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Motor control stabilisation exercise for patients with non-specific low back pain: a prospective meta-analysis with multilevel meta-regressions on intervention effects |
Niederer D, Engel T, Vogt L, Arampatzis A, Banzer W, Beck H, Catala MM, Brenner-Fliesser M, Guthoff C, Haag T, Honning A, Pfeifer AC, Platen P, Schiltenwolf M, Schneider C, Trompeter K, Wippert PM, Mayer F |
Journal of Clinical Medicine 2020 Sep;9(9):3058 |
systematic review |
Low-to-moderate quality meta-analytic evidence shows that motor control stabilisation exercise (MCE) is an effective treatment of non-specific low back pain. A possible approach to overcome the weaknesses of traditional meta-analyses would be that of a prospective meta-analyses. The aim of the present analysis was to generate high-quality evidence to support the view that motor control stabilisation exercises (MCE) lead to a reduction in pain intensity and disability in non-specific low back pain patients when compared to a control group. In this prospective meta-analysis and sensitivity multilevel meta-regression within the MiSpEx-Network, 18 randomized controlled study arms were included. Participants with non-specific low back pain were allocated to an intervention (individualized MCE, 12 weeks) or a control group (no additive exercise intervention). From each study site/arm, outcomes at baseline, 3 weeks, 12 weeks, and 6 months were pooled. The outcomes were current pain (NRS or VAS, 11 points scale), characteristic pain intensity, and subjective disability. A random effects meta-analysis model for continuous outcomes to display standardized mean differences between intervention and control was performed, followed by sensitivity multilevel meta-regressions. Overall, 2,391 patients were randomized; 1,976 (3 weeks, short-term), 1,740 (12 weeks, intermediate), and 1,560 (6 months, sustainability) participants were included in the meta-analyses. In the short-term, intermediate and sustainability, moderate-to-high quality evidence indicated that MCE has a larger effect on current pain (SMD -0.15, -0.15 to -0.19), pain intensity (SMD -0.19, -0.26 to -0.26) and disability (SMD -0.15, -0.27 to -0.25) compared with no exercise intervention. Low-quality evidence suggested that those patients with comparably intermediate current pain and older patients may profit the most from MCE. Motor control stabilisation exercise is an effective treatment for non-specific low back pain. Sub-clinical intermediate pain and middle-aged patients may profit the most from this intervention.
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