To assess and compare the effects of SHT on pain and disability in adults with LBP; and to explore the commonly delivered modalities and dosage of SHT
PubMed, CINAHL, Cochrane, Europe PMC, ProQuest, PEDro and SPORT Discus were searched from inception to July 4, 2024. Only randomised controlled trials that utilised heat wraps or hot packs in participants with acute, subacute or chronic non-specific LBP were included. Risk of bias was assessed using Cochrane Risk of Bias Tool 2.0. Meta-analysis was only possible for two studies. All included studies were qualitatively synthesised.
Fourteen studies with 1300 participants were included in the review. Risk of bias was low in one trial, with "some concerns" in 11 trials and high in two trials. The most common SHT was continuous heat wrap therapy for eight hours daily (n=7). Only immediate-term and short-term effects (two weeks) were reported. The meta-analysis showed that in two trials of 258 participants with acute and subacute LBP, heat wrap significantly reduced pain after five days (MD 1.06, 95%CI 0.68 to 1.45, I2=0%). Significant improvements in pain and function were observed for SHT compared to no heat, for acute to chronic LBP. SHT combined with exercise, education, paracetamol or nonsteroidal anti-inflammatory drugs (NSAIDs) significantly decreased pain and disability compared to the interventions alone. Heat wrap was significantly better for pain and function than analgesics, NSAIDs and educational booklet for acute and subacute LBP.
SHT, delivered alone or with education, exercise or pain medication, may reduce pain and disability for acute, subacute and chronic LBP in the immediate to short term. SHT is more effective than education and pharmacological interventions. The quality of the current evidence base in this field of research highlights a need for future higher-quality trials to reinforce the role of SHT in LBP management and to establish the dosage and long-term effects.
SHT, with or without pharmacological interventions, education or exercise, can improve pain and function for acute, subacute and chronic LBP in the short term. Our findings may inform current national guidelines of the use of SHT for the management of non-specific LBP.
Superficial heat
Disability
