Effects of Physical Exercise on Pain in Patients With Lumbar Disc Herniation: A Systematic Review and Meta-Analysis of Randomised Controlled Trials.

OBJECTIVE

The aim of this study was to analyse the effects of physical exercise on pain in patients with lumbar disc herniation, regardless of whether they had undergone surgery.

METHODS

A meta-analysis was conducted according to the PRISMA guidelines. Randomised controlled trials (RCTs) were selected based on the PICOS strategy, and methodological quality and risk of bias were assessed using the TESTEX scale and the RoB 2 tool, respectively. The GRADE tool was used to assess the quality of evidence. Electronic searches were performed in the PubMed, Scopus, Web of Science, Cochrane, and PEDro databases. Subgroup analyses were conducted in an attempt to explain heterogeneity.

RESULTS

A total of 864 studies were identified. After applying the eligibility criteria, 13 randomised controlled trials were included in the systematic review, with 12 studies included in the forest plot, comprising 18 analyses. Pain outcomes were assessed using different measurement instruments, and the meta-analysis demonstrated a significant reduction in pain favouring the exercise intervention, with a standardised mean difference of -0.68 (95% CI: -1.11 to -0.25; p = 0.002). However, substantial heterogeneity was observed among the included studies (I2 = 89%; p < 0.0001). As this heterogeneity was not explained by subgroup analysis or meta-regression, a random-effects model was used for statistical adjustment.

CONCLUSION

This meta-analysis concluded that physical exercise improves pain-related outcomes in adult patients. Notably, the forest plot demonstrated a significant mean difference. These findings suggest that physical exercise is associated with a better prognosis in the treatment of lumbar disc herniation.