting list control     30
Unsgaard-Tondel et al., Norway [106] Primary care Low load exercise 41 81 312 36
   High load sling exercise 43 64 468 36
   General exercise 36 65 312 37
van der Roer et al., Netherlands [107] Physiotherapy Intensive protocol training 42 55 54 60
   Guidelines based physiotherapy 42 48 47 54
Wand et al., UK [108] General practice + A/E patients Assess & Advice & Physiotherapy 34 44   43
   Assess & Advice & wait 35 55   51
Werners et al., Germany [109] General practice Interferential therapy: electrotherapy, to stimulate muscles fibres 38 43   68
   Motorised lumbar traction & massage 39 49   72
Yelland et al., Australia [110] General practice Glucose lignocaine injection 52 59 770 28
   Exercise (Alternating: flexion and extension of spine and hips) 49 55 718 26
   Saline injection 50 56 759 27
   Normal activity 51 58 733 29
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BMC Musculoskeletal Disorders

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