OBJECTIVE: To estimate the effects of musculoskeletal rehabilitation interventions on movement-evoked pain and to explore the methods/protocols used to evaluate movement-evoked pain in adults with musculoskeletal pain. DESIGN: Systematic review with meta-analysis. LITERATURE SEARCH: Three electronic databases (PubMed, Web of Science, and Scopus) were searched. STUDY SELECTION CRITERIA: Randomized controlled trials investigating musculoskeletal rehabilitation interventions on movement-evoked pain in adults with musculoskeletal pain were included. DATA SYNTHESIS: Meta-analysis was conducted for outcomes with homogeneous data from at least 2 trials. The mean change in movement-evoked pain was the primary outcome measure. Certainty of evidence was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework. RESULTS: Thirty-eight trials were included, and 60 different interventions were assessed. There was moderate-certainty evidence of a beneficial effect of exercise therapy compared to no treatment (SMD -0.65; 95%CI -0.83 to -0.47; p < 0.001) on movement-evoked pain in adults with musculoskeletal pain. There was low-certainty evidence of a beneficial effect of transcutaneous electrical nerve stimulation compared to no treatment (SMD -0.46; 95%CI -0.71,-0.21; p = 0.0004). There was no benefit of transcutaneous electrical nerve stimulation when compared to sham transcutaneous electrical nerve stimulation (SMD -0.28; 95%CI -0.60 to 0.05; p = 0.09; moderate-certainty evidence). CONCLUSIONS: There was moderate-certainty evidence that exercise therapy is effective for reducing movement-evoked pain in patients with musculoskeletal pain compared to no treatment. Consider exercise therapy as the first-choice treatment for movement-evoked pain in clinical practice.

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