Effectiveness of nonpharmacologic interventions on pregnancy-related low back pain: A network meta-analysis of randomized controlled trials

Background: Pregnancy-related low back pain (PLBP) is a prevalent clinical condition occurring antenatally and postnatally. Given limited evidence on conservative management, this study systematically assessed the efficacy of non-pharmacological interventions for pain relief and physical function improvement in females with PLBP. Methods: The Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines were followed. A systematic search was performed across 12 electronic databases from inception to March 30, 2024. Eligibility screening was performed according to predefined criteria, followed by the quality assessment utilizing the Cochrane Risk of Bias Tool. Data analysis was conducted using Stata 18.0. Network meta-analysis applied the node-cut method for the consistency test, and used the surface under the cumulative ranking curve to reflect the likelihood of each non-pharmacological intervention being the best intervention. Results: Thirty-six randomized controlled trials were examined (N = 4511 participants). The surface under the cumulative ranking curve identified music-relaxation as the highest-ranked therapy for pain reduction (97.1%), and manipulation-acupuncture as the highest-ranked therapy for physical function indicators (78.3%). Conclusion: Limited evidence indicated that music-relaxation therapy may be the most effective strategy for alleviating pain, while manipulation-acupuncture therapy may be optimal for enhancing physical function. Integrated non-pharmacological interventions demonstrated greater effectiveness compared to monotherapy in improving PLBP.