How effective is physiotherapy for sciatica? A systematic review and meta-analysis.

Purpose

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.

This systematic review will establish whether physiotherapy is effective for patients with sciatica.

Approach

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

Outcomes

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 (e.g 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.

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.

Funding acknowledgements

None. 

Additional notes

This work was presented at Physiotherapy UK 2019, presented as poster at WCPT May 2019, and NeuPSIG May 2019, and published in peer review journal prior to November 2019.