Comparative efficacy of 12 non-drug interventions on non-specific chronic low back pain in nurses: A systematic review and network meta-analysis

BACKGROUND: Many non-drug interventions for decreasing non-specific chronic low back pain (NSCLBP) in nurses have been extensively studied, but the most effective approach is still unclear. OBJECTIVE: This systematic review and network meta-analysis evaluated the efficacies of 12 non-drug interventions in reducing NSCLBP in nurses. METHODS: PubMed, ScienceDirect, Web of Science, Cochrane, EMBASE, CINAHL, Medline, WANFANG, VIP, China Knowledge Integrated, and SinoMed were searched from their establishment to July 2019. Randomized controlled trials (RCTs) comparing non-drug interventions for NSCLBP in nurses were included and analyzed using Stata v15 statistical software. RESULTS: A total of 31 RCTs (n = 7116) and 12 non-drug interventions were included. The first three results with the highest surface areas under the curve ranking area (SUCRAs) were low back exercise plus healthy education, single low back exercise, and yoga (SUCRAs: 79.4%, 76.2%, and 75.1%, respectively). In addition, single yoga was inferior to protective equipment (standardized mean difference [SMD] = 3.88, 95% confidence interval [CI]: 0.92 to 6.84) and multidisciplinary intervention (SMD = 4.06, 95% CI: 7.33 to 0.78). CONCLUSIONS: Low back exercise plus health education may be the best approach to reduce NSCLBP in nurses. Considering the heterogeneity, our findings need to be confirmed in future multicenter large sample RCTs in different countries.