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Advice to Stay Active or Structured Exercise in the Management of Sciatica: A Systematic Review and Meta-analysis

Fernandez, Matt, MChiro*; Hartvigsen, Jan, PhD; Ferreira, Manuela L., PhD‡,§; Refshauge, Kathryn M., PhD*; Machado, Aryane F., BPT*; Lemes, Ítalo R., BPT*; Maher, Chris G., PhD; Ferreira, Paulo H., PhD*

doi: 10.1097/BRS.0000000000001036
Literature Review

Study Design. A systematic review and meta-analysis.

Objective. To evaluate the evidence on comparative effectiveness of advice to stay active versus supervised structured exercise in the management of sciatica.

Summary of Background data. Conservative management of sciatica usually includes interventions to promote physical activity in the form of advice to stay active or exercise, but there has been no systematic review directly comparing the effectiveness of these 2 approaches.

Methods. Data Sources included MEDLINE, CINAHL, EMBASE, and PEDro databases. Studies were randomized controlled trials comparing advice with exercise. Two independent reviewers extracted data and assessed methodological quality using the PEDro scale. Pain and disability data were extracted for all time points and converted to a common 0 to 100 scale. Data were pooled with a random effects model for short, intermediate, and long-term follow-ups. The GRADE approach was used to summarize the strength of evidence.

Results. Five trials were included in the meta-analysis, which showed a significant, although small effect favoring exercise over advice for reducing leg pain intensity in the short term (weighted mean difference: 11.43 [95% confidence interval, 0.71–22.16]) but no difference for disability (weighted mean difference: 1.45 [95% confidence interval, −2.86 to 5.76]). Furthermore, there was no difference at intermediate and long-term follow-ups between advice and exercise for patient-relevant outcomes.

Conclusion. There is low-quality evidence (GRADE) that exercise provides small, superior effects compared with advice to stay active on leg pain in the short term for patients experiencing sciatica. However, there is moderate-quality evidence showing no difference between advice to stay active and exercise on leg pain and disability status in people with sciatica in the long term.

Level of Evidence: 1

A systematic review and meta-analysis compared advice to stay active versus structured exercise in the management of sciatica. Results showed low-quality evidence that exercise has a small superior statistically significant effect over advice on leg pain relief in the short term. However, long-term results showed no differences between the 2 interventions.

*Faculty of Health Science, The University of Sydney, New South Wales, Australia

Institute of Sports Science and Clinical Biomechanics and Nordic Institute of Chiropractic and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark

The George Institute for Global Health; Sydney Medical School, The University of Sydney, New South Wales, Australia; and

§Institute of Bone and Joint Research, Sydney Medical School, The University of Sydney, New South Wales, Australia.

Address correspondence and reprint requests to Matt Fernandez, MChiro, Faculty of Health Science, The University of Sydney, 75 East St, Lidcombe, Sydney, New South Wales, Australia 2141; E-mail:

Acknowledgment date: February 10, 2015. Revision date: April 28, 2015. Acceptance date: June 23, 2015.

The manuscript submitted does not contain information about medical device(s)/drug(s).

No funds were received in support of this work.

Relevant financial activities outside the submitted work: consultancy, employment, grants, payment for development of educational presentations, payment for lectures, travel/accommodations/meeting expenses.

Copyright © 2015 Wolters Kluwer Health, Inc. All rights reserved.