Download the supplement (208 p.) - KCE
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<strong>KCE</strong> reports vol. 40 APPENDICES Physio<strong>the</strong>rapy 157<br />
Table 9 Acute low back pain: treatment modalities applied by Belgian ambulatory physio<strong>the</strong>rapists and evidence-based literature<br />
Treatment modality<br />
Frequency<br />
(proportion<br />
± accuracy)<br />
Education of <strong>the</strong> patient 86 ± 4%<br />
Massage 75 ± 5%<br />
Mobilizations 74 ± 5%<br />
Type of<br />
evidence<br />
Evidence for<br />
(moderate to<br />
strong)<br />
Evidence for<br />
(moderate)<br />
? Evidence<br />
for ?<br />
(moderate to<br />
strong)<br />
Evidence available in <strong>the</strong> literature on physio<strong>the</strong>rapy of acute low back pain (LBP)<br />
There is moderate to strong evidence that educational interventions are effective to<br />
reduce disability and increase return to work but are ineffective to reduce pain level.<br />
Concerning back schools: There is moderate evidence suggesting that back schools are<br />
effective in reducing pain, improving function and return to work rate during short and<br />
intermediate-terms follow-up. There is moderate evidence suggesting that back schools have<br />
better short- and intermediate-terms effects on pain and function in patients with recurrent or<br />
chronic low back pain than o<strong>the</strong>r traditional treatments. Back schools programs usually include<br />
education, exercise and interventions on movement and postures ergonomics in proportions<br />
and quantities that may considerably vary. More studies should be conducted to identify <strong>the</strong><br />
optimal proportion of <strong>the</strong> different components of back schools programs as well as <strong>the</strong><br />
characteristics of <strong>the</strong> total program in terms of number, frequency, duration and composition<br />
of <strong>the</strong> sessions.<br />
Concerning advice to stay active: Educating <strong>the</strong> patient with acute low back pain on <strong>the</strong><br />
importance to stay active and to resume normal activities of daily life as soon as possible is<br />
effective.<br />
Concerning bed rest: There is strong evidence that bed rest is ineffective in acute low back<br />
pain and may induce undesirable effects.<br />
There is moderate evidence that massage has a superior positive effect on low back pain as<br />
compared to passive <strong>the</strong>rapeutic modalities such as relaxation, acupuncture and self-care<br />
education.<br />
Adopted under <strong>the</strong> term Exercise <strong>the</strong>rapy (COST B13 Working Group 2004).<br />
There is a moderate to strong evidence supporting a positive but modest short-term effect<br />
of exercise <strong>the</strong>rapy. There is no clear evidence on <strong>the</strong> type of exercises that should be<br />
recommended. Although low intensity exercises seem ineffective, <strong>the</strong>re is no clear evidence on<br />
<strong>the</strong> frequency, duration and intensity of exercises that should be recommended.