Eficácia da terapia manual aos exercícios para melhora da intensidade da dor e incapacidade funcional em pacientes com dor lombar crônica inespecífica: Revisão sistemática e metanálise

Abstract

Low back pain is among the main causes of global disability, with symptoms lasting more than 12 weeks. Manual therapy is a recommended treatment strategy, in addition to therapeutic exercises, which have shown beneficial neurophysiological effects. However, it is still unclear whether there are benefits of manual therapy and exercises compared to isolated exercises. Objectives: To evaluate the effectiveness of manual therapy combined with exercises versus isolated exercises for improving pain intensity and functional disability in patients with chronic nonspecific low back pain. Methods: This is a systematic review. Searches were performed in the following databases: PubMed, PEDro, Cochrane, Library, EMBASE, Web of Science and CINAHL. Two independent reviewers selected randomized clinical trials that verified improvement in pain intensity and/or functional disability in patients with chronic nonspecific low back pain undergoing manual therapy and exercises compared to isolated exercises. Results: In the end, five randomized clinical trials were included, totaling 260 participants. It was possible to conduct a meta- analysis, which demonstrated that manual therapy associated with exercises compared to isolated exercises was not effective in the pain outcome (SMD = -0.87, CI: -1.87; 0.12, I2 = 90%), but the disability outcome showed statistically significant results in the short term (SMD = -0.73, CI: -1.05 to -0.42, I2 = 0%) and long term (SMD = -1.13, CI: -2.06; -0.19, I2 = 80%). However, these findings were classified as having moderate to low GRADE evidence. Conclusion: Patients who performed one therapy associated with the other compared to isolated therapy did not obtain improvement in pain intensity, but the functional disability outcome obtained statistically significant results in the short and long term; these findings proved to be beneficial. Although the overall quality of evidence in the studies was moderate to very low, these findings represent an important field of research that should be guided by studies with more participants and homogeneous methods of analysis and this can guide the management of low back pain.