A critical appraisal of “Effectiveness and cost-effectiveness of neuromuscular exercise and back care counseling in female healthcare workers with recurrent non-specific low back pain: a blinded four-arm randomized controlled trial”

Abstract

Low back pain is a common injury for nurses and physical therapists, two professions that involve large loads being placed on the lumbar spine during patient transfers and lifting maneuvers. Unfortunately, scant research has been done into the role that therapeutic exercise may play in reducing low back pain. The article being reviewed sought to answer the question of “In workers suffering from job-related low back pain, are therapeutic exercises effective in reducing pain?”. Through a randomized controlled trial consisting of four different groups, (lifting form counseling only, therapeutic exercise only, combined counseling and exercise, and control) the authors found that therapeutic exercises alone are not effective in reducing low back pain. Unfortunately, the authors’ lack of transparency undermined the credibility of this claim. By not including the specific exercise program that was administered, the authors failed to make the experiment replicable by a broader audience. Also, by not taking any measurements of low back pain prior to six months of treatment completed, the authors did not account for the possibility of a short-term decrease or increase in back pain to occur. When the authors do exercise transparency, the reader learns that 10.5% of subjects in the therapeutic exercise only group completed zero exercise sessions, likely skewing the results towards therapeutic exercise not being effective. Therefore, the study fails to create a compelling or credible addition to current low back pain treatment literature.