Background & Aims
Low back pain (LBP) is a top-ranked source of disability in low and middle-income countries (LMICs). Two key factors contribute to this: 85% of the world’s population lives in them, thus the absolute number of LBP cases is higher in these areas; these countries are facing a rapid transition towards population ageing, which leads to the rise in LBP cases. Still, much of the LBP epidemiological research is conducted in high-income countries (HIC), and there is a call to further the understanding of LBP to decrease its associated burden in LMICs. Exercise therapy is a universally recommended first-line care for chronic LBP, including the World Health Organization guideline for chronic LBP. Yet, there is little insight into the origin of the research that supports these recommendations and what proportion of it was conducted in LMICs. We aimed to describe the geographic distribution of randomized controlled trials (RCTs) conducted in exercise interventions in people with LBP from LMICs.
Methods
We cross-sectionally examined studies that were included in the most recent four Cochrane Reviews on exercise interventions for people with LBP: exercise interventions for acute LBP, exercise for chronic LBP, yoga, and McKenzie exercises. We counted duplicate trials once. This study specifically focused on analyzing RCTs conducted in LMICs, sub-classified into low-income, lower-middle-income, and upper-middle-income countries based on World Bank classification. To explore the participation of these countries in RCTs we extracted information on the country in which the study was conducted, the total number of participants, and other trial characteristics (e.g., language and year of publication). We plotted the proportion of RCTs conducted in LMICs, and the proportion of participants enrolled in LMICs from the total RCTs examined.
Results
A total of 28,340 participants were enrolled in 288 RCTs after removing duplicates (n=10). The mean age of study participants ranged from 21 to 74 years of age. LMICs were a minority, representing 23% of total studies (n = 67). Among total studies, 10% (n=29) were from lower-middle-income countries, and 12% (n=36) from upper-middle-income countries. Only 1% was from low-income countries (n=3). Only 17% (n=4.815) of total RCT participants were studies conducted in LMICs. A majority of these, i.e., 61% were from upper-middle-income countries (n=2917), 36% (n=1731) were from lower-middle-income countries, and 3% ( n=167) were from three trials from one low-income country, Nigeria. Enrollment by specific country revealed that Brazil was the country with the most representation in number of trials, with 15 trials (1302 participants), followed by India (n=14 studies; 998 participants) Iran (n=12 studies; 446 participants), Turkey (n=9 studies, 555 participants), China (n=5 studies, 492 participants), and Thailand (n=6 studies, 467 participants).
Conclusions
LMICs are underrepresented in RCTs that investigate the effect of exercise interventions for LBP. Three countries (Brazil, India, and Iran) dominated the LMIC representation in total exercise trials for LBP (with 61% of all studies published from all LMICs) with very little representation from low-income countries.
References
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Presenting Author
Fabianna Resende de Jesus-Moraleida
Poster Authors
Fabianna Resende de Jesus-Moraleida
PhD
Federal University of Ceará
Lead Author
Luana Pinheiro
Bpt
Federal University of Ceará
Lead Author
Jessica Fernandez
PhD
Centro Universitário Augusto Motta
Lead Author
Jill A. Hayden
DC, PhD
Dalhousie University
Lead Author
Romy Parker
PhD
University of Cape Town
Lead Author
Saurab Sharma
PhD
University of New South Wales
Lead Author