{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T01:53:57Z","timestamp":1790819637957,"version":"4.1.0"},"reference-count":44,"publisher":"BMJ","issue":"3","content-domain":{"domain":["bmj.com"],"crossmark-restriction":true},"short-container-title":["BMJ EBM"],"accepted":{"date-parts":[[2024,12,17]]},"published-print":{"date-parts":[[2025,6]]},"abstract":"<jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To assess the therapeutic quality of exercise interventions delivered in chronic low back pain (cLBP) trials using the international Consensus on Therapeutic Exercise aNd Training (i-CONTENT) tool and its inter-rater agreement.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods<\/jats:title>\n                    <jats:p>We performed a meta-research study, starting from the trials\u2019 arms included in the published Cochrane review (2021) \u2018Exercise therapy for chronic low back pain\u2019. Two pairs of independent reviewers applied the i-CONTENT tool, a standardised tool designed to ensure the quality of exercise therapy intervention, in a random sample of 100 different exercise arms. We assessed the inter-rater agreement of each category calculating the specific agreement. A percentage of 70% was considered satisfactory.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>We included 100 arms from 68 randomised controlled trials published between 1991 and 2019. The most assessed exercise types were core strengthening (n=27 arms) and motor control (n=13 arms). Among alternative approaches, yoga (n=11) and Pilates (n=7) were the most representative. Overall, most exercise interventions were rated as having a low risk of ineffectiveness for patient selection (100%), exercise type (92%), outcome type and timing (89%) and qualified supervisor (84%). Conversely, some items showed more uncertainty: the safety of exercise programmes was rated as \u2018probably low risk\u2019 in 58% of cases, exercise dosage in 34% and adherence to exercise in 44%. The items related to exercise dosage (31%) and adherence (29%) had heterogenous judgements, scoring as high risk of ineffectiveness or probably not done. Among all exercise types, Pilates scored best in all domains. A satisfactory specific agreement for \u2018low risk category\u2019 was achieved in all items, except dosage of exercise (60%) and adherence to exercise (54%).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion<\/jats:title>\n                    <jats:p>Exercises delivered for patients with cLBP generally demonstrate favourable therapeutic quality, although some exercise modalities may present poor therapeutic quality related to dosage and adherence. While the i-CONTENT judgements generally showed satisfactory specific agreement between raters, disagreements arose in evaluating some crucial items.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1136\/bmjebm-2024-113235","type":"journal-article","created":{"date-parts":[[2025,1,23]],"date-time":"2025-01-23T13:20:17Z","timestamp":1737638417000},"page":"194-201","update-policy":"https:\/\/doi.org\/10.1136\/crossmarkpolicy","source":"Crossref","is-referenced-by-count":8,"title":["Therapeutic quality of exercise interventions for chronic low back pain: a meta-research study using i-CONTENT tool"],"prefix":"10.1136","volume":"30","author":[{"ORCID":"https:\/\/orcid.org\/0009-0008-5781-743X","authenticated-orcid":false,"given":"Ignazio","family":"Geraci","sequence":"first","affiliation":[{"name":"Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI), University of Genova, Genova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Bargeri","sequence":"additional","affiliation":[{"name":"Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giacomo","family":"Basso","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI), University of Genova, Genova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Greta","family":"Castellini","sequence":"additional","affiliation":[{"name":"Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Chiarotto","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands"},{"name":"Department of General Practice, University Medica Center, Erasmus MC, Rotterdam, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Silvia","family":"Gianola","sequence":"additional","affiliation":[{"name":"Unit of Clinical Epidemiology, IRCCS Istituto Ortopedico Galeazzi, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Raymond","family":"Ostelo","sequence":"additional","affiliation":[{"name":"Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands"},{"name":"Department of Epidemiology and Data Science, Vrije Universiteit & Amsterdam Movement Sciences, Musculoskeletal Health, Amsterdam, Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marco","family":"Testa","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI), University of Genova, Genova, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tiziano","family":"Innocenti","sequence":"additional","affiliation":[{"name":"Department of Neurosciences, Rehabilitation, Ophthalmology, Genetic and Maternal Infantile Sciences (DINOGMI), University of Genova, Genova, Italy"},{"name":"Department of Health Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands"},{"name":"GIMBE Foundation, Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"239","published-online":{"date-parts":[[2025,1,23]]},"reference":[{"key":"2025102020401072000_30.3.194.1","doi-asserted-by":"publisher","DOI":"10.1016\/S2665-9913(23)00098-X"},{"key":"2025102020401072000_30.3.194.2","doi-asserted-by":"crossref","DOI":"10.21037\/atm.2020.02.175","article-title":"Global low back pain prevalence and years lived with disability from 1990 to 2017: estimates from the Global Burden of Disease Study 2017","volume":"8","author":"Wu","year":"2020","journal-title":"Ann Transl Med"},{"key":"2025102020401072000_30.3.194.3","doi-asserted-by":"publisher","DOI":"10.1016\/S0140-6736(18)30480-X"},{"key":"2025102020401072000_30.3.194.4","doi-asserted-by":"publisher","DOI":"10.2522\/ptj.20080103"},{"key":"2025102020401072000_30.3.194.5","doi-asserted-by":"publisher","DOI":"10.2522\/ptj.20090218"},{"key":"2025102020401072000_30.3.194.6","unstructured":"Tulder van M . 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