The (cost-)effectiveness of combined lifestyle interventions for people with persistent low-back pain who are overweight or obese: A systematic review.

J C J Huijbers, P Coenen, G L B Burchell, M W Coppieters, I H M Steenhuis, J H Van Dieën, B W Koes, D H R Kempen, J R Anema, I Kingma, L Voogt, C M Williams, J M Van Dongen, H P Van der Ploeg, R W J G Ostelo, G G M Scholten-Peeters

Journal: Musculoskeletal science & practice 2023;65():102770

PMID: 37167807

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Abstract

INTRODUCTION

Lifestyle factors are expected to contribute to the persistence and burden of low-back pain (LBP). However, there are no systematic reviews on the (cost-)effectiveness of combined lifestyle interventions for overweight or obese people with LBP.

AIM

To assess whether combined lifestyle interventions are (cost-)effective for people with persistent LBP who are overweight or obese, based on a systematic review.

DESIGN

Systematic review METHOD: PubMed, Cochrane, Embase, CINAHL, PsycINFO and the Wiley/Cochrane Library were searched from database inception till January 6 2023. Two independent reviewers performed study selection, data-extraction and risk of bias scoring using the Cochrane RoB tool 2 and/or the Consensus Health Economic Criteria list. GRADE was used to assess the level of certainty of the evidence.

RESULTS

In total 2510 records were screened, and 4 studies on 3 original RCTs with 216 participants were included. Low certainty evidence (1 study) showed that combined lifestyle interventions were not superior to usual care for physical functioning, pain and lifestyle outcomes. Compared to usual care, moderate certainty evidence showed that healthcare (-$292, 95%CI: 872; -33), medication (-$30, 95% CI -65; -4) and absenteeism costs (-$1000, 95%CI: 3573; -210) were lower for the combined lifestyle interventions.

CONCLUSION

There is low certainty evidence from 3 studies with predominantly small sample sizes, short follow-up and low intervention adherence that combined lifestyle interventions are not superior to physical functioning, pain and lifestyle outcomes compared to usual care, but are likely to be cost-effective.

Address: Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences Vrije Universiteit Amsterdam, Amsterdam Movement Sciences Program Musculoskeletal Health, the Netherlands.; Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam, the Netherlands; Amsterdam Movement Sciences, Amsterdam, the Netherlands. Electronic address: [email protected].; Medical Library, Vrije Universiteit Amsterdam, the Netherlands.; Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences Vrije Universiteit Amsterdam, Amsterdam Movement Sciences Program Musculoskeletal Health, the Netherlands; Menzies Health Institute Queensland, Griffith University, Brisbane & Gold Coast, Australia.; Department of Human Movement Sciences, Faculty of Behavioral and Movement Sciences Vrije Universiteit Amsterdam, Amsterdam Movement Sciences Program Musculoskeletal Health, the Netherlands; Amsterdam Public Health Research Institute, Amsterdam, the Netherlands.; Erasmus Medical Center, University Medical Center Rotterdam, Department of General Practice, the Netherlands.; Department of Orthopedic Surgery, Joint Research, OLVG Amsterdam, Amsterdam, the Netherlands.; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam, the Netherlands.; NVVR, Dutch Society of Back Pain, the Netherlands.; School of Health Sciences, University of Sydney, Australia; Research and Knowledge Translation Directorate, Mid-North Coast Local Health District, Australia.; Faculty of Science and the Amsterdam Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands; Faculty of Science and Amsterdam Public Health Research Institute, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands.; Amsterdam Public Health Research Institute, Amsterdam, the Netherlands; Amsterdam UMC, Vrije Universiteit Amsterdam, Department of Public and Occupational Health, Amsterdam, the Netherlands.; Department of Health Sciences, Faculty of Science and Amsterdam Movement Sciences, Vrije Universiteit, Amsterdam, the Netherlands; Department of Epidemiology and Biostatistics, Vrije Universiteit Medical Center, Amsterdam, the Netherlands.

DOI: 10.1016/j.msksp.2023.102770

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MeSH Terms: Healthy Lifestyle, Low Back Pain, Obesity, Overweight, Cost-Effectiveness Analysis, Cost-Benefit Analysis, Physical Therapy Modalities