While our issues typically feature a diverse mix of physiotherapy subdisciplines, this one—by coincidence— brings together a remarkable collection of research, clinical insights and evidence-based approaches specifically related to low back pain. 

Group-based exercise is beneficial in older people with chronic low back pain 

Chronic non-specific low back pain is a prevalent and disabling condition among older people. 

Although preliminary evidence about the effect of exercise on low back pain in older people is promising, robust studies of group-based exercise in primary healthcare settings for older people with chronic low back pain are lacking. 

Hytalo Silva and colleagues from Brazil report their randomised trial in which eight weeks of group-based, face-to-face exercise is compared with a wait-list control. 

Randomisation allocated 120 older people (60 to each group), with 100 per cent follow-up at the end of the intervention and 98 per cent follow-up 12 months later. 

Compared with the control, group-based exercise reduced pain intensity by around two on a 10-point scale and disability by around three on a 24-point scale. 

Group-based exercise participants also had higher levels of physical activity and a better global perceived effect at week eight and fewer falls at five months (by 36 per cent) and 12 months (by 27 per cent). 

These clinically worthwhile effects confirm that group-based exercise is beneficial in older people with chronic low back pain. 

Low-intensity Pilates is as effective as high-intensity Pilates but has fewer adverse effects 

Clinical practice guidelines for chronic non-specific low back pain recommend regular therapeutic exercise. 

Previous research published in the Journal has shown that Pilates has moderate, clinically important benefits on pain and disability that exceed those of most or all other exercise interventions. 

Anita Coelho and colleagues from Brazil randomised 170 people with chronic nonspecific low back pain to either low- or high-intensity Pilates, twice per week for six weeks, with 98 per cent follow-up at the end of the intervention and 85 per cent follow-up 12 months later. 

Regardless of whether the Pilates was prescribed at low or high intensity, the effects were similar throughout the trial. 

However, adverse events were more common with high-intensity Pilates, which led the authors to recommend low-intensity Pilates. 

The smallest worthwhile effect of surgery versus non-surgical interventions for sciatica 

Ali Salame and colleagues from Sydney report their research examining how much benefit people with sciatica need to receive from discectomy to make them feel that the surgery was worthwhile compared with non-surgical treatments. 

This benefit–harm tradeoff study enrolled 200 people with sciatica. 

The study estimated the smallest worthwhile effect of discectomy to be an additional 15 per cent reduction in leg pain, beyond any reduction achieved by non-surgical treatments. 

People who are dissatisfied with previous non-surgical treatments and who have low pain self-efficacy have a lower smallest worthwhile effect; that is, they would consider an even smaller improvement on top of that provided by non-surgical treatment to consider surgery worthwhile. 

The smallest worthwhile effect estimated in this study indicates that the short-term effects of discectomy are worthwhile for people with sciatica. 

Exercise adherence is associated with clinical effects of exercise in low back pain 

Matthew Jones and colleagues from Australia and Canada examined the association between adherence to exercise and its clinical effects in people with chronic non-specific low back pain. 

They used data from 4227 participants obtained from 46 included trials. 

Improvements in pain intensity and functional limitations were associated with exercise adherence. 

When compared with low adherence, mean differences in pain intensity and functional limitations for high adherence was small, but the confidence intervals included a clinically important benefit. 

Two editorials also address low back pain 

Natasha Pocovi from Sydney led an article collection summarising papers on low back pain recently published in Journal of Physiotherapy. 

The editorial to introduce this collection discusses back pain guidelines and standards; secondary papers related to two high-profile multicentre randomised trials (WalkBack and RESTORE); and three other randomised trials by Turci et al, Miyamoto et al and Magalhães et al, among other studies. 

The other editorial discusses how sex and gender influence the biopsychosocial components of pain (including several examples from low back pain) and may therefore inform and guide how researchers develop, and clinicians implement, treatments that relieve pain for everyone. 

Of course, there is also plenty of content in this issue related to other conditions such as pleural effusion, stress urinary incontinence, anterior cruciate ligament reconstruction, breast cancer, paediatric cerebral palsy, obesity and knee osteoarthritis. 

>> Clinical Associate Professor Mark Elkins APAM is the scientific editor of Journal of Physiotherapy. 

Follow the Journal on X @JPhysiother and be sure to read the research at journal.physio 

Course of interest

• Stepping up clinical care of back pain through deliberate practice: key tools for clinical diagnosis and management