Are group-based and individual physiotherapy exercise programmes equally effective for musculoskeletal conditions? A systematic review and meta-analysis.

BACKGROUND: Musculoskeletal pain is common and its treatment costly. Both group and individual physiotherapy interventions which incorporate exercise aim to reduce pain and disability. Do the additional time and costs of individual physiotherapy result in superior outcomes?

OBJECTIVE: To compare the effectiveness of group and individual physiotherapy including exercise on musculoskeletal pain and disability.

METHODS: Eleven electronic databases were searched by two independent reviewers. Randomised controlled trials (RCTs) including participants with musculoskeletal conditions which compared group and individual physiotherapy interventions that incorporated exercise were eligible. Study quality was assessed using the PEDro scale by two independent reviewers, and treatment effects were compared by meta-analyses.

RESULTS: Fourteen RCTs were eligible, including patients with low back pain (7 studies), neck pain (4), knee pain (2) and shoulder pain (1). We found no clinically significant differences in pain and disability between group and individual physiotherapy involving exercise.

CONCLUSIONS: Only small, clinically irrelevant differences in pain or disability outcomes were found between group and individual physiotherapy incorporating exercise. Since all but one study included other interventions together with exercise in either the group or individual arm, deciphering the unique effect of the way in which exercise is delivered is difficult. Group interventions may need to be considered more often, given their similar effectiveness and potentially lower healthcare costs.