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158 APPENDICES Physiotherapy KCE reports vol.40 Table 9 Acute low back pain: treatment modalities applied by Belgian ambulatory physiotherapists and evidence-based literature Treatment modality Frequency (proportion ± accuracy) Home exercises 62 ± 6% Stretching 55 ± 6% Thermotherapy 46 ± 6% Muscle strengthening 44 ± 6% Type of evidence ? Evidence for ? (moderate to strong) Evidence for (moderate to strong) Evidence for (weak) Evidence for (moderate to strong) Evidence available in the literature on physiotherapy of acute low back pain (LBP) Adopted under the term Exercise therapy (COST B13 Working Group 2004). There is a moderate to strong evidence supporting a positive but modest short-term effect of exercise therapy. There is no clear evidence on the type of exercises that should be recommended. Although low intensity exercises seem ineffective, there is no clear evidence on the frequency, duration and intensity of exercises that should be recommended. Adopted under the term Exercise therapy (COST B13 Working Group 2004). There is a moderate to strong evidence supporting a positive but modest short-term effect of exercise therapy. There is no clear evidence on the type of exercises that should be recommended. Although low intensity exercises seem ineffective, there is no clear evidence on the frequency, duration and intensity of exercises that should be recommended. Stretching exercises may improve pain and function. There is weak evidence that heat therapy in patients with acute and subacute low back pain slightly reduce pain and disability at short-term. There is no evidence available for or against the effectiveness of cold therapy. Adopted under the term Exercise therapy (COST B13 Working Group 2004). There is a moderate to strong evidence supporting a positive but modest short-term effect of exercise therapy. There is no clear evidence on the type of exercises that should be recommended. Although low intensity exercises seem ineffective, there is no clear evidence on the frequency, duration and intensity of exercises that should be recommended. Although muscle strengthening is a common component of exercise programmes, it is no more effective than other types of exercises. Muscle strengthening may improve pain and function.
KCE reports vol. 40 APPENDICES Physiotherapy 159 Table 9 Acute low back pain: treatment modalities applied by Belgian ambulatory physiotherapists and evidence-based literature Treatment modality Frequency (proportion ± accuracy) Electrophysiotherapy 39 ± 6% Spinal manipulations 38 ± 6% Type of evidence Conflicting evidence (only chronic LBP) ? Evidence against (weak) ? Evidence against (weak) Evidence for (moderate) but not safety Evidence available in the literature on physiotherapy of acute low back pain (LBP) TENS: There is conflicting evidence that TENS as an isolated intervention is effective in patients with chronic low back pain. Some studies support a limited effect of TENS in reducing pain and improving function. However, more studies of sufficient power are needed before definitive conclusions can be drawn. Ionization / inteRFTrential currents: There is very little evidence available in the literature on the effectiveness of electrotherapy (ionization, inteRFTrential currents ). The effectiveness of such physical therapy modalities remains unknown. Such treatment modalities should thus not be recommended. Ultrasounds: There is weak evidence that ultrasounds are ineffective to treat low back pain. However very little good quality studies on this topic are available in the literature. Based on the available evidence, ultrasounds should not be recommended. Electromagnetic waves: There is no evidence available in the literature on the effectiveness of electromagnetic waves. Laser: There is weak evidence that laser therapy is ineffective to treat low back pain. However very little good quality studies on this topic are available in the literature. Based on the available evidence, laser therapy should not be recommended. There is moderate evidence that spinal manipulations are more effective than no treatment to treat low back pain. There is moderate evidence that spinal manipulations are as effective as more traditional physiotherapeutic treatments. There is little and sometimes conflicting evidence on safety of manipulative treatment for low back pain. Minor secondary effects (headache, fatigue sensation, general transient unwellness state and/or pain enhancement) seem frequent and self-limiting. Major complications (stroke due to vertebro-basilar artery dissection, herniated discs, cauda equina syndrome) seem very uncommon but potentially dramatic.
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