Mind-Body Exercise Performed by Physical Therapists for Reducing Pain and Disability in Low Back Pain: A Systematic Review With Meta-analysis |
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| Affiliation: | 1. Department of Exercise Science, University of South Carolina, Columbia, SC;2. Department of Orthopaedic Surgery and Duke Clinical Research Institute, Duke University, Durham, NC;3. Departments of Orthopaedic Surgery and Population Health Sciences, Duke University, Durham, NC;4. Medical Center Library and Archives, Duke University, Durham, NC;1. Department of Epidemiology and Biostatistics, Michigan State University – College of Human Medicine, Grand Rapids, MI;2. John F. Butzer Center for Research and Innovation, Mary Free Bed Rehabilitation Hospital, Grand Rapids, MI;3. Division of Rehabilitation, Michigan State University – College of Human Medicine, Grand Rapids, MI;4. Department of Biostatistics, Grand Valley State University, Grand Rapids, MI;1. NHMRC Centre of Research Excellence in Aphasia Recovery and Rehabilitation, Melbourne, Australia;2. Discipline of Speech Pathology, School of Allied Health, Human Services and Sport, La Trobe University, Bundoora, Australia;3. School of Medical and Health Sciences, Edith Cowan University, Perth, Australia;4. Queensland Aphasia Research Centre, University of Queensland, Brisbane, Australia;5. Faculty of Health and Behavioural Sciences, School of Health and Rehabilitation Sciences, University of Queensland, Brisbane, Australia;6. Melbourne Medical School, University of Melbourne, Parkville, Australia;7. Stroke Division, The Florey Institute of Neuroscience and Mental Health, University of Melbourne, Heidelberg, Australia;8. Department of Communication Science and Disorders, University of Pittsburgh, Pittsburgh PA;9. Geriatric Research, Education, and Clinical Center and Audiology and Speech Pathology Service, VA Pittsburgh Healthcare System, Pittsburgh PA;10. Brain Recovery and Rehabilitation Group, Department of Neuroscience, Central Clinical School, Monash University, Melbourne, Australia;11. School of Psychological Sciences, Macquarie University, Sydney, Australia;1. Massachusetts Veterans Epidemiology and Research Information Center (MAVERIC), VA Boston Healthcare System, Boston, MA;2. Department of Gerontology, University of Massachusetts Boston, Boston, MA;3. Medical Practice Evaluation Center and Center for Aging and Serious Illness, Mongan Institute, Department of Medicine, Massachusetts General Hospital, Boston, MA;4. Department of Clinical Research, Copenhagen University Hospital, Hvidovre, Denmark;5. Department of Clinical Medicine, University of Copenhagen, Denmark;6. New England Geriatric Research Education and Clinical Center, VA Boston Healthcare System, Boston, MA;7. Harvard Medical School, Boston, MA;8. Boston University, Boston, MA;9. Brigham and Women''s Hospital, Boston, MA;10. Geriatrics and Extended Care, VA Boston Healthcare System, Boston, MA;11. Spaulding Rehabilitation Hospital, Boston, MA;1. Shepherd Center, Virginia C. Crawford Research Institute, Atlanta, GA;2. Department of Kinesiology, University of Georgia, Athens, GA;1. Université Versailles-Saint-Quentin-en-Yvelines, “End:icap” U1179 Inserm, UFR des sciences de la santé-Simone-Veil, Versailles, France;2. Département Parasport Santé, Service de médecine physique et de réadaptation, Hôpital Raymond-Poincaré, Assistance Publique–Hôpitaux de Paris (AP-HP), Garches, France;3. UPOH (Unité Péri Opératoire du Handicap, Perioperative Disability Unit), Service de médecine physique et de réadaptation, Hôpital Raymond-Poincaré, Assistance Publique–Hôpitaux de Paris (AP-HP), Garches, France;4. Service de médecine physique et de réadaptation, Hôpital d''Instruction des Armées Laveran, Marseille, France;5. Service d''explorations fonctionnelles, Hôpital Raymond-Poincaré, Assistance Publique–Hôpitaux de Paris (AP-HP), Garches, France;6. Military Educational Establishment of the Army Health Service, Ecole du Val de Grâce, 1 Pl. Alphonse Laveran, 75005 Paris, France |
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| Abstract: | ObjectiveTo assess the effectiveness of mind-body (MB) exercise interventions provided by physical therapists for reducing pain and disability in people with low back pain (LBP).Data SourcesMEDLINE, Embase, CINAHL, and the Cochrane Library were searched for articles published in English between December 2010 and June 2020.Study SelectionRandomized controlled trials evaluating the effects of Pilates, yoga, and tai chi interventions performed by physical therapists on pain or disability outcomes in adults with musculoskeletal LBP were included.Data ExtractionData were extracted by 2 independent reviewers. Quality of evidence and risk of bias were assessed using the Grading of Recommendations Assessment, Development, and Evaluation framework and Cochrane risk of bias tools, respectively.Data Synthesis21,230 exercise trials were identified; 161 progressed to full-text review. Eight trials, 7 reporting on Pilates and 1 reporting on yoga, were included. Short-term outcomes for pain (SMD: -0.93; 95% confidence interval [CI]: -1.65 to -0.021) and disability (SMD: -0.74 95% CI: -1.36 to -0.012) indicated MB exercise was more effective than control intervention. Tests for subgroup differences between studies with exercise vs non-exercise control groups revealed a moderating effect on short-term outcomes where larger effects were observed in studies with non-exercise comparators. Long-term outcomes for pain (SMD: -0.60; 95% CI:-1.43 to 0.23) and disability (SMD: -1.05; 95% CI:-3.51 to 1.41) suggested that MB exercise is not more effective than control interventions for pain or disability. Quality of the evidence ranged from very low to low.ConclusionsPhysical therapist-delivered MB exercise interventions, which overwhelmingly consisted of Pilates, were more effective than control in the short and long-term for pain and in the short-term for disability, with differences in the short-term effects lessened when compared with an active intervention. Pilates interventions delivered by physical therapists represent a viable tool for the clinical management of chronic LBP. |
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