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Open AccessArticle

Best Evidence Rehabilitation for Chronic Pain Part 3: Low Back Pain

1,2,3,4,5,*, 1,2,3,4, 1,2,3,4,6, 2,3,4,5, 2,3,5, 2,3, 2,3,7, 2,3, 2,3,8 and 2,3,4,*
1
Research Foundation–Flanders (FWO), 1090 Brussels, Belgium
2
Department of Physiotherapy, Human Physiology and Anatomy (KIMA), Faculty of Physical Education & Physiotherapy, Vrije Universiteit Brussel, 1090 Brussels, Belgium
3
Pain in Motion International Research Group, 1090 Brussels, Belgium
4
Department of Physical Medicine and Physiotherapy, University Hospital Brussels, Laarbeeklaan 101, 1090 Brussels, Belgium
5
Department of Rehabilitation Sciences and Physiotherapy, Faculty of Medicine and Health Sciences, Ghent University, 9000 Gent, Belgium
6
Department of Public Health (GEWE), Faculty of Medicine and Pharmacy, Vrije Universiteit Brussel, 1090 Brussels, Belgium
7
Department of Experimental-Clinical and Health Psychology, Ghent University, 9000 Ghent, Belgium
8
Transcare, Transdisciplinary Pain Management Centre, 9728 EE Groningen, The Netherlands
*
Authors to whom correspondence should be addressed.
J. Clin. Med. 2019, 8(7), 1063; https://doi.org/10.3390/jcm8071063
Received: 6 June 2019 / Revised: 3 July 2019 / Accepted: 16 July 2019 / Published: 19 July 2019
(This article belongs to the Special Issue Rehabilitation for Persistent Pain Across the Lifespan)
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PDF [482 KB, uploaded 25 July 2019]
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Abstract

Chronic Low Back Pain (CLBP) is a major and highly prevalent health problem. Given the high number of papers available, clinicians might be overwhelmed by the evidence on CLBP management. Taking into account the scale and costs of CLBP, it is imperative that healthcare professionals have access to up-to-date, evidence-based information to assist them in treatment decision-making. Therefore, this paper provides a state-of-the-art overview of the best evidence non-invasive rehabilitation for CLBP. Taking together up-to-date evidence from systematic reviews, meta-analysis and available treatment guidelines, most physically inactive therapies should not be considered for CLBP management, except for pain neuroscience education and spinal manipulative therapy if combined with exercise therapy, with or without psychological therapy. Regarding active therapy, back schools, sensory discrimination training, proprioceptive exercises, and sling exercises should not be considered due to low-quality and/or conflicting evidence. Exercise interventions on the other hand are recommended, but while all exercise modalities appear effective compared to minimal/passive/conservative/no intervention, there is no evidence that some specific types of exercises are superior to others. Therefore, we recommend choosing exercises in line with the patient’s preferences and abilities. When exercise interventions are combined with a psychological component, effects are better and maintain longer over time. View Full-Text
Keywords: pain neuroscience; musculoskeletal pain; rehabilitation medicine; physiotherapy; lifestyle pain neuroscience; musculoskeletal pain; rehabilitation medicine; physiotherapy; lifestyle
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Malfliet, A.; Ickmans, K.; Huysmans, E.; Coppieters, I.; Willaert, W.; Van Bogaert, W.; Rheel, E.; Bilterys, T.; Van Wilgen, P.; Nijs, J. Best Evidence Rehabilitation for Chronic Pain Part 3: Low Back Pain. J. Clin. Med. 2019, 8, 1063.

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