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P. Ouellet1, S. Lafrance1,2, A. Pizzi2, J.-S. Roy3,4, J. Lewis5,6,7, D.H. Christiansen8,9, B. Dubois10, P. Langevin3,4, F. Desmeules1,2
1University of Montreal, School of Rehabilitation, Montreal, Canada, 2Maisonneuve-Rosemont Hospital Research Center, University of Montreal Affiliated Research Center, Montreal, Canada, 3Laval University, Department of Rehabilitation, Quebec, Canada, 4Center for Interdisciplinary Research in Rehabilitation and Social Integration (CIRRIS), Quebec, Canada, 5University of Hertfordshire, School of Health and Social Work, Hatfield, United Kingdom, 6Central London Community Healthcare National Health Service Trust, Therapy Department, London, United Kingdom, 7Qatar University, Department of Physical Therapy & Rehabilitation Science, Doha, Qatar, 8, Regional Hospital West Jutland University Research Clinic, Department of Occupational Medicine, Herning, Denmark, 9Aarhus University, Department of Clinical Medicine, Aarhus, Denmark, 10The Running Clinic, Quebec, Canada
Background: Musculoskeletal disorders (MSKDs) are among the leading causes of long-term pain and physical disability in adults. Physical activity and therapeutic exercises are often recommended and are found to be effective interventions in the treatment of patients with various MSKDs, such as neck pain, low back pain (LBP) or osteoarthritis (OA). It remains unclear which type of exercises is more effective and if general physical exercises could have equivalent benefits when compared to a more specific approach with a certain population of MSKDs. This is of particular interest since general exercises may be more accessible, affordable or may not require specific equipment.
Purpose: To compare the efficacy of specific exercises to general exercises for adults with MSKDs on pain and disability-related outcomes.
Methods: A systematic review with meta-analyses was performed. Electronic searches were conducted up to April 2020 in Medline, Embase, Cochrane CENTRAL and CINAHL. Studies had to be randomized controlled trials (RCTs) on the efficacy of specific exercises compared to general exercises for adults with MSKDs. Two reviewers independently reviewed titles and abstracts to identify trials of interest. To be considered for inclusion, one of the groups needed to investigate the effect of a specific exercise strategy, while the other group had to be prescribed a general exercise program. Specific exercises were defined as exercises targeting specific musculature and/or dynamic muscle group stabilizers or specific movements and general exercises were defined as any aerobic exercises (walking or cycling), yoga, Tai Chi, Pilates exercise method and/or general resistance exercises i.e., not aimed at a defined area of the body. RCTs were appraised with the Risk of Bias Tool from the Cochrane Collaboration and the GRADE (Grading of Recommendations, Assessment, Development and Evaluations) approach was used for grading the quality of evidence and presenting final recommendations. Mean differences (MD) and standardized mean differences (SMD) were calculated using random-effects inverse variance modeling.
Results: Eighteen RCTs (n=1,719) were included. Most of cohorts were composed of participants with chronic neck pain or LBP. Based on very low to low quality evidence, there were no statistically significant differences between specific and general exercises in terms of pain reduction in the short-term (MD -0.17 out of 10 points; 95%CI: -0.65 to 0.31; n=1,116), the mid-term (MD -0.37 out of 10 points; 95%CI: -1.08 to 0.33; n=548) or the long-term (MD -0.38 out of 10 points; 95%CI: -1.50 to 0.75; n=396) and no significant reduction in disability in the short-term (SMD 0.01; 95%CI: -0.22 to 0.25; n=1,091), the mid-term (SMD 0.11; 95%CI: -0.41 to 0.63; n=621) or the long-term (SMD -0.08; 95%CI: -0.55 to 0.39; n=686). However, both approaches showed statistically significant and clinically important reductions in pain and disabilities.
Conclusion(s): There are no statistically significant differences between specific and general exercises for pain reduction and disability for adults with MSKDs. Results from future trials could change the current conclusions.
Implications: A general exercise regimen could be as effective as a more specific exercise approach to treat MSKDs.
Funding, acknowledgements: Dr. Desmeules’ Canadian Institutes of Health Research Program New Investigator Salary and Research Award in Clinical Rehabilitation (201609NCR-375311-130299).
Keywords: therapeutic exercise, musculoskeletal disorders, chronic pain
Topic: Musculoskeletal
Did this work require ethics approval? No
Institution: None
Committee: None
Reason: Systematic review with meta-analyses
All authors, affiliations and abstracts have been published as submitted.
