Sustainability effects of motor control stabilisation exercises on pain and function in chronic nonspecific low back pain patients: A systematic review with meta-analysis and meta-regression


Autoři: Daniel Niederer aff001;  Juliane Mueller aff002
Působiště autorů: Department of Sports Medicine and Exercise Physiology, Institute of Sports Sciences, Goethe University Frankfurt, Frankfurt am Main, Germany aff001;  Department of Computer Science / Therapy Sciences, Professorship for Physiotherapy: Exercise Science and Applied Biomechanics, Trier University of Applied Sciences, Trier, Germany aff002
Vyšlo v časopise: PLoS ONE 15(1)
Kategorie: Research Article
doi: 10.1371/journal.pone.0227423

Souhrn

Study design

Systematic review with meta-analysis and meta-regression.

Background and objectives

We systematically reviewed and delineated the existing evidence on sustainability effects of motor control exercises on pain intensity and disability in chronic low back pain patients when compared with an inactive or passive control group or with other exercises. Secondary aims were to reveal whether moderating factors like the time after intervention completion, the study quality, and the training characteristics affect the potential sustainability effects.

Methods

Relevant scientific databases (Medline, Web of Knowledge, Cochrane) were screened. Eligibility criteria for selecting studies: All RCTs und CTs on chronic (≥ 12/13 weeks) nonspecific low back pain, written in English or German and adopting a longitudinal core-specific/stabilizing sensorimotor control exercise intervention with at least one pain intensity and disability outcome assessment at a follow-up (sustainability) timepoint of ≥ 4 weeks after exercise intervention completion.

Results and conclusions

From the 3,415 studies that were initially retrieved, 10 (2 CTs & 8 RCTs) on N = 1081 patients were included in the review and analyses. Low to moderate quality evidence shows a sustainable positive effect of motor control exercise on pain (SMD = -.46, Z = 2.9, p < .001) and disability (SMD = -.44, Z = 2.5, p < .001) in low back pain patients when compared to any control. The subgroups’ effects are less conclusive and no clear direction of the sustainability effect at short versus mid versus long-term, of the type of the comparator, or of the dose of the training is given. Low quality studies overestimated the effect of motor control exercises.

Klíčová slova:

Comparators – Database searching – Exercise therapy – Lower back pain – Metaanalysis – Pain sensation – Randomized controlled trials – Strength training


Zdroje

1. Hartvigsen J, Lings S, Leboeuf-Yde C, Bakketeig L. Psychosocial factors at work in relation to low back pain and consequences of low back pain; a systematic, critical review of prospective cohort studies. Occup Environ Med. 2004; 61: e2. 14691283

2. Borghuis J, Hof AL, Lemmink KAPM. The importance of sensory-motor control in providing core stability: implications for measurement and training. Sports Med. 2008; 38: 893–916. doi: 10.2165/00007256-200838110-00002 18937521

3. Brown SHM, McGill SM. The intrinsic stiffness of the in vivo lumbar spine in response to quick releases: implications for reflexive requirements. Journal of Electromyography and Kinesiology. 2009; 19: 727–736. doi: 10.1016/j.jelekin.2008.04.009 18513993

4. Searle A, Spink M, Ho A, Chuter V. Exercise interventions for the treatment of chronic low back pain: a systematic review and meta-analysis of randomised controlled trials. Clin Rehabil. 2015; 29: 1155–1167. doi: 10.1177/0269215515570379 25681408

5. Saragiotto BT, Maher CG, Yamato TP, Costa LOP, Menezes Costa LC, Ostelo RWJG, et al. Motor control exercise for chronic non-specific low-back pain. Cochrane Database Syst Rev. 2016: CD012004. doi: 10.1002/14651858.CD012004

6. Lim ECW, Poh RLC, Low AY, Wong WP. Effects of Pilates-based exercises on pain and disability in individuals with persistent nonspecific low back pain: a systematic review with meta-analysis. JOURNAL OF ORTHOPAEDIC & SPORTS PHYSICAL THERAPY. 2011; 41: 70–80.

7. Wang X-Q, Zheng J-J, Yu Z-W, Bi X, Lou S-J, Liu J, et al. A meta-analysis of core stability exercise versus general exercise for chronic low back pain. PLoS One. 2012; 7: e52082. doi: 10.1371/journal.pone.0052082 23284879

8. Gomes-Neto M, Lopes JM, Conceição CS, Araujo A, Brasileiro A, Sousa C, et al. Stabilization exercise compared to general exercises or manual therapy for the management of low back pain: A systematic review and meta-analysis. Phys Ther Sport. 2017; 23: 136–142. doi: 10.1016/j.ptsp.2016.08.004 27707631

9. Owen PJ, Miller CT, Mundell NL, Verswijveren SJ, Tagliaferri SD, Brisby H, et al. Which specific modes of exercise training are most effective for treating low back pain? Network meta-analysis. Br J Sports Med. 2019. doi: 10.1136/bjsports-2019-100886 31666220

10. Smith BE, Littlewood C, May S. An update of stabilisation exercises for low back pain: a systematic review with meta-analysis. BMC Musculoskelet Disord. 2014; 15: 416. doi: 10.1186/1471-2474-15-416 25488399

11. Riemann BL, Lephart SM. The Sensorimotor System, Part I: The Physiologic Basis of Functional Joint Stability. J Athl Train. 2002; 37: 71–79. 16558670

12. Hicks GE, Fritz JM, Delitto A, McGill SM. Preliminary development of a clinical prediction rule for determining which patients with low back pain will respond to a stabilization exercise program. Arch Phys Med Rehabil. 2005; 86: 1753–1762. doi: 10.1016/j.apmr.2005.03.033 16181938

13. Choi BK, Verbeek JH, Tam WW-S, Jiang JY. Exercises for prevention of recurrences of low-back pain. Cochrane Database Syst Rev. 2010: CD006555. doi: 10.1002/14651858.CD006555.pub2 20091596

14. Follmann D, Elliott P, Suh I, Cutler J. Variance imputation for overviews of clinical trials with continuous response. Journal of Clinical Epidemiology. 1992; 45: 769–773. doi: 10.1016/0895-4356(92)90054-q 1619456

15. de Morton NA. The PEDro scale is a valid measure of the methodological quality of clinical trials: a demographic study. Aust J Physiother. 2009; 55: 129–133. doi: 10.1016/s0004-9514(09)70043-1 19463084

16. Higgins JPT, Altman DG, Gøtzsche PC, Jüni P, Moher D, Oxman AD, et al. The Cochrane Collaboration’s tool for assessing risk of bias in randomised trials. BMJ. 2011; 343: d5928. doi: 10.1136/bmj.d5928 22008217

17. Atkins D, Best D, Briss PA, Eccles M, Falck-Ytter Y, Flottorp S, et al. Grading quality of evidence and strength of recommendations. BMJ. 2004; 328: 1490. doi: 10.1136/bmj.328.7454.1490 15205295

18. Giesche F, Streicher H, Maiwald M, Wagner P. [Inpatient multimodal pain therapy. Additive value of neuromuscular core stability exercises for chronic back pain]. Schmerz. 2017; 31: 115–122.

19. Unsgaard-Tøndel M, Fladmark AM, Salvesen Ø, Vasseljen O, Unsgaard-Tondel M, Salvesen O. Motor control exercises, sling exercises, and general exercises for patients with chronic low back pain. A randomized controlled trial with 1-year follow-up. Phys Ther. 2010; 90: 1426–1440. doi: 10.2522/ptj.20090421 20671099

20. Bae C-R, Jin Y, Yoon B-C, Kim N-H, Park K-W, Lee S-H. Effects of assisted sit-up exercise compared to core stabilization exercise on patients with non-specific low back pain. A randomized controlled trial. J Back Musculoskelet Rehabil. 2018; 31: 871–880. doi: 10.3233/BMR-170997 29889057

21. Critchley DJ, Ratcliffe J, Noonan S, Jones RH, Hurley MV. Effectiveness and cost-effectiveness of three types of physiotherapy used to reduce chronic low back pain disability. A pragmatic randomized trial with economic evaluation. Spine (Phila Pa 1976). 2007; 32: 1474–1481. doi: 10.1097/BRS.0b013e318067dc26 17572614

22. Ferreira ML, Ferreira PH, Latimer J, Herbert RD, Hodges PW, Jennings MD, et al. Comparison of general exercise, motor control exercise and spinal manipulative therapy for chronic low back pain. A randomized trial. Pain. 2007; 131: 31–37. doi: 10.1016/j.pain.2006.12.008 17250965

23. Macedo LG, Latimer J, Maher CG, Hodges PW, McAuley JH, Nicholas MK, et al. Effect of Motor Control Exercises Versus Graded Activity in Patients With Chronic Nonspecific Low Back Pain. A Randomized Controlled Trial. Phys Ther. 2012; 92: 363–377. doi: 10.2522/ptj.20110290 22135712

24. Marshall PWM, Kennedy S, Brooks C, Lonsdale C. Pilates exercise or stationary cycling for chronic nonspecific low back pain. Does it matter? A randomized controlled trial with 6-month follow-up. Spine (Phila Pa 1976). 2013; 38: E952–9. doi: 10.1097/BRS.0b013e318297c1e5 23615384

25. Rasmussen-Barr E, Nilsson-Wikmar L, Arvidsson I. Stabilizing training compared with manual treatment in sub-acute and chronic low-back pain. MANUAL THERAPY. 2003; 8: 233–241. doi: 10.1016/s1356-689x(03)00053-5 14559046

26. Rasmussen-Barr E, Ang B, Arvidsson I, Nilsson-Wikmar L, Äng B. Graded Exercise for Recurrent Low-Back Pain A Randomized, Controlled Trial With 6-, 12-, and 36-Month Follow-ups. Spine (Phila Pa 1976). 2009; 34: 221–228. doi: 10.1097/BRS.0b013e318191e7cb 19179916

27. Kofotolis N, Kellis E, Vlachopoulos SP, Gouitas I, Theodorakis Y. Effects of Pilates and trunk strengthening exercises on health-related quality of life in women with chronic low back pain. J Back Musculoskelet Rehabil. 2016; 29: 649–659. doi: 10.3233/BMR-160665 26922845

28. Gutknecht M, Mannig A, Waldvogel A, Wand BM, Luomajoki H. The effect of motor control and tactile acuity training on patients with non-specific low back pain and movement control impairment. J Bodyw Mov Ther. 2015; 19: 722–731. doi: 10.1016/j.jbmt.2014.12.003 26592230

29. Lin I, Wiles L, Waller R, Goucke R, Nagree Y, Gibberd M, et al. What does best practice care for musculoskeletal pain look like? Eleven consistent recommendations from high-quality clinical practice guidelines: systematic review. Br J Sports Med. 2019. doi: 10.1136/bjsports-2018-099878 30826805

30. Sharan D, Rajkumar JS, Mohandoss M, Ranganathan R. Myofascial low back pain treatment. Curr Pain Headache Rep. 2014; 18: 449. doi: 10.1007/s11916-014-0449-9 25091133

31. Egan M, Seeger D, Schöps P. Physiotherapie und physikalische Therapie in der Schmerzmedizin. Schmerz. 2015; 29: 562–568. doi: 10.1007/s00482-015-0043-z

32. Cuijpers P, van Straten A, Bohlmeijer E, Hollon SD, Andersson G. The effects of psychotherapy for adult depression are overestimated: a meta-analysis of study quality and effect size. Psychol Med. 2010; 40: 211–223. doi: 10.1017/S0033291709006114 19490745

33. Bell JA, Burnett A. Exercise for the primary, secondary and tertiary prevention of low back pain in the workplace: a systematic review. J Occup Rehabil. 2009; 19: 8–24. doi: 10.1007/s10926-009-9164-5 19219537

34. Niederer D, Vogt L, Banzer W. Physical activity, training and exercise in the prevention of low back pain: a focus review with special emphasis on motor control. Dtsch Z Sportmed. 2018; 2018: 262–266. doi: 10.5960/dzsm.2018.321

35. Niederer D, Vogt L, Wippert P-M, Puschmann A-K, Pfeifer A-C, Schiltenwolf M, et al. Medicine in spine exercise (MiSpEx) for nonspecific low back pain patients: study protocol for a multicentre, single-blind randomized controlled trial. Trials. 2016; 17: 507. doi: 10.1186/s13063-016-1645-1 27765058

36. O’Sullivan PB, Phyty GD, Twomey LT, Allison GT. Evaluation of specific stabilizing exercise in the treatment of chronic low back pain with radiologic diagnosis of spondylolysis or spondylolisthesis. Spine (Phila Pa 1976). 1997; 22: 2959–2967. doi: 10.1097/00007632-199712150-00020 9431633


Článek vyšel v časopise

PLOS One


2020 Číslo 1