Bobos, Pavlos

Kyrou, Konstantina

Sheeran, Liba

English

Online Research @ Cardiff

PROSPEROInternational prospective register of systematic reviewsExercise-based interventions in multidisciplinary rehabilitation for reducing fear avoidancein non-specific chronic low back pain: a systematic review and meta-analysisKonstantina Kyrou, Pavlos Bobos, Liba Sheeran CitationKonstantina Kyrou, Pavlos Bobos, Liba Sheeran. Exercise-based interventions in multidisciplinaryrehabilitation for reducing fear avoidance in non-specific chronic low back pain: a systematicreview and meta-analysis. PROSPERO 2019 CRD42019139947 Available from: https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42019139947 Review questionAre exercise-based interventions a beneficial addition in multidisciplinary rehabilitation for reducing fearavoidance in patients with non-specific chronic low back pain? SearchesWe will perform systematic electronic searches to identify relevant studies in MEDLINE, EMBASE, CINAHL,Web of Science, Scopus and Cochrane Library from inception to June 2019. Types of study to be includedOnly Randomized Controlled Trials (RCTs) will be included in this review. Condition or domain being studiedLow back pain (LBP) is now the most disabling condition globally with 18% increase in years lived withdisability, from 2006 to 2016. LBP is defined as pain and discomfort below the costal margin and above theinferior gluteal folds, with or without referred leg pain. The majority of LBP patients present with non-specificlow back pain (the pathoanatomical cause of pain is unknown). Chronic low back pain (CLBP) has beendefined as LBP that is persistent for more than 3 months or does not subside after the normal healing period.CLBP is usually experienced as recurrent episodes of LBP in primary care. The individual’s false beliefs about their condition, defined as fear-avoidance beliefs (FABs), cause a raisein pain-related fear leading to avoidance behaviours, such as fear of movement/ (re)injury or kinesiophobia,which is described as avoiding activities, that are irrationally expected to elevate the levels of pain orconstitute a potential threat of re-injury. Due to the strong association of FABs and disability, persistentelevated FABs in CLBP can reduce the treatment effect on disability outcomes, result in underperformanceon functional tasks and constitute a strong prognostic factor for long-term work disability and delayed returnto work. Participants/populationInclusion criteria: adults (>18yrs) with non-specific chronic low back pain (NSCLBP) (recurrent or persistentLBP > 12 weeks)Exclusion criteria:• Acute/ sub-acute LBP (<12 weeks)• <18 years old• spinal surgery • specific pathoanatomical cause of LBP (e.g. any type of arthritis, spondylolysis/spondylolisthesis etc.)• red flag pathologies (e.g. cancer, spinal fracture etc.) Intervention(s), exposure(s)                               Page: 1 / 5PROSPEROInternational prospective register of systematic reviewsExercise-Based Interventions that are LBP-specific, intensive, progressive and under supervision. Comparator(s)/controlUsual care defined as:• patient advice/education, • guidance to exercise, • unsupervised/home-based exercise (as the main treatment),• low key exercise• not progressive exercise,• exercise not specific to condition (general exercise),• or passive treatments (manual therapy, electrophysical agents, medication). Context Main outcome(s)Fear avoidance. Based on the preliminary literature review the most common outcome measures identifiedwere the Fear-Avoidance Beliefs Questionnaire (FABQ) and the Tampa Scale of Kinesiophobia (TSK), whichhave both been tested for validity and reliability, revealing positive results.* Measures of effectTiming: short-term (3-4 months or less), midterm (6-8 months) and long term (12 months or more)Effect Measures: To quantify and interpret our data, an improvement of a standard deviation (effect size) of0.5 points will be used to indicate a clinically important change. Additional outcome(s)Pain intensity and disability, due to their intricate link to fear avoidance. Pain intensity will be evaluated withthe Visual Analogue Scale (VAS) or the Numeric Rating Scale (NRS) and disability with the Roland-MorrisDisability Questionnaire (RMDQ) or the Oswestry Disability Index (ODI), as these are widely used in theliterature for CLBP.* Measures of effectTiming: short-term (3-4 months or less), midterm (6-8 months) and long term (12 months or more)Effect Measures: To quantify and interpret our data, an improvement of a standard deviation (effect size) of0.5 points will be used to indicate a clinically important change. Data extraction (selection and coding)The selection of individual studies will involve two independent reviewers (KK and PB) who will perform thesystematic electronic searches in each database. The two reviewers will then identify and remove theduplicate studies and then independently screen titles and abstracts. The full text format of any study markedas included/uncertain, by either reviewer will be obtained, and inclusion/exclusion criteria will be applied todetermine final study eligibility. One independent researcher (KK) will extract the data from the eligible included studies and one otherresearcher (PB) will cross-check the extracted data. Data extraction will include the study/authors, year,sample characteristics, intervention/comparison groups, adverse events, compliance rates, outcomesassessed and follow up. Follow-up periods, if applicable, will also be categorized as following: short-term(3-4 months or less), midterm (6-8 months) and long term (12 months or more). When insufficient data arepresented, (KK) will contact the authors by email and request further data.                               Page: 2 / 5PROSPEROInternational prospective register of systematic reviews Risk of bias (quality) assessmentTwo independent review authors will assess the included RCTs for risk of bias using the Cochrane Risk ofBias tool and any discrepancies will be resolved through discussion, or with the arbitration of a third rater, toensure dependability. We will summarize the assessment of risk of bias per outcome, as Low risk of bias (iflow risk of bias was judged for all the seven domains); as Unclear risk of bias (if unclear risk of bias wasjudged for one or more of the seven domains); and, as High risk of bias (if high risk of bias was judged forone or more of the seven domains). Funnel plots will be utilized to estimate visually the potential publicationbias. The GRADE approach for systematic reviews will be used, to assess the quality of individual trials peroutcome. Strategy for data synthesisWe will utilise the Review Manager 5.3 (RevMan 5.3) software to perform our review and a random-effectsmodel to pool outcomes (fear avoidance, disability and pain). For outcomes of the same construct that arequantified using a different metric, we will use the standardized mean difference (SMD) and reported 95%confidence intervals. If all eligible trials quantify an outcome using the same metric, we will report theweighted mean difference (WMD) along with the 95% confidence intervals. Analysis of subgroups or subsetsIn the presence of statistical heterogeneity in the meta-analyses, we plan to perform the following subgroupanalyses (a priori): trials at low risk of bias (low risk of bias in randomization, allocation concealment andblinding domains) – would show a smaller effect size. An I² estimate of at least 50% along with a statisticallysignificant ?² statistic (P = 0.10), will be used to interpret for evidence of a substantial heterogeneity. A meta-regression will be performed if more than 10 studies can be pooled to assess potential sources ofheterogeneity. Contact details for further informationKonstantina Kyroukonstantina.kyrou@gmail.com Organisational affiliation of the reviewCardiff Universityhttps://www.cardiff.ac.uk/ Review team members and their organisational affiliationsMiss Konstantina Kyrou. Cardiff UniversityMr Pavlos Bobos. Western UniversityDr Liba Sheeran. Cardiff University Type and method of reviewMeta-analysis, Systematic review Anticipated or actual start date05 June 2019 Anticipated completion date05 December 2019 Funding sources/sponsorsNone. Conflicts of interest Language                               Page: 3 / 5PROSPEROInternational prospective register of systematic reviewsEnglish CountryWales Stage of reviewReview Ongoing Subject index terms statusSubject indexing assigned by CRD Subject index termsAvoidance behaviour; Humans; Low Back Pain; Therapy, Exercise Date of registration in PROSPERO08 July 2019 Date of publication of this version08 July 2019 Details of any existing review of the same topic by the same authors Stage of review at time of this submission Stage Started CompletedPreliminary searches Yes YesPiloting of the study selection process Yes NoFormal screening of search results against eligibility criteria Yes NoData extraction No NoRisk of bias (quality) assessment No NoData analysis No NoThe record owner confirms that the information they have supplied for this submission is accurate andcomplete and they understand that deliberate provision of inaccurate information or omission of data may beconstrued as scientific misconduct.The record owner confirms that they will update the status of the review when it is completed and will addpublication details in due course. Versions08 July 2019 PROSPEROThis information has been provided by the named contact for this review. CRD has accepted this information in goodfaith and registered the review in PROSPERO. The registrant confirms that the information supplied for this submissionis accurate and complete. CRD bears no responsibility or liability for the content of this registration record, anyassociated files or external websites.                                Page: 4 / 5PROSPEROInternational prospective register of systematic reviewsPowered by TCPDF (www.tcpdf.org)                               Page: 5 / 5

A protocol for Exercise-based interventions in multidisciplinary rehabilitation for reducing fear avoidance in non-specific chronic low back pain: a systematic review and meta-analysis

https://orca.cardiff.ac.uk/id/eprint/131304/1/Prospero%20registry%20CRD42019139947.pdf

A protocol for Exercise-based interventions in multidisciplinary rehabilitation for reducing fear avoidance in non-specific chronic low back pain: a systematic review and meta-analysis

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