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Oliveira C.B.1, Franco M.R.1, Morelhao P.K.1, Maher C.2, Ferreira P.H.3, Hisamatsu T.M.1, Damato T.M.1, Pinto R.Z.1
1São Paulo State University (UNESP), Physiotherapy Department, Presidente Prudente, Brazil, 2University of Sydney, Australia, The George Institute for Global Health, Sydney Medical School, Sydney, Australia, 3Faculty of Health Sciences, The University of Sydney, Sydney, NSW, Australia, Sydney, Australia
Background: Chronic musculoskeletal pain (CMP) is responsible for the high rates of disability which is related to low physical activity levels in these patients. Current evidence shows that physical activity-based interventions are effective to reduce pain and disability, but post-interventions improvements are not sustained for long periods. Several behavior change techniques have been recently incorporated to influence the effectiveness of physical activity-based interventions, including the provision of feedback that can be delivered face-to-face or using electronic devices. However, there is no evidence investigating the effectiveness of physical activity-based using electronic feedback to reduce pain and disability in patients with CMP.
Purpose: Systematically review the effectiveness of physical activity-based interventions using electronic feedback compared to no/minimal interventions in patients with CMP.
Methods: This systematic review was previously registered in PROSPERO (CRD42016049730). The following databases were searched: EMBASE, MEDLINE, the Cochrane Central Register of Controlled Trials (CENTRAL), PsycINFO, CINAHL, SPORTDiscus, Web of Science, PEDro and main clinical trial registers. The search was not restricted to any language or date of publication. Randomized controlled trials (RCTs) and quasi-RCTs investigating interventions to promote physical activity that included an electronic feedback no/minimal intervention (e.g. no intervention, education) in adults with CMP were considered eligible. The studies had to report data of at least one primary (pain and disability) or secondary outcome (quality of life and physical activity levels). The outcomes were summarized by the following time-points of assessment: short-term (less than 3 months); intermediate-term (between 3 and 12 months) and long-term (more than 12 months). Pooled effects were calculated with standardized mean difference (SMD) and the meta-analysis using random effect models in the Comprehensive Meta-Analysis software V.2.2.064 (Biostat, Englewood, NJ).
Results: Six published trials and eight register trials were included. For short-term follow-up, pooled estimations showed no significant differences between physical activity-based interventions compared to minimal intervention in pain (SMD= -0.17, 95%CI: -0.54 to 0.20) and disability (SMD= -0.37, 95%CI: -0.99 to 0.25), physical activity levels (SMD= -0.24, 95%CI: 0.57 to 1.38) and quality of life (SMD= 0.09, 95%CI: -0.18 to 0.36). Similarly, non-significant results were found for the intermediate and long-term follow-ups. According to GRADE, the overall quality of evidence was considered to be of low quality.
Conclusion(s): Our findings suggest that physical activity-based interventions enhanced with electronic feedback was not significant different compared to minimal intervention in pain and disability of patients with CMP. However, eight unpublished were identified and might change the findings reported in this review.
Implications: Further studies should be conducted to estimate the effectiveness of physical activity-based interventions using electronic feedback on pain and disability and estimating the cost-effectiveness of these electronic devices. Clinicians need to be cautious when implementing electronic feedback in physical activity-based interventions to improve clinical outcomes.
Funding acknowledgements: Supported by the São Paulo Research Foundation (grant nos. 2016/03826-5, 2015/17093-7, 2015/07704-9, 2015/02744-2, and 2014/14077-8).
Topic: Musculoskeletal
Ethics approval: Ethical approval was not required for this systematic review.
All authors, affiliations and abstracts have been published as submitted.
