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- Therapeutic quality of exercise interventions for chronic low back pain: a meta-research study using i-CONTENT tool
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Original research
Therapeutic quality of exercise interventions for chronic low back pain: a meta-research study using i-CONTENT tool
- http://orcid.org/0009-0008-5781-743XIgnazio Geraci1,
- Silvia Bargeri2,
- Giacomo Basso1,
- Greta Castellini2,
- Alessandro Chiarotto3,4,
- Silvia Gianola2,
- Ostelo Raymond3,5,
- Marco Testa1,
- Tiziano Innocenti1,3,6
- 1Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI), University of Genova, Genova, Italy
- 2Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy
- 3Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- 4Department of General Practice, University Medica Center, Erasmus MC, Rotterdam, Netherlands
- 5Department of Epidemiology and Data Science, Vrije Universiteit & Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, Netherlands
- 6GIMBE Foundation, Bologna, Italy
- Correspondence to Dr Ignazio Geraci; ignazio.geraci{at}virgilio.it
Abstract
Objective To assess the therapeutic quality of exercise interventions delivered in chronic low back pain (cLBP) trials using the international Consensus on Therapeutic Exercise aNd Training (i-CONTENT) tool and its inter-rater agreement.
Methods We performed a meta-research study, starting from the trials’ arms included in the published Cochrane review (2021) ‘Exercise therapy for chronic low back pain’. Two pairs of independent reviewers applied the i-CONTENT tool, a standardised tool designed to ensure the quality of exercise therapy intervention, in a random sample of 100 different exercise arms. We assessed the inter-rater agreement of each category calculating the specific agreement. A percentage of 70% was considered satisfactory.
Results We included 100 arms from 68 randomised controlled trials published between 1991 and 2019. The most assessed exercise types were core strengthening (n=27 arms) and motor control (n=13 arms). Among alternative approaches, yoga (n=11) and Pilates (n=7) were the most representative. Overall, most exercise interventions were rated as having a low risk of ineffectiveness for patient selection (100%), exercise type (92%), outcome type and timing (89%) and qualified supervisor (84%). Conversely, some items showed more uncertainty: the safety of exercise programmes was rated as ‘probably low risk’ in 58% of cases, exercise dosage in 34% and adherence to exercise in 44%. The items related to exercise dosage (31%) and adherence (29%) had heterogenous judgements, scoring as high risk of ineffectiveness or probably not done. Among all exercise types, Pilates scored best in all domains. A satisfactory specific agreement for ‘low risk category’ was achieved in all items, except dosage of exercise (60%) and adherence to exercise (54%).
Conclusion Exercises delivered for patients with cLBP generally demonstrate favourable therapeutic quality, although some exercise modalities may present poor therapeutic quality related to dosage and adherence. While the i-CONTENT judgements generally showed satisfactory specific agreement between raters, disagreements arose in evaluating some crucial items.
- Physical and Rehabilitation Medicine
- Musculoskeletal Diseases
Data availability statement
All data relevant to the study are included in the article or uploaded as online supplemental information.
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- Physical and Rehabilitation Medicine
- Musculoskeletal Diseases
Data availability statement
All data relevant to the study are included in the article or uploaded as online supplemental information.
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Footnotes
IG and SB contributed equally.
Contributors IG: Guarantor of the study. IG and GB: Conceptualisation, investigation, data curation, writing—review and editing. SB, GC, SG: Conceptualisation, methodology, investigation, data curation, writing—review and editing. AC and RO: Conceptualisation, methodology, writing—review and editing. MT: Conceptualisation, writing—review and editing. TI: Conceptualisation, methodology, data curation, writing—review and editing.
Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.
Competing interests None declared.
Patient and public involvement Patients and/or the public were not involved in the design, or conduct, or reporting or dissemination plans of this research.
Provenance and peer review Not commissioned; externally peer reviewed.
Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.
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