The main objective of this systematic review was to describe the extent to which PROGRESS-Plus equity factors are considered in NSCLBP physical rehabilitation RCTs. The PROGRESS-Plus framework is a comprehensive list of equity factors for health research, designed to show the determinants of health across which inequities may exist. These factors directly impact rehabilitation participation and are therefore a public health priority. This has been highlighted by the World Health Organisation and the National Institute for Health and Care Research, who found that deprived communities with higher rates of ill health do not participate in research, which consequently does not represent them.
A comprehensive search was conducted in five databases (CINAHL, MEDLINE, Scopus, Web of Science, and SPORTDiscus), for published randomised controlled trials (RCTs) of physical rehabilitation interventions for adults with NSCLBP. Reasons for exclusion were considered, as well as counts and proportions of those excluded and for what reason.
N=42 studies were included. Where reported, one third of participants were excluded based on equity factors. Participants with high body-mass index, severe risk of disability, those experiencing language barriers, and elderly patients, were the most underrepresented. However overall results were inconclusive due to limited inclusion of participant information within the studies.
The population of those with NSCLBP is diverse. Therefore, minimisation of inequity and maximisation of participation should be the primary target of NSCLBP rehabilitation trials. Studies should consider alternatives to overcome barriers to participation. Exclusions should be justified, and when justifying, a careful consideration of risk versus benefit should be demonstrated.
Clear reporting of exclusion criteria in line with the PROGRESS-Plus equity factors would ensure practitioners are informed as to the generalisability of an intervention to a particular patient or patient group, and thereby enhance clinical decision making. In terms of inequity in clinical practice, shared decision-making between stakeholders and researchers could be beneficial in terms of recognising targetable areas of inequity, in addition to exploring enablers to participation during the research process.
Chronic lower back pain
Systematic review
