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Effect of differentiating exercise guidance based on a patient’s level of low back pain in primary care: a mixed-methods systematic review protocol
  1. Jens Erik Jorgensen,
  2. Tamana Afzali,
  3. Allan Riis
  1. Research Unit for General Practice in Aalborg, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
  1. Correspondence to Jens Erik Jorgensen; jeja26{at}


Introduction Low back pain (LBP) is one of the health conditions that lead to the most disability worldwide. Guidelines aimed at management of LBP recommend non-invasive and non-pharmacological management, including patient education, advice to stay active and exercise therapy; however, the guidelines offer no recommendation as to the allowable level of pain during exercise or how specific levels of pain should be reflected in the stage and progression of exercises or activities. The purpose of this review is to study the effect of differentiation of exercise guidance based on the level of LBP in patients in primary care.

Methods and analysis A systematic search will be performed on PubMed, EMBASE, The Cumulative Index to Nursing and Allied Health Literature (CINAHL), PsycINFO, Physiotherapy Evidence Database (PEDRO), Cochrane and PROSPERO from their inception until September 2017. Published peer-reviewed human experimental and observational studies with quantitative or qualitative designs will be included. Two independent reviewers will identify papers by reviewing titles and abstracts. Papers passing the initial selection will be appraised by two reviewers, based on their full texts. Furthermore, the reference lists of included studies will be snowballed for identification of other relevant studies. Data will be extracted using a standard extraction sheet by two independent reviewers. Disagreements will be resolved by discussion and consensus with a third reviewer. The methodological quality of studies will be assessed using the Grading of Recommendations, Assessment, Development and Evaluation risk of bias tool, or the Critical Appraisal Skills Programme. Results will be reported narratively. Search histories will be documented on EndNote X8 (Clarivate Analytics).

Ethics and dissemination Ethical approval for this review was not required as primary data will not be collected. The results will be disseminated through a peer-reviewed international journal and conference presentations.

PROSPERO registration number CRD42017074880.

  • Low Back Pain
  • Exercise Therapy
  • Primary Care
  • Pain Management

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  • Contributors This study was conceptualised by JEJ and AR. JEJ drafted the manuscript. All authors contributed equally to the design of the study. The search strategy was developed by all authors. JEJ and TA will contribute to data collection. All the authors will contribute equally to the data analysis and interpretation for the review. All the authors will critically revise the review. All authors will read and approve the final manuscript.

  • Funding This work is supported by the Novo Nordisk Foundation grant number NNF17OC0024422. The funder has no role in the study design, collection of data, management, analysis, interpretation of data, writing of the review or the decision to submit this paper for publication.

  • Competing interests None declared.

  • Patient consent Not required.

  • Ethics approval Ethical approval for this review was not sought as primary data will not be collected.

  • Provenance and peer review Not commissioned; externally peer reviewed.