Prevention of non-specific back pain through exercise and education: A systematic review and meta-analysis

BACKGROUND: Clinical practice guidelines stress the importance of prevention and treatment of non-specific back pain through exercise therapy. However, it has not yet been confirmed whether the combination of exercise plus education is more effective than such interventions taken separately. OBJECTIVE: To determine if the combination of exercise plus education is more effective for the prevention of non-specific back pain than exercise or education alone. METHOD: A systematic search of studies whose sample consisted of participants without non-specific back pain (primary prevention) and participants with non-specific back pain (secondary and tertiary prevention) was conducted in the following databases in March 2023: PubMed, Scopus, Web of Science and Medline. RESULTS: A total of 16 articles were selected. Statistically significant results were found in the pain variable with SMD = 2.02 (95% CI = 2.71 to 1.33; p < 0.001), the disability variable with SMD = 1.14 (95% CI = 1.63 to 0.65; p < 0.001), and the kinesiophobia variable with SMD = 1.8 (95% CI = 2.54 to 1.05; p < 0.001). CONCLUSION: Interventions that combine exercise and education seem to have a greater preventive effect on non-specific back pain, disability and kinesiophobia than those that include exercise or education in an isolated manner.