Chronic low back pain, supervised motor-based physical therapy versus conventional pharmacological treatment: A systematic review with meta-analysis

Abstract

Introduction: Chronic low back pain is a disabling condition with worldwide prevalence. Although evidence exists for individual therapeutic measures, the lack of consensus regarding the superiority of active interventions versus pharmacotherapy justifies this investigation. Objective: To describe the efficacy of supervised physical therapy compared to pharmacological treatment in reducing pain intensity and functional disability in adults with non-surgical chronic low back pain. Methods: A systematic review with meta-analysis was conducted, searching the PubMed/MEDLINE, Embase, Scopus, Cochrane Library (Cochrane Central Register of Controlled Trials), LILACS/BVS, SciELO, and PEDro databases for randomized clinical trials published since January 2022. The study evaluated adults (≥18 years old) undergoing supervised physical therapy compared to usual care or pharmacological treatment. Risk of bias was assessed using the Risk of Bias 2 tool, and the meta-analysis employed mean difference within a random-effects model. Results: Of the 376 records identified, 3 clinical trials totaling 278 participants were included. Supervised physical therapy significantly reduced pain intensity compared to the control group (mean difference = -1.52; 95% confidence interval: -2.35 to -0.70; p=0.0003), with substantial heterogeneity (I²=70.0%; tau²=0.33; p=0.0357). Conclusion: Supervised physical therapy was superior to conventional pharmacological treatment for non-surgical chronic low back pain, promoting greater pain reduction and functional improvement; however, the heterogeneity of the studies necessitates cautious interpretation and individualized therapeutic approaches.