• Matt Fernandez, Jan Hartvigsen, Manuela L Ferreira, Kathryn M Refshauge, Aryane F Machado, Ítalo R Lemes, Chris G Maher, and Paulo H Ferreira.
• *Faculty of Health Science, The University of Sydney, New South Wales, Australia †Institute of Sports Science and Clinical Biomechanics and Nordic Institute of Chiropractic and Clinical Biomechanics, University of Southern Denmark, Odense M, Denmark ‡The George Institute for Global Health; Sydney Medical School, The University of Sydney, New South Wales, Australia; and §Institute of Bone and Joint Research, Sydney Medical School, The University of Sydney, New South Wales, Australia.
• Spine. 2015 Sep 15; 40 (18): 1457-66.

Study DesignA systematic review and meta-analysis.ObjectiveTo evaluate the evidence on comparative effectiveness of advice to stay active versus supervised structured exercise in the management of sciatica.Summary Of Background DataConservative management of sciatica usually includes interventions to promote physical activity in the form of advice to stay active or exercise, but there has been no systematic review directly comparing the effectiveness of these 2 approaches.MethodsData Sources included MEDLINE, CINAHL, EMBASE, and PEDro databases. Studies were randomized controlled trials comparing advice with exercise. Two independent reviewers extracted data and assessed methodological quality using the PEDro scale. Pain and disability data were extracted for all time points and converted to a common 0 to 100 scale. Data were pooled with a random effects model for short, intermediate, and long-term follow-ups. The GRADE approach was used to summarize the strength of evidence.ResultsFive trials were included in the meta-analysis, which showed a significant, although small effect favoring exercise over advice for reducing leg pain intensity in the short term (weighted mean difference: 11.43 [95% confidence interval, 0.71-22.16]) but no difference for disability (weighted mean difference: 1.45 [95% confidence interval, -2.86 to 5.76]). Furthermore, there was no difference at intermediate and long-term follow-ups between advice and exercise for patient-relevant outcomes.ConclusionThere is low-quality evidence (GRADE) that exercise provides small, superior effects compared with advice to stay active on leg pain in the short term for patients experiencing sciatica. However, there is moderate-quality evidence showing no difference between advice to stay active and exercise on leg pain and disability status in people with sciatica in the long term.Level Of Evidence1.

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