OBJECTIVE: Investigate if integrated exercise and psychosocial (EP) interventions effect self-efficacy to manage pain and self-efficacy for physical functioning compared to alternate interventions, usual care, waitlists and attention controls for individuals with chronic low back pain (CLBP). METHODS: Medline, Embase, CINAHL, Web of Science, PsychINFO, PEDro, and the Cochrane Library were searched. Included randomized controlled trials utilized an EP intervention for CLBP and measured self-efficacy. Independent reviewers screened abstracts, reviewed full-texts, extracted data, and assessed risk of bias. GRADE, synthesis without meta-analysis, and ranges of effects (Hedges' g) were used. RESULTS: 2207 Participants were included (22 studies). EP interventions positively effected self-efficacy to manage pain short-term compared to usual care (range of effects -0.02 to 0.94) and controls (range of effects 0.69 to 0.80) and intermediately compared to usual care (range of effects 0.11 to 0.29), however, no differences were found when compared to alternate interventions. EP interventions positively effected self-efficacy for physical functioning short-term compared to alternate interventions (range of effects 0.57 to 0.71), usual care (range of effects -0.15 to 0.94), and controls (range of effects 0.31 to 0.56), and intermediately compared to alternate interventions (1 study, effect 0.57) and controls (1 study, effect 0.56). Conclusions were limited by low to very low-quality-evidence often from risk of bias, imprecision, and clinical/statistical heterogeneity. CONCLUSIONS: EP interventions may be more effective short-term for self-efficacy to manage pain than usual care and waitlists, but not alternate interventions. EP interventions may be effective for self-efficacy for physical functioning at short-and intermediate-term compared to alternate interventions, usual care, waitlist and attention controls. Considerations for future research include methods for blinding and measurement of self-efficacy for physical functioning.
With permission from Excerpta Medica Inc.

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