TY - JOUR
T1 - Active and passive physical therapy in patients with chronic low-back pain
T2 - a level I Bayesian network meta-analysis
AU - Baroncini, Alice
AU - Maffulli, Nicola
AU - Manocchio, Nicola
AU - Bossa, Michela
AU - Foti, Calogero
AU - Schäfer, Luise
AU - Klimuch, Alexandra
AU - Migliorini, Filippo
N1 - Lehr-KH Academic Hospital of Bolzano (SABES-ASDAA), Via Lorenz Böhler 5, 39100, Bolzano, Italy
PY - 2025/10/3
Y1 - 2025/10/3
N2 - BackgroundChronic low back pain (cLBP) is common. Physiotherapy is frequently indicated as a non-pharmacological management of these patients. This Bayesian network meta-analysis compared active versus passive physiotherapy versus their combination in terms of pain and disability in patients with mechanical and/or aspecific cLBP.MethodsIn June 2025, the following databases were accessed: PubMed, Web of Science, Google Scholar and Embase. All the randomised controlled trials (RCTs) which evaluated the efficacy of a physiotherapy program in patients with LBP were accessed. Data regarding pain scores, the Roland-Morris Disability Questionnaire (RMQ) and the Oswestry Disability Index (ODI) were collected. The network meta-analyses were performed using the STATA (version 14; StataCorp, College Station, TX, USA) routine for Bayesian hierarchical random-effects model analysis, employing the inverse variance method. The standardised mean difference (STD) was used for continuous data.ResultsData from 2768 patients (mean age 46.9 +/- 10.9 years, mean BMI 25.8 +/- 2.9 kg/m2) were collected. The mean length of follow-up was 6.2 +/- 6.1 months. Between groups, comparability was found at baseline in terms of mean age, proportion of women, mean BMI, symptom duration and patient-reported outcome measures (PROMs). By the end of the follow-up period, the active group evidenced the lowest pain scores (SMD 1.00; 95% CI -3.28 to 5.28). The active group evidenced the lowest RMQ score (SMD 0.94; 95% CI -4.96 to 3.09). The active group evidenced the lowest ODI score (SMD -1.23; 95% CI -9.83 to 7.36).ConclusionActive physiotherapy showed better results than passive physiotherapy and a combination of both for the management of mechanical and/or non-specific cLBP.Level of evidence: Level I, Bayesian network meta-analysis of RCTs.ConclusionActive physiotherapy showed better results than passive physiotherapy and a combination of both for the management of mechanical and/or non-specific cLBP.Level of evidence: Level I, Bayesian network meta-analysis of RCTs.
AB - BackgroundChronic low back pain (cLBP) is common. Physiotherapy is frequently indicated as a non-pharmacological management of these patients. This Bayesian network meta-analysis compared active versus passive physiotherapy versus their combination in terms of pain and disability in patients with mechanical and/or aspecific cLBP.MethodsIn June 2025, the following databases were accessed: PubMed, Web of Science, Google Scholar and Embase. All the randomised controlled trials (RCTs) which evaluated the efficacy of a physiotherapy program in patients with LBP were accessed. Data regarding pain scores, the Roland-Morris Disability Questionnaire (RMQ) and the Oswestry Disability Index (ODI) were collected. The network meta-analyses were performed using the STATA (version 14; StataCorp, College Station, TX, USA) routine for Bayesian hierarchical random-effects model analysis, employing the inverse variance method. The standardised mean difference (STD) was used for continuous data.ResultsData from 2768 patients (mean age 46.9 +/- 10.9 years, mean BMI 25.8 +/- 2.9 kg/m2) were collected. The mean length of follow-up was 6.2 +/- 6.1 months. Between groups, comparability was found at baseline in terms of mean age, proportion of women, mean BMI, symptom duration and patient-reported outcome measures (PROMs). By the end of the follow-up period, the active group evidenced the lowest pain scores (SMD 1.00; 95% CI -3.28 to 5.28). The active group evidenced the lowest RMQ score (SMD 0.94; 95% CI -4.96 to 3.09). The active group evidenced the lowest ODI score (SMD -1.23; 95% CI -9.83 to 7.36).ConclusionActive physiotherapy showed better results than passive physiotherapy and a combination of both for the management of mechanical and/or non-specific cLBP.Level of evidence: Level I, Bayesian network meta-analysis of RCTs.ConclusionActive physiotherapy showed better results than passive physiotherapy and a combination of both for the management of mechanical and/or non-specific cLBP.Level of evidence: Level I, Bayesian network meta-analysis of RCTs.
KW - Humans
KW - Low Back Pain/therapy
KW - Bayes Theorem
KW - Physical Therapy Modalities
KW - Network Meta-Analysis as Topic
KW - Chronic Pain/therapy
KW - Pain Measurement
KW - Randomized Controlled Trials as Topic
KW - Middle Aged
U2 - 10.1186/s10195-025-00885-4
DO - 10.1186/s10195-025-00885-4
M3 - Review article
C2 - 41042338
SN - 1590-9921
VL - 26
SP - 66
JO - JOURNAL OF ORTHOPAEDICS AND TRAUMATOLOGY
JF - JOURNAL OF ORTHOPAEDICS AND TRAUMATOLOGY
IS - 1
M1 - 66
ER -