Effectiveness of self-management of low back pain: systematic review with meta-analysis

you can do it

This week in Scotland has been designated as self-management week. There is a growing awareness that low back pain (LBP) is a long term condition and that self-management can decrease the burden of this, and many other, conditions. To date, self-management has been described as a model of care where patients use strategies to manage and monitor their own health, retaining a primary role in management, and where they learn skills to be used in the daily management of their health condition.

As part of the redesigned musculoskeletal services in Scotland patients are often directed, via NHS24, to self-management resources online or a through a mobile phone app. But how effective is the self-management of LBP? This was the question asked in a systematic review by Oliveira et al. (2012).

Here’s what they did

Studies were retrieved from searches of the following databases from earliest record to April 2011: MEDLINE, EMBASE, CINAHL, PsycINFO, LILACS, PEDro, AMED, SPORTDiscus and Cochrane Register of Clinical Trials. Trials were eligible if they included participants with non-specific LBP of any duration. They included trials in which at least one intervention was indicated by authors as self-management for LBP by naming the intervention using the terms “self-management” or “self-care”. Eligible studies were assessed for methodological quality using the PEDro scale (0-10), and the Grades of Recommendation, Assessment, Development and Evaluation (GRADE) system was used to summarise the strength of the recommendation for each outcome:

Here’s what they found

Search strategies identified 2325 titles after removing duplicates. Screening of titles and abstracts identified 154 potentially eligible papers and 13 original trials were included that recruited a total of 3063 participants. Trials used written information, discussion sessions and audiovisual resources (i.e. audiotape, videotape or website) as self-management strategies. The amount of support given by health care providers or lay-trained leaders varied between one and thirteen sessions. The mean score for methodological quality using the PEDro scale was 6.5/10

The authors concluded

signs pointing to change

“There is moderate quality evidence that self-management has small effects on pain and disability in people with LBP.”

Their review provided moderate evidence that the effects of self-management for non-specific LBP (less than 6 points on a 100-point scale) are only small if compared to minimal intervention, posing the question of whether or not this is a worthwhile approach.
However, the authors cation that it would be premature to completely dismiss self-management of LBP. Instead they advocate an increase in research seeking to further understand the limitations of self-management and how its effectiveness may be increased.

The Musculoskeletal Elf’s view

Many primary cThe Musculoskeletal Elfare and LBP management clinical guidelines promote the use of self-management; however, when it comes to LBP, it appears that there is work to be done in defining what a ‘self-management intervention’ is and how it is best introduced to patients and delivered.

Another review conducted by the Health Foundation (de Silva, 2011) concluded that information provision alone is unlikely to be sufficient to motivate behaviour change and improve outcomes, and that interventions such as motivational interviewing, telephone coaching and active group interventions should be used.

What are your experiences of giving or receiving self-management resources/ interventions? What feedback have you had from your patients on their views of self-management resources? How can you improve any current self-management resources that you are delivering?

Send us your views on this blog and become part of the ever expanding Musculoskeletal Elf community.


Oliveira, V.C., Ferreira, P.H., Maher, C.G., Pinto, R.Z., Refshauge, K.M. & Ferreira, M.L. 2012, “Effectiveness of self-management of low back pain: Systematic review with meta-analysis”, Arthritis Care & Research, online ahead of publication, http://www.ncbi.nlm.nih.gov/pubmed/22623349 [PubMed abstract]

de Silva, D. (2011) Evidence: Helping people help themselves, A review of the evidence considering whether it is worthwhile to support self-management, The Health Foundation, London, [online] http://www.health.org.uk/resource-centre/new-sms/overview/evidence-sms-improves-outcomes/ [accessed 29/9/12]

Arthritis Care (2012) Self management [online] http://www.arthritiscare.org.uk/LivingwithArthritis/Self-management [accessed 29/9/12]

The Health Foundation (2012) Self management support research centre [online] http://www.health.org.uk/resource-centre/new-sms  [accessed 29/9/12]

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Heather Gray

I am currently the Head of Physiotherapy & Paramedicine at Glasgow Caledonian University and Chair of the Chartered Society of Physiotherapy's Professional Committee. I have worked at the University of Glasgow in several research positions. I am on the Editorial Board of the Journal of Physical Therapy Education. Other work in which I have been involved is as an Educational Consultant with NHS Education for Scotland. Prior to moving into academia I worked in the National Health Service (NHS) in Scotland as a physiotherapist for 11 years.

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