Exercise Increases Pain Self-efficacy in Adults With Nonspecific Chronic Low Back Pain: A Systematic Review and Meta-analysis.

Abstract

<b>OBJECTIVE:</b> To determine the effect of exercise on pain self-efficacy in adults with nonspecific chronic low back pain (NSCLBP). <b>DESIGN:</b> Intervention systematic review with meta-analysis <b>LITERATURE SEARCH:</b> We searched the Cochrane Central Register of Controlled Trials (CENTRAL), PubMed, Embase, PsycINFO, and CINAHL databases from October 20, 2018, to March 23, 2022. <b>SELECTION CRITERIA:</b> We included randomized controlled trials that compared the effect of exercise on pain self-efficacy to control, in adults with NSCLBP. <b>DATA SYNTHESIS:</b> We conducted a meta-analysis using a random-effects model. We evaluated the risk of bias using the Cochrane risk-of-bias tool (RoB 2) and judged the certainty of evidence using the Grading of Recommendations, Assessment, Development, and Evaluations (GRADE) framework. <b>RESULTS:</b> Seventeen trials were included, of which eight (n = 1121 participants; 60.6% female; mean age: 49.6 years) were included in the meta-analysis. Exercise increased pain self-efficacy by 3.02 points (95% confidence interval: 1.72, 4.32) on the 60-point Pain Self-Efficacy Questionnaire. The certainty of evidence was moderate; all trials were at high risk of bias. <b>CONCLUSION:</b> There was moderate-certainty evidence that exercise increased pain self-efficacy in adults with NSCLBP. Future research should investigate if this effect is meaningful, whether it increases with more targeted treatments to enhance pain self-efficacy, and the effects on outcomes for adults with NSCLBP. <i>J Orthop Sports Phys Ther 2023;53(6):1-8. Epub: 10 May 2023. doi:10.2519/jospt.2023.11622</i>.