Is fatty infiltration in paraspinal muscles reversible with exercise in people with low back pain? A systematic review.

PURPOSE: Increased fatty infiltration in paraspinal muscles has been recognized as a feature of muscle quality loss in people with Low Back Pain (LBP) and is highly associated with the severity of LBP and dysfunction. Reducing fatty infiltration has been recognized as a rehabilitation aim. An earlier systematic review published in 2014 revealed conflicting evidence for the reversibility of paraspinal muscle quality by means of exercise and no updates have been published since. A new systematic literature search is warranted. METHOD: Pubmed, CINAHL and Embase were searched from inception to July 2022. Randomized, non-randomized controlled trials (RCT and non-RCT) and single-arm trials were included if they reported the effect of exercise on paraspinal fatty infiltration in people with LBP. Effect sizes and statistical power were calculated for (1) exercise versus control, and (2) pre-post exercise changes. Available data from the RCTs were pooled via meta-analysis when appropriate. Otherwise, data were synthesized qualitatively. RESULTS: Two RCTs, one non-RCT and three single-arm trials met the selection criteria. Data were not pooled due to substantial clinical heterogeneity. Effect sizes from the RCTs revealed no significant difference for exercise versus control. One single-arm trial with high risk of bias demonstrated a significant pre-post difference with moderate effect size, but only at one (T12-L1) of the investigated levels. CONCLUSION: Moderate quality evidence is available that paraspinal fatty infiltration is not reversible with exercise in people with LBP. More larger RCT's are needed to draw firmer conclusions.

Clinimetric properties of sacroiliac joint mobility tests: A systematic review.

BACKGROUND: Previous systematic reviews revealed poor reliability and validity for sacroiliac joint (SIJ) mobility tests. However, these reviews were published nearly 20 years ago and recent evidence has not yet been summarised. OBJECTIVES: To conduct an up-to-date systematic review to verify whether recommendations regarding the clinical use of SIJ mobility tests should be revised. STUDY DESIGN: Systematic review. METHOD: The literature was searched for relevant articles via 5 electronic databases. The review was conducted according to the PRISMA guidelines. COSMIN checklists were used to appraise the methodological quality. Studies were included if they had at least fair methodology and reported clinimetric properties of SIJ mobility tests performed in adult patients with non-specific low back pain, pelvic (girdle) pain and/or SIJ pain. Only tests that can be performed in a clinical setting were considered. RESULTS: Twelve relevant articles were identified, of which three were of sufficient methodological quality. These three studies evaluated the reliability of eight SIJ mobility tests and one test cluster. For the majority of individual tests, the intertester reliability showed slight to fair agreement. Although some tests and one test cluster had higher reliability, the confidence intervals around most reliability estimates were large. Furthermore, there were no validity studies of sufficient methodological quality. CONCLUSION: Considering the low and/or imprecise reliability estimates, the absence of high-quality diagnostic accuracy studies, and the uncertainty regarding the construct these tests aim to measure, this review supports the previous recommendations that the use of SIJ mobility tests in clinical practice is problematic.

The effectiveness of generic self-management interventions for patients with chronic musculoskeletal pain on physical function, self-efficacy, pain intensity and physical activity: A systematic review and meta-analysis.

Generic self-management programs aim to facilitate behavioural adjustment and therefore have considerable potential for patients with chronic musculoskeletal pain. Our main objective was to collect and synthesize all data on the effectiveness of generic self-management interventions for patients with chronic musculoskeletal pain in terms of physical function, self-efficacy, pain intensity and physical activity. Our secondary objective was to describe the content of these interventions, by means of classification according to the Behaviour Change Technique Taxonomy. We searched PubMed, CENTRAL, Embase and Psycinfo for eligible studies. Study selection, data extraction and risk of bias were assessed by two researchers independently. Meta-analyses were only performed if the studies were sufficiently homogeneous and GRADE was used to determine the quality of evidence. We identified 20 randomized controlled trials that compared a self-management intervention to any type of control group. For post-intervention results, there was moderate quality evidence of a statistically significant but clinically unimportant effect for physical function and pain intensity, both favouring the self-management group. At follow-up, there was moderate quality evidence of a small clinically insignificant effect for self-efficacy, favouring the self-management group. All other comparisons did not indicate an effect. Classification of the behaviour change techniques showed large heterogeneity across studies. These results indicate that generic self-management interventions have a marginal benefit for patients with chronic musculoskeletal pain in the short-term for physical function and pain intensity and for self-efficacy in the long-term, and vary considerably with respect to intervention content. SIGNIFICANCE: This study contributes to a growing body of evidence that generic self-management interventions have limited effectiveness for patients with chronic musculoskeletal pain. Furthermore, this study has identified substantial differences in both content and delivery mode across self-management interventions.