Table iChanges in effect size or SOE between the 2018 report and the 2019 update report
| Condition | Intervention (Comparator) | Outcome, Timing | Prior (2018) Report | 2019 Update | Change |
|---|---|---|---|---|---|
| LBP | Exercise (vs. UC, AC, or placebo) | Function, short term | Small effect Low SOE 6 RCTs (N=553) | Small effect Moderate SOE 9 RCTs (N=1,056) | SOE upgraded one level |
| Pain, short term | Small effect Moderate SOE 6 RCTs (N=553) | Moderate effect Low SOE 10 RCTs (N=1,098) | Effect size upgraded one level; SOE downgraded one levela | ||
| Physical modalities: Interferential therapy (vs. placebo) | Function and pain, short term | No evidence | No effect Low SOE 1 new RCT (N=150) | New evidence | |
| Mind-body practices: Yoga (vs. AC or WL) | Function, short term | Small effect Moderate SOE 6 RCTs (N=922) | Moderate effect Moderate SOE 8 RCTs (N=1,149) | Effect size upgraded one level | |
| Pain, short term | Moderate effect Low SOE 5 RCTs (N=770) | Small effect Low SOE 7 RCTs (N=997) | Effect size downgraded one level | ||
| Neck pain | Exercise (Pilates) (vs. acetaminophen) | Function, short term | Insufficient evidence 1 RCT (N=40) | Small effect Low SOE 1 new trial (N=64) | SOE upgraded one level, new evidenceb |
| Pain, short term | Insufficient evidence 1 RCT (N=40) | Large effect Low SOE 1 new trial (N=64) | SOE upgraded one level, new evidenceb | ||
| Manual Therapies: Massage (vs. AC or WL) | Function, short term | No effect Low SOE 1 RCT (N=58) | Small effect Low SOE 2 RCTs (N=150) | Effect size upgraded one level | |
| Pain, short term | No evidence | Moderate effect Low SOE 1 new RCT (N=92) | New evidence | ||
| Knee OA | Exercise (vs. UC, NT, sham or AC) | Function, intermediate term | Small effect Low SOE 9 RCTs (N=637) | Moderate effect Low SOE 11 RCTs (N=879) | Effect size upgraded one level |
| Pain, long term | No effect Low SOE 2 RCTs (N=914) | Small effect Low SOE 4 RCTs (N=1,199) | Effect size upgraded one level | ||
| Exercise (vs. acetaminophen and NSAIDs) | Function and Pain, intermediate term | No evidence | No effect Low SOE 1 new RCT (N=93) | New evidence | |
| Psychological Therapies: CBT/MI/pain coping skills training (vs. UC) | Pain, Short term | No effect Low SOE 2 RCTs (N=222) | Small effect Low SOE 2 new trials (N=210) | Effect size upgraded one level, new evidencec | |
| Physical Modalities: continuous and pulsed US (vs. sham) | Function and pain, Short term | Small effect Low SOE 1 RCT (N=90) | No effect Low SOE 3 RCTs (N=249) | Effect size downgraded one level | |
| FM | Exercise (vs. UC, NT, sham or AC) | Pain, intermediate term | No effect Moderate SOE 7 RCTs (N=327) | Small effect Moderate SOE 8 RCTs (N=362) | Effect size upgraded one level |
| Psychological Therapies: CBT, biofeedback, guided-imagery (vs. UC, AC, WL) | Function, Short term | Small effect 2 RCTs Pooled (N=97) | No effect 3 RCTs Pooled (N=169) | Effect size downgraded one level | |
| Function, Intermediate term | Small effect 2 RCTs Pooled (N=176) 1 RCT (N=82) | Moderate effect 3 RCTs Pooled (N=280) 1 RCT (N=82) | Effect size upgraded one level | ||
| Mindfulness Practices: MBSR, MAT (vs. AC or WL) | Function and pain, Intermediate term | No evidence | Small effect Low SOE 1 RCT (N=148) | New evidence | |
| Mind-Body Therapies: Yang Style tai chi (vs. exercise) | Function, Short- and intermediate term | No evidence | Small effect Low SOE 1 RCT (N= 181) | New evidence | |
| Function, Long term | No evidence | No effect Low SOE 1 RCT (N=158) | New evidence |
AC = attention control;
CBT = cognitive-behavioral therapy;
FM = fibromyalgia;
LBP = low back pain;
MAT = meditation awareness training;
MBSR = mindfulness-based stress reduction;
MI = Motivational Interviewing (IMPAACT);
NSAID = nonsteroidal anti-inflammatory drug;
NT = no treatment;
OA = osteoarthritis;
RCT = randomized controlled trial;
SOE = strength of evidence;
UC = usual care;
WL = waitlist.
SOE downgraded; addition of 4 new trials increased inconsistency/heterogeneity across trials
Differences in study quality and pharmacological therapies precluded pooling of the trial included in the prior report (poor quality; NSAIDs and muscle relaxants) with the new trial (fair quality; acetaminophen); both trials reported effect sizes in the same direction (favoring exercise) though the differences were not statistically significant in the trial included in the previous (2018) report.
The two previously included trials (1 fair, 1 poor) averaged effects across time frames finding no difference between groups. Only the two new fair quality trials could be pooled at this time frame.