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THE AUTHORS REPLY

THE AUTHORS REPLY We thank Alwardat (1) for his interest in our meta-analytic review (2). PICO or PICOT (Participants, Intervention, Comparison, Outcomes, Time frame/Type of study) is routinely used in systematic reviews and meta-analyses of controlled trials (3, 4). Although, as reported, we used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement (4) when developing our review protocol, the information that we presented in our introduction and methods sections accords with PICOT, as Alwardat (1) quotes from our inclusion and exclusion criteria: “Trials were eligible for inclusion in the review if they compared an exercise intervention with usual daily activities.” Three components of PICOT are defined in that sentence: I (exercise intervention), C (usual daily activities), and Type of study (trials). We clearly defined our outcomes in the introduction. Low back pain (LBP) was the primary outcome, while the secondary outcomes were intensity of LBP, disability due to LBP, health-care consultation for LBP, and sick leave due to LBP. With regard to participants, we reported that we included interventions that targeted defined population groups with no attempt to screen out participants with LBP at the time of recruitment, but we excluded controlled trials in which participants all had LBP at baseline. We were also clear that controlled trials were eligible for inclusion in the review if at least some of the participants were free from LBP at baseline. To date, only a limited number of controlled trials on the effectiveness of exercise in the primary prevention of LBP and associated disability have been published. We therefore included trials on different types and intensities of exercise. However, for the primary outcome of the review, despite heterogeneous interventions, the amount of between-study heterogeneity was low. Moreover, we performed subgroup analyses by type and frequency of exercise. For the primary outcome, we reported estimates for strengthening and stretching exercises, strengthening and aerobic exercises, and strengthening and either stretching or aerobic exercises, as well as estimates for daily exercise and exercise 2–3 times/week. Acknowledgments This study was funded by the Finnish Ministry of Education and Culture (grant 253715). Conflict of interest: none declared. references 1 Alwardat M . Re: “Exercise for the prevention of low back pain: systematic review and meta-analysis of controlled trials” . Am J Epidemiol . 2018 ; 187 ( 6 ): 1340 . 2 Shiri R , Coggon D , Falah-Hassani K Exercise for the prevention of low back pain: systematic review and meta-analysis of controlled trials . Am J Epidemiol . 2018 ; 187 ( 5 ): 1093 - 1101 . Google Scholar CrossRef Search ADS PubMed 3 Higgins J , Green S . Cochrane Handbook for Systematic Reviews of Interventions, Version 5.1.0. The Cochrane Collaboration ; 2009 . http://training.cochrane.org/handbook. Updated March 2011. Accessed February 20, 2018. 4 Moher D , Liberati A , Tetzlaff J , et al. . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement . PLoS Med . 2009 ; 6 ( 7 ): e1000097 . Google Scholar CrossRef Search ADS PubMed © The Author(s) 2018. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices) http://www.deepdyve.com/assets/images/DeepDyve-Logo-lg.png American Journal of Epidemiology Oxford University Press

THE AUTHORS REPLY

Shiri, Rahman; Coggon, David; Falah-Hassani, Kobra
American Journal of Epidemiology , Volume Advance Article (6) – Mar 20, 2018
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Publisher
Oxford University Press
Copyright
© The Author(s) 2018. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.
ISSN
0002-9262
eISSN
1476-6256
DOI
10.1093/aje/kwy043
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Abstract

We thank Alwardat (1) for his interest in our meta-analytic review (2). PICO or PICOT (Participants, Intervention, Comparison, Outcomes, Time frame/Type of study) is routinely used in systematic reviews and meta-analyses of controlled trials (3, 4). Although, as reported, we used the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) statement (4) when developing our review protocol, the information that we presented in our introduction and methods sections accords with PICOT, as Alwardat (1) quotes from our inclusion and exclusion criteria: “Trials were eligible for inclusion in the review if they compared an exercise intervention with usual daily activities.” Three components of PICOT are defined in that sentence: I (exercise intervention), C (usual daily activities), and Type of study (trials). We clearly defined our outcomes in the introduction. Low back pain (LBP) was the primary outcome, while the secondary outcomes were intensity of LBP, disability due to LBP, health-care consultation for LBP, and sick leave due to LBP. With regard to participants, we reported that we included interventions that targeted defined population groups with no attempt to screen out participants with LBP at the time of recruitment, but we excluded controlled trials in which participants all had LBP at baseline. We were also clear that controlled trials were eligible for inclusion in the review if at least some of the participants were free from LBP at baseline. To date, only a limited number of controlled trials on the effectiveness of exercise in the primary prevention of LBP and associated disability have been published. We therefore included trials on different types and intensities of exercise. However, for the primary outcome of the review, despite heterogeneous interventions, the amount of between-study heterogeneity was low. Moreover, we performed subgroup analyses by type and frequency of exercise. For the primary outcome, we reported estimates for strengthening and stretching exercises, strengthening and aerobic exercises, and strengthening and either stretching or aerobic exercises, as well as estimates for daily exercise and exercise 2–3 times/week. Acknowledgments This study was funded by the Finnish Ministry of Education and Culture (grant 253715). Conflict of interest: none declared. references 1 Alwardat M . Re: “Exercise for the prevention of low back pain: systematic review and meta-analysis of controlled trials” . Am J Epidemiol . 2018 ; 187 ( 6 ): 1340 . 2 Shiri R , Coggon D , Falah-Hassani K Exercise for the prevention of low back pain: systematic review and meta-analysis of controlled trials . Am J Epidemiol . 2018 ; 187 ( 5 ): 1093 - 1101 . Google Scholar CrossRef Search ADS PubMed 3 Higgins J , Green S . Cochrane Handbook for Systematic Reviews of Interventions, Version 5.1.0. The Cochrane Collaboration ; 2009 . http://training.cochrane.org/handbook. Updated March 2011. Accessed February 20, 2018. 4 Moher D , Liberati A , Tetzlaff J , et al. . Preferred reporting items for systematic reviews and meta-analyses: the PRISMA statement . PLoS Med . 2009 ; 6 ( 7 ): e1000097 . Google Scholar CrossRef Search ADS PubMed © The Author(s) 2018. Published by Oxford University Press on behalf of the Johns Hopkins Bloomberg School of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com. This article is published and distributed under the terms of the Oxford University Press, Standard Journals Publication Model (https://academic.oup.com/journals/pages/about_us/legal/notices)

Journal

American Journal of Epidemiology – Oxford University Press

Published: Mar 20, 2018

References

  • Re: “Exercise for the prevention of low back pain: systematic review and meta-analysis of controlled trials”
    Alwardat
  • Exercise for the prevention of low back pain: systematic review and meta-analysis of controlled trials
    Shiri