OBJECTIVE: To evaluate the evidence from randomised controlled trials (RCTs) on the effectiveness of prevention strategies to reduce future impact of low back pain (LBP), where impact is measured by LBP intensity and associated disability. DESIGN: Systematic review with meta-analysis. DATA SOURCES: Medline, Embase, CINAHL, PEDro and The Cochrane (CENTRAL) databases from inception to 22 October 2018. ELIGIBILITY CRITERIA: RCTs evaluating any intervention aiming to prevent future impact of LBP, reporting an outcome measure of LBP intensity and/or disability measured at least 3 months post-randomisation, and the intervention group must be compared with a group that received no intervention/placebo or minimal intervention. Trials restricting recruitment to participants with current LBP were excluded. RESULTS: 27 published reports of 25 different trials including a total of 8,341 participants fulfilled the inclusion criteria. The pooled results, from three RCTs (612 participants), found moderate-quality evidence that an exercise programme can prevent future LBP intensity (mean difference (MD) -4.50; 95% CI -7.26 to -1.74), and from 4 RCTs (471 participants) that an exercise and education programme can prevent future disability due to LBP (MD -6.28; 95% CI -9.51 to -3.06). It is uncertain whether prevention programmes improve future quality of life (QoL) and workability due to the overall low-quality and very low-quality available evidence. CONCLUSIONS: This review provides moderate-quality evidence that an exercise programme, and a programme combining exercise and education, are effective to reduce future LBP intensity and associated disability. It is uncertain whether prevention programmes can improve future QoL and workability. Further high-quality RCTs evaluating prevention programmes aiming to reduce future impact of LBP are needed.
Reproduced with permission from the BMJ Publishing Group.

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