Conservative management for patients with sciatica: a systematic review

Abstract

Background: Sciatica is a broad term describing spinally referred pain of neural origin that radiates into the leg. Sciatica is a significant burden to healthcare and health economies globally. Physiotherapy is often prescribed for the treatment of sciatica, however its effectiveness remains controversial. Purpose: This systematic review will establish whether physiotherapy is effective for patients with sciatica. Methods: Cochrane Central Register of Controlled Trials (CENTRAL), CINAHL (EBSCO), Embase, PEDro, PubMed and Scopus were searched from inception to July 2018 without language restrictions. Inclusion criteria were randomised controlled trials evaluating physiotherapy intervention compared to a control intervention with a long-term follow-up of at least six months. The systematic review was registered on PROSPERO CRD42018103900. Results: 3479 records were identified, of which 22 studies, (from 19 randomized controlled trials) were included. Eighteen studies had a high or unclear risk of bias. Meta-analysis suggested that at one year there is minimal evidence to support the use of physiotherapy for pain and disability compared with minimal intervention such as GP care, or advice. Surgery is slightly more effective than physiotherapy at one year for pain and disability. Clinical and statistical heterogeneity of included studies was however high, especially in regards to diagnosis and duration of symptoms. Conclusion(s): Based on currently available, mostly high risk of bias data, there is inadequate evidence to make clinical recommendations on the effectiveness of physiotherapy for patients with sciatica. Implications: High quality trials are required to establish the effectiveness of physiotherapy in patients with sciatica. Key-Words: Sciatica, Radiculopathy, Physiotherapy Funding acknowledgements: None Ethics approval: Did this work require ethics approval?:No Institution: University of Hertfordshire Ethics Committee: None required Please state the reasons why ethics approval was not required: This is a systematic review and is therefore secondary research.