Efficacy of non-surgical treatments for acute non-specific low back pain: protocol for systematic review and network meta-analysis of randomised controlled trials
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2025-07
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<jats:sec> <jats:title>Introduction</jats:title> <jats:p>Acute low back pain (LBP) is a prevalent condition with various non-surgical treatment options, yet no comprehensive network meta-analysis has systematically compared their relative efficacy for pain and disability. This study aims to fill that gap by synthesising available evidence on the efficacy of different types of non-surgical interventions for acute LBP, such as various medications, manual therapies and education-based therapies. Our coprimary objectives are to (1) compare each active treatment to an inert reference for measures of LBP and related disability and (2) rank the efficacy of treatments.</jats:p> </jats:sec> <jats:sec> <jats:title>Methods and analysis</jats:title> <jats:p>We will conduct a systematic search across multiple databases, including grey literature, to identify randomised controlled trials evaluating non-surgical treatments for acute LBP. Eligible studies must report on pain and/or disability outcomes in adults. The risk of bias will be assessed using the Risk of Bias tool, and the certainty of evidence will be graded using CINeMA (Confidence in Network Meta-Analysis). We will use a frequentist network meta-analysis to pool standardised mean differences in pain and disability, employing random-effects models to account for heterogeneity. A qualitative analysis will assess study characteristics and transitivity, while a quantitative analysis will evaluate efficacy and inconsistency. Results will be presented using network geometry, p-scores, forest plots, funnel plots, Egger’s test, Q-statistics and league tables to visualise both direct and indirect evidence and to identify potential biases.</jats:p> </jats:sec> <jats:sec> <jats:title>Ethics and dissemination</jats:title> <jats:p>This review protocol does not involve any primary research with human participants, animal subjects or medical record review. Consequently, this work did not require approval from an institutional review board or ethics committee. Results will be submitted to a peer-reviewed journal and presented at conference(s). De-identified data will be made available in a public repository.</jats:p> </jats:sec>
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Trager, Robert J, Anthony N Baumann, Geronimo Bejarano, Wren Burton, Elizabeth R Blackwood, Benjamin D Holmes and Christine M Goertz (2025). Efficacy of non-surgical treatments for acute non-specific low back pain: protocol for systematic review and network meta-analysis of randomised controlled trials. BMJ Open, 15(7). pp. e100520–e100520. 10.1136/bmjopen-2025-100520 Retrieved from https://hdl.handle.net/10161/33040.
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Beth Blackwood
Beth Blackwood (she, her) is a Research & Education Librarian at the Medical Center Library & Archives, where she serves as the Lead for Research Impact and the Liaison to the Department of Global Health. Her primary duties focus on assisting researchers and administrators with bibliometric questions and program evaluations, as well as specialized teaching and searching. Prior to Duke, she served as the Digital Archivist & Data Librarian at California State University Channel Islands, where she on-boarded a variety of new library infrastructure, developed and taught for-credit courses in data and algorithmic literacy, and implemented data management best practices across campus.
Benjamin Dean Holmes
Chiropractor and researcher with interests in manual therapy, yoga, and spinal healthcare practices in global and low-resource settings.
Christine Goertz
Christine Goertz, D.C., Ph.D. is a Professor in Musculoskeletal Research at the Duke Clinical Research Institute and Vice Chair for Implementation of Spine Health Innovations in the Department of Orthopaedic Surgery at Duke University. She is also the Chief Executive Officer of the Spine Institute for Quality and an Adjunct Professor in the Department of Epidemiology, College of Public Health at the University of Iowa. Formerly she was Vice Chancellor of Research and Health Policy at Palmer College of Chiropractic for eleven years. Dr. Goertz received her Doctor of Chiropractic (D.C.) degree from Northwestern Health Sciences University in 1991 and her Ph.D. in Health Services Research, Policy and Administration from the School of Public Health at the University of Minnesota in 1999. Her 30-year research career has focused on working with multi-disciplinary teams to design and implement clinical and health services research studies designed to increase knowledge regarding the effectiveness and cost of patient-centered, non-pharmacological treatments for spine-related disorders. Dr. Goertz has received nearly $44M in federal funding as either principal investigator or co-principal investigator, primarily from NIH and the Department of Defense, and co-authored over 130 peer-reviewed papers. Dr. Goertz has previously served as a Member of the Interagency Pain Research Coordinating Committee (IPRCC), the Bone and Joint Initiative Low Back Pain Task Force, the CDC Opioid Workgroup and Chairperson of the Board of Governors for the Patient Centered Outcomes Research Institute (PCORI).
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