Table 5 Reported pain outcomes by study

 Bekkering, 2005 [29]

NRS

Pain improved in both groups over initial 12 weeks

Baseline: Intervention 7.0, IQR 5.0–8.0; Control 7.0, IQR 5.0–8.0

6 week: Intervention 3.0, IQR 2.0–5.0; Control 3.0, IQR 2.0–5.0

12 week: Intervention 2.0, IQR 1.0–4.0; Control 2.0, IQR 1.0–4.0

26 week: Intervention 2.0, IQR 1.0–4.0; Control 1.0, IQR 0.0–4.0

52 week: Intervention 2.0, IQR 0.0–4.0; Control 1.0, IQR 0.3–3.0

At 12 weeks: difference in pain intensity was 0.34, (95% CI −0.19 to 0.88)

No difference between groups over the 12 months. (X²=6.05, df=4, P>.05)

 Kongsted, 2019 [32]

NRS

Change Scores baseline to 4 months:

Before 0.6 (95%CI −0.05 to 1.3)

After 1.9 (95%CI 1.2 to 2.7)

GLA:D 1.2 (95%CI 0.6 to 1.7)

 Lemieux

NRS

Back Pain:

Pre-training median 5, (Q1, Q3 3,7)

Post-training median 3 (Q1, Q3 1,4)

Difference in median −2, P<.001

Leg Pain:

Pre-training median 2 (Q1,Q3 0.5,5.0)

Post-training median 1 (Q1, Q3 0,3)

Difference in median −1, P<.001

 Rutten, 2010 [35]

VAS

Association between % Guideline adherence and VAS Average: B = −0.17, Beta= −0.07, P=.499

Correlation of Adherence with VAS Average for Subgroups:

Acute −.06, P>.05

Subacute −.14, P>.05

Chronic −.45, P<.01

 Sharma, 2019 [26]

PROMIS Pain Intensity (NRS)

PROMIS short form pain intensity:

PEG Change 5.28, (95% CI 2.91 to 7.65), P<.001

CG Change 1.72, (95% CI −0.82 to 4.26) P>.05

Between groups: t = 2.16, difference 3.56, (95% CI 0.21 to 6.91),P<.05

PROMIS short form pain interference:

PEG Change 4.47, (95% CI 1.191 to 7.04), P<.001

CG Change 3.03, (95% CI 0.69 to 5.36), P<.05

Between groups: t = 0.88, difference 1.45, (95% CI −1.90 to 4.79), P>.05

 Schroder, 2021 [23]

NRS

Between-Group Effects Adherent/Nonadherent Care

Baseline: Non CPQI 6.3 (5.5 to 7.1) CPQI Adherent 6.1 (5.4 to 6.9)

3 months: Non CPQI Adherent −2.5 (95% CI −3.0 to −2.0) P< .001; CPQI Adherent −3.4 (95% CI −4.0 to −2.8) P< .001; Between-Group Effect 0.9 (95% CI 0.3 to 1.6) P= .004

6 months: Non CPQI Adherent −2.1 (95% CI −2.7 to −1.5) P< .001; CPQI Adherent −3.2 (95% CI −3.8 to −2.6) P< .001; Between-Group Effect 1.1 (95% CI 0.4 to 1.8) P= .002

12 months: Non CPQI Adherent −2.6 (95% CI −3.2 to −2.0) P< .001; CPQI Adherent −3.1 (95% CI −3.7 to −2.5) P< .001; Between-Group Effect 0.5 (95% CI −0.2 to 1.2) P = .169

Between-Group Effects of Control and Intervention Group

Baseline: Control 6.1 (5.6 to 6.7), Intervention 6.4 (5.7 to 7.0)

3 months: Control −2.6 (95% CI −3.1 to −2.1) P< .001; Intervention −2.9 (95% CI −3.4 to −2.5) P< .001 Between-Group Effect −0.3 (95% CI −0.3 to 0.9) P = .263

6 months: Control −2.4 (95% CI −3.0 to −1.8) P< .001; Intervention −2.7 (95% CI −3.2 to −2.2) P< .001; Between-Group Effect −0.3 (95% CI −0.3 to 0.9) P = .357

12 months: Control −3.1 (95% CI −3.7 to −2.5) P< .001 Intervention −2.8 (95% CI −3.3 to −2.3) P< .001; Between-Group Effect −0.3 (95% CI −0.9 to 0.3) P = .297

Bonferroni corrected P value of P < .017

 Fritz, 2007 [17]

NPRS

Adherent vs nonadherent care 22.4% mean difference in improvement, (95% CI 17.5 to 27.3), P<.001

Change in pain rating:

All 3.0 (SD 2.7)

Adherent 3.6 (SD 2.8)

Nonadherent 2.6 (SD 2.7)

Percentage change in pain rating, Between groups: P<.05

All 47.1% (SD 43.5)

Adherent 60.5% (SD 39.1)

Nonadherent 38.0% (SD 44.1)

 Fritz, 2008 [18]

NPRS

Percent change in pain rating: mean difference 11.3% (95% CI 1.6 to 20.9), P<.05

Adherent 49.1% (SD 45.9)

Nonadherent 39.2% (SD 46.8)

 Van der Roer, 2008 [24]

NRS

No significant difference between groups:

−1.02 points; (95% CI −2.14 to 0.09)

 Hahne, 2017 [27]

NRS

All groups improved

Back pain: (SMD=standardized mean difference)

5-week NRS: Intervention 3.1(SD 2.2), Control 3.5 (SD 2.5), Adjusted SMD 0.1 (95% −0.4 to 0.6) Adjusted between-group difference 0.2 (95% CI −1.0 to 1.5) P=.72

10-week NRS: Intervention 2.4 (SD 1.6), Control 4.0 (SD 2.6), Adjusted SMD 0.7 (95% CI 0.1 to 1.2), Adjusted between-group difference 1.4 (95% CI 0.2 to 2.7) P=.02

26-week NRS: Intervention 2.4 (SD 1.6), Control 3.5 (SD 2.6), Adjusted SMD 0.4 (95% CI −0.1 to 0.9), Adjusted between-group difference 0.9 (95% CI −0.3 to 2.2) P=.13

52-week NRS: Intervention 2.4 (SD 2.0), Control 3.6 (SD 2.5), Adjusted SMD 0.5 (95% CI −0.1 to 1.0), Adjusted between-group difference 1.1 (95% CI 0.2 to 2.3) P=.9

Leg pain:

5-week NRS: Intervention 3.6 (SD 2.4), Control 4.4 (SD 3.0), Adjusted SMD 0.4 (95% CI −0.2 to 0.9), Adjusted between-group differences 1.0 (95% CI −0.4 to 2.3) P=.16

10-week NRS: Intervention 2.9 (SD 2.3), Control 3.8 (SD 3.0), Adjusted SMD 0.4 (95% CI −0.2 to 0.9), Adjusted between-group difference 1.1 (95% CI −0.3 to 2.4) P=.13

26-week NRS: Intervention 2.0 (SD 2.1), control 3.0 (SD 2.9), Adjusted SMD 0.5 (95% CI −0.1 to 1.0), Adjusted between-group difference 1.2 (95% CI −0.2 to 2.6) P=.09

52-week NRS: Intervention 2.1 (SD 2.4), Control 2.9 (SD 2.8), Adjusted SMD 0.3 (95% CI −0.2 to 0.9), Adjusted between-group difference 0.9 (95% CI −0.5 to 2.3) P=.21

 Cote, 2019 [28]

NRS

NRS improved within all groups but no differences between groups (P>.05)

Baseline: Government guideline 5.6 (SD 2.1), Preferred-provider 5.7 (SD 2.0), Education and activation 5.9 (SD 2.1)

6 weeks: Government guideline 2.7 (95% CI 2.1 to 3.3), Preferred-provider 2.2 (95% CI 1.6 to 2.8), GP Education and activation 2.4 (95% CI 1.7 to 3.0)

3 months: Government guideline 3.5 (95% CI 2.9 to 4.0), Preferred-provider 3.3 (95% CI 2.7 to 3.9), GP Education and activation 3.3 (95% CI 2.6 to 3.9)

6 months: Government guideline 3.4 (95% CI 2.8 to 4.1), Preferred-provider 3.2 (95% CI 2.5 to 3.8), GP Education and activation 3.6 (95% CI 3.0 to 4.3)

9 months: Government guideline 3.7 (95% CI 3.1 to 4.3), Preferred-provider 4.0 (95% CI 3.4 to 4.5), GP Education and activation 3.8 (95% CI 3.1 to 4.4)

12 months: Government guideline 3.6 (95% CI 3.0 to 4.2), Preferred-provider 3.2 (95% CI 2.6 to 3.8), GP Education and activation 3.6 (95% CI 2.9 to 4.2)

 Horn, 2016 [19]

NPRS

The nonadherent group demonstrated greater percentage improvement in pain. P=.01

Adherent 7.04 (95% CI −11.73 to 25.70)

Nonadherent 33.11 (95% CI 25.99 to 40.22)