BACKGROUND: Low back pain is considered to be one of the leading causes of activity limitation and work absence throughout the world with major consequences for health-care resources. Advice and education, and exercise and manual therapy form the most common management recommendations across all international guidelines. However, little is known about the relative merits of exercise and/or manual therapy compared to advice and education for the management of chronic non-specific low back pain (NSLBP). OBJECTIVES: The aim of this systematic review was to examine the evidence pertaining to the effects of advice/education versus exercise and/or manual therapy on patients with chronic NSLBP. METHODS: Eligible studies were identified by searching Medline, Embase, CINAHL, AMED, SPORTDiscus, and the Cochrane CENTRAL Register of controlled trials. Randomized controlled trials (RCTs) on patients with chronic NSLBP were considered. Two independent reviewers extracted data and assessed methodological quality. RESULTS: Data from four RCTs (483 participants) were included in this review. All four studies were classified as having low risk of bias. Two studies found a statistically significant improvement in pain and functional capacities at short term in the exercise group (p < 0.05). One study reported positive results in favor of the advice group, while the other study reported no significant difference between groups. Heterogeneity in the nature of the interventions, outcome measures, duration and frequency of treatment, and follow-up periods were identified. CONCLUSION: There is low-quality evidence that exercise is no more effective than advice/education for patients with chronic NSLBP at short-term follow-up (3 months). These results indicate the lack of inequality research in this field and the necessity for high-quality research comparing the effectiveness of guideline-recommended interventions for chronic NSLBP.

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