Summary of findings 2. Therapeutic ultrasound plus exercise versus exercise alone.
| Therapeutic ultrasound plus exercise compared to exercise alone for chronic low back pain | ||||||
|
Patient or population: adults with chronic low back pain Settings: secondary care Intervention: therapeutic ultrasound plus exercise Comparison: exercise | ||||||
| Outcomes | Illustrative comparative risks (95% CI) | Relative effect (95% CI) | No. of participants (studies) | Certainty of the evidence (GRADE) | Comments | |
| Assumed risk | Corresponding risk | |||||
| Exercise | Therapeutic ultrasound plus exercise | |||||
|
Pain intensity Scale: VAS (100‐point scale; higher scores mean increased pain) Follow‐up: short term (post‐treatment) |
The mean pain intensity in the control groups ranged from 28.3 to 30.5. | The mean pain intensity in the intervention groups was 21.1 points lower (27.6 lower to 14.5 lower). | MD −21.07 (−27.60 to −14.54) | 70 (2 RCTs) | ⊕⊝⊝⊝ verylow1,2 | Estimate is not clinically important and is very uncertain. 1 study did not provide data in a form to permit pooling. |
|
Pain intensity Scale: VAS (number of responders at 30% reduction of pain) |
No trials were identified that reported on this outcome. | |||||
|
Back‐specific functional status Scale: Oswestry Disability Questionnaire (higher scores mean worse function) Follow‐up: short term (post‐treatment) |
The mean back‐specific functional status in the control groups ranged from 8.2% to 18%. | The mean back‐specific functional status in the intervention groups was 0.41 lower (3.14 lower to 2.32 higher). | MD −0.41 (−3.14 to 2.32) | 79 (2 RCTs) | ⊕⊝⊝⊝ verylow2,3 | Estimate is not clinically important and is very uncertain. |
| Overall improvement or satisfaction | No trials were identified that reported on this outcome. | |||||
|
Well‐being Scale: general health subscale of SF‐36 (higher scores mean worse well‐being) Follow‐up: short term (post‐treatment) |
The mean well‐being scores in the control groups ranged from 64.2 to 66.8. | The mean well‐being score in the intervention groups was 2.50 points lower (9.53 lower to 4.53 higher). | MD −2.50 (−9.53 to 4.53) | 79 (2 RCTs) | ⊕⊝⊝⊝ verylow2,3 | Estimate is not clinically important and is very uncertain. |
| Disability | No trials were identified that reported on this outcome. | |||||
| Adverse events | No trials were identified that reported on this outcome. | |||||
| Abbreviations: CI: confidence interval; MD: mean difference; RCT: randomised controlled trial; VAS: visual analogue scale | ||||||
| GRADE Working Group grades of evidence High certainty: Further research is very unlikely to change our confidence in the estimate of effect. Moderate certainty: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate. Low certainty: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate. Very low certainty: We are very uncertain about the estimate. | ||||||
1Downgraded one level for imprecision, small sample size. 2Downgraded two levels for serious limitations in design; both included studies had a high risk of performance and detection bias and an unclear risk of selection bias. 3Downgraded two levels for serious imprecision; small sample size, and the resulting estimate had a wide 95% confidence interval which includes both potential harm and potential benefit from the intervention.