9. Pain severity.
| Review | Number of trials (and participants) assessing 'pain severity' | Baseline pain score | Post‐intervention reported result or change data (or if only one data point reported in review) | Follow‐up | Overall comment/statement |
|
Bartels 2007 (osteoarthritis) |
Hip + knee OA: Post‐intervention: 4 (638) Follow‐up: 1 (310) Hip only: follow‐up: 1 (17) Knee only: post‐intervention: 1 (46) |
Control baseline: Hip + knee OA WOMAC 0 to 20 (2 studies): 9.10 (SD 3.14) VAS 0 to 100 (1 study): 55.3 (SD 24.6) HAQ 0 to 3 (1 study): 1.05 (SD 0.61) Hip only VAS 0 to 100 (1 study): 56 (SD 21.89) Knee only VAS 0 to 10 (1 study): 5.6 (SD 1.4) |
Hip + knee OA A minor effect of a 3% absolute reduction (0.6 fewer points on WOMAC 0 to 20 scale) and 6.6% relative reduction SMD 0.19 (95% CI 0.04 to 0.35) (P = 0.02) Knee only SMD 0.86 (95% CI 0.25 to 1.47) (P = 0.005) Absolute difference 12% (1.2 fewer points on a 0 to 10 scale) Relative change 22% improvement |
Hip + knee OA Follow‐up at 6 months: SMD 0.11 (95% CI ‐0.12 to 0.33) (ns) No difference Hip only SMD 1.00 (95% CI ‐0.04 to 2.04) (P = 0.06, ns) |
Statistically significant post‐intervention in hip + knee OA group, but not clinically significant. Knee‐only OA had moderate to large effect size (statistically significant) immediately post‐intervention. |
|
Bidonde 2014 (fibromyalgia) |
Post‐intervention: 7 (382) | Weighted mean score at baseline (all participants): 69.59 median value for pain was 70.9 in studies comparing aquatic training to control | On 100‐point scale: MD ‐6.59 (95% CI ‐10.71 to ‐2.48) SMD ‐0.53 (95% CI ‐0.76 to ‐0.31) Absolute difference ‐7% (95% CI ‐11 to ‐3) NNTB 5 (95% CI 3 to 8) |
3 studies at 12, 48, or 52 weeks' post‐intervention could not be combined. 2 studies showed SMD favouring intervention at follow‐up. | "We found a moderate effect favouring the aquatic exercise training for pain" …"similar improvements in pain in the low pain groups (SMD ‐0.60, 95% CI ‐0.98 to ‐0.23) and in the high pain groups (SMD ‐0.57, 95% CI ‐1.11 to ‐0.03)." Among the major wellness outcomes, none of the outcomes met the threshold for clinically relevant differences (15%). |
|
Boldt 2014 (spinal cord injury) |
Post‐intervention: 3 (149) | WUSPI score 22.6 (exercise group) to 11.05 (control group) in 1 group at baseline Not reported for 2 studies |
WUSPI change score: Exercise group: ‐7.7 (SD 19.01) Control group: 12.8 (SD 12.74) SF‐36 (pain experience): ‐1.9 (95% CI ‐3.4 to ‐0.4) favoured exercise (P = 0.01) VAS (0 to 10): MD ‐2.8 (95% CI ‐3.77 to ‐1.83) favoured exercise (P < 0.00001) |
1 study at 4 weeks: VAS (0 to 10): ‐2.50 (95% CI ‐3.48 to ‐1.52) (P < 0.00001) WUSPI: ‐26.40 (95% CI ‐37.62 to ‐15.18favoured exercise (P < 0.00001) |
"All three studies were fraught with high overall risk of bias. In particular, the comparison with 'no treatment' or waiting lists as control interventions likely leads to an overestimation of the effectiveness of the exercise programmes provided in these studies. Consequently, no conclusion on their effectiveness can be drawn." |
|
Busch 2007 (fibromyalgia) |
Strength training: 1 (21) Aerobic training: 3 (183) | Control baseline: Aerobic: 6.1/10 (VAS) (SD 1.97) Strength: 35/100 (VAS) (SD 19) |
Aerobic training: SMD 0.65 (95% CI ‐0.09 to 1.39) (ns) Weighted absolute change 13% (1.3 cm lower on 10‐cm scale) Relative change 21% Strength training: SMD 3.00 (95% CI 1.68 to 4.32) (ns) Weighted absolute change 49% (49 points lower on 100‐point scale) Relative change 140%, NNTB 2 |
n/a | ">30% improvement was seen in the strength training group as compared to an untreated control group in pain." Aerobic training led to an improvement of 1.3/10. |
|
Busch 2013 (fibromyalgia) |
Post‐intervention: 2 (81) Follow‐up at 8 weeks, 16 weeks, 28 weeks: 1 (60) |
Not reported ‐ change data only | Change score on VAS (in cm):
MD ‐3.30 (95% CI ‐6.35 to ‐0.26) (P = 0.03) SMD ‐1.89 (95% CI ‐3.86 to 0.07) Relative % change 44.6% (95% CI 3.5 to 85.9) favoured exercise NNTB 2 (95% CI 1 to 34) |
8 weeks: MD ‐0.68 (95% CI ‐1.62 to 0.26) (ns) 16 weeks: MD ‐1.79 (95% CI ‐2.70 to ‐0.88) (P < 0.001) 28 weeks: MD ‐0.85 (95% CI ‐1.77 to 0.07) (P = 0.07, ns) Overall (n = 180): MD ‐1.12 (95% CI ‐1.65 to ‐0.58) (P < 0.0001) |
> 30% improvement post‐intervention. |
|
Cramp 2013 (rheumatoid arthritis) |
4 (not reported) | Not reported | In narrative only ‐ Harkcom 1985: statistics not reported separately for pain data, but reported as improvement over time; Hakkinen 2003: "stat significant improvement in 24 months"; Evans 2012 and Wang 2008: no statistically significant effects | Not reported | "Improvement over time" with "significant improvement in 24 months." No actual data available. |
|
Fransen 2014 (OA) |
End of treatment: 9 (549) 3 to 6 months: 5 (391) |
Not reported; land based exercise vs no exercise: mean pain in control group ˜ 29/100 (based on 9 studies' control values) | End of treatment: SMD ‐0.38 (95% CI ‐0.55 to ‐0.20) "small to moderate" favoured exercise (P < 0.0001) | 3 to 6 months: SMD ‐0.38 (95% CI ‐0.58 to ‐0.18) "small to moderate" favoured exercise (P = 0.0002) | "Small to moderate" statistically significant improvement, but only mild pain at baseline. |
|
Fransen 2015 (OA) |
End of treatment: 44 (3537) Follow‐up (2 to 6 months): 12 (1468) Follow‐up (> 6 months): 8 (1272) |
Not reported; land‐based exercise vs no exercise: mean pain in control group 44/100 (based on 1 study control values) | Land‐based exercise vs no exercise: Mean pain in intervention groups was 0.49 SDs lower (95% CI 0.39 to 0.59 lower). This translates to an absolute mean reduction of 12 points (95% CI 10 to 15) compared with control group on a 0 to 100 scale. SMD ‐0.49 (95% CI ‐0.39 to ‐0.59) (P < 0.00001) Absolute reduction 12% (95% CI 10% to 15%) Relative change 27% (95% CI 21% to 32%) NNTB 4 (95% CI 3 to 5) |
2 to 6 months: SMD ‐0.24 (95% CI ‐0.35 to ‐0.14) favoured exercise (P < 0.00001) > 6 months: SMD ‐0.52 (95% CI ‐1.01 to ‐0.03) favoured exercise (P = 0.04) |
Absolute improvement of 12/100 post‐intervention (statistically significant). |
|
Gross 2015a (mechanical neck disorders) |
12‐week treatment: 2 (147) 24 week (or 12‐week treatment + 12‐week follow‐up): 2 (140) |
Not reported, but control scores at end of treatment 40 to 60/100 (moderate pain) | 12 weeks: pooled MD ‐14.90 (95% CI ‐22.40 to ‐7.39) favoured exercise (P = 0.0001) | 24 weeks: pooled MD ‐10.94 (95% CI ‐18.81 to ‐3.08) favoured exercise (P = 0.0064) | 2 trials showed a moderate (statistically significant) reduction in pain post‐intervention (14.9/100). |
|
Hayden 2005 (low back pain) |
Earliest follow‐up: 8 (370) Follow‐up (time since randomisation) Short term (6 weeks): 6 (268) Intermediate term (6 months): 5 (249) Long term (12 months): 2 (126) |
"Chronic group" at baseline: mean 46/100 (95% CI 41 to 50) (moderate pain) | Earliest: MD ‐10.20 (95% CI ‐19.09 to ‐1.31) (P = 0.02) | Short term: MD ‐8.58 (95% CI ‐18.46 to 1.29) (P = 0.09, ns) Intermediate term: MD ‐12.48 (95% CI ‐22.69 to ‐2.27) (P = 0.02) Long term: MD ‐3.93 (95% CI ‐9.89 to 2.02) (P = 0.2, ns) |
Reduction of ˜ 10/100 at earliest measurement point. |
|
Hurkmans 2009 (rheumatoid arthritis) |
4 studies (total 188 participants) in different categories (results not combined) | Not reported | Short‐term (12 weeks): Short‐term land‐based (aerobic and strength training) SMD ‐0.53 (95% CI ‐1.09 to 0.04) Short‐term land‐based (aerobic only) SMD ‐0.27 (95% CI ‐0.79 to 0.26) Short‐term water‐based SMD 0.06 (95% CI ‐0.43 to 0.54) |
Long‐term (24 months)
land‐based (aerobic and strength training) SMD 0.35 (95% CI ‐0.46 to 1.16) |
No significant difference between control and intervention. |
|
Koopman 2015 (postpolio syndrome) |
1 (55) | Not reported, but control scores at end of treatment mean 44 (SD 24) on a 0 to 100 scale (moderate pain) | 3 months post‐intervention: VAS (0 to 100): MD 11.00 (95% CI ‐0.98 to 22.98) (P = 0.072) |
n/a | No significant effect/no difference between groups. |
|
Regnaux 2015 (OA) |
Only 1 study that had a no‐exercise control: 1 (68) ‐ excluded data for control (no exercise) from analysis (n = 34) |
Not reported | Post‐intervention: WOMAC (0 to 20) Change data presented for high‐ vs low‐intensity groups only, not compared to control |
n/a | Actual individual study data was extracted (where possible) instead of pooled MD or SMD due to comparison this overview wishes to make (exercise vs no‐exercise only). Could not extract exercise vs control data. |
|
Saragiotto 2016 (low back pain) |
Short term (< 3 months): 4 (291) Intermediate term (3 to 12 months): 4 (348) Long term (> 12 months): 3 (279) |
Not reported, but control scores at follow‐up range 25 to 56/100 (mild‐moderate pain) | Short term: MD ‐10.01 (95% CI ‐15.67 to ‐4.35) favoured exercise (P < 0.001) | Intermediate term: MD ‐12.61 (95% CI ‐20.53 to ‐4.69) favoured exercise (P = 0.002) Long term: MD ‐12.97 (95% CI ‐18.51 to ‐7.42) favoured exercise (P < 0.001) |
Medium effect size favouring exercise at all follow‐up assessments (moderate quality evidence at short‐ and long‐term, low quality evidence at intermediate term). Clinically important effect. |
|
van der Heijden 2015 (patellofemoral pain syndrome) |
3 studies with pain > 3 months (135 participants), 2 studies used in analysis (41 participants) Long‐term follow‐up: 1 (94) |
Not reported, but control scores at follow‐up range 2.1 to 6.0/10 (mild‐moderate pain) | Short‐term (4 to 8 weeks): MD for usual pain in the exercise group was 0.93 (95% CI 1.60 to 0.25) SDs lower SMD ‐0.93 (95% CI ‐1.60 to ‐0.25) (P = 0.008) |
"Long term" (16 weeks) VAS (0 to 10): MD ‐4.42 (95% CI ‐7.75 to ‐0.89) favoured exercise (P = 0.01) | Reduction in pain of 4/10 at 16 weeks' follow‐up. |
|
Yamato 2015 (low back pain) |
Short term: 6 (265) Intermediate term: 2 (148) |
Not reported, but control scores at earliest follow‐up range 18 to 52/100 (mild‐moderate pain) | Short‐term follow‐up (< 3 months): MD ‐14.05 (95% CI ‐18.91 to ‐9.19) (P < 0.001) |
Intermediate term (3 to 12 months): MD ‐10.54, (95% CI ‐18.54 to ‐2.62) (P = 0.009) | "Low quality evidence (downgraded due to imprecision and risk of bias) that Pilates reduces pain compared with minimal intervention at short‐term follow‐up, with a medium effect size... intermediate‐term follow‐up, two trials, provided moderate quality evidence (downgraded due to imprecision) that Pilates reduces pain compared with minimal intervention, with a medium effect size" |
CI: confidence interval; HAQ: Health Assessment Questionnaire; MD: mean difference; n/a: not applicable; NNTB: number needed to treat for an additional beneficial outcome; ns: not significant; OA: osteoarthritis; SD: standard deviation; SF‐36: 36‐item Short Form; SMD: standardised mean difference; VAS: visual analogue score; WOMAC: Western Ontario and McMaster Universities Osteoarthritis Index; WUSPI; Wheelchair User Shoulder Pain Index.