OBJECTIVE: The purpose of this review was to compare the efficacy of motor control exercises (MCE) to strengthening exercises for adults with upper or lower extremity musculoskeletal disorders (MSKDs). METHODS: Electronic searches were conducted up to April 2020 in Medline, Embase, Cochrane CENTRAL and CINAHL. Randomized controlled trials (RCTs) were identified on the efficacy of MCE compared to strengthening exercises for adults with upper or lower extremity MSKDs. Data were extracted with a standardized form that documented the study characteristics and results. For pain and disability outcomes, pooled mean differences (MD) and standardized mean differences (SMD) were calculated using random-effects inverse variance models. RESULTS: Twenty-one RCTs (n = 1244 participants) were included. Based on moderate quality evidence, MCE leads to greater pain (MD -0.41 out of 10 points; 95% CI -0.72 to -0.10; n = 626) and disability reductions (SMD -0.28; 95% CI -0.43 to -0.13; n = 713) when compared to strengthening exercises in the short term; these differences are not clinically important. When excluding trials on osteoarthritis (OA) participants and evaluating only the trials involving participants with rotator cuff-related shoulder pain, shoulder instability, hip-related groin pain or patellofemoral pain syndrome, there is moderate quality evidence that MCE leads to greater pain (MD -0.74 out of 10 points; 95% CI -1.22 to -0.26; n = 293) and disability reductions (SMD -0.40; 95% CI -0.61 to -0.19; n = 354) than strengthening exercises in the short term; these differences might be clinically important. CONCLUSIONS: MCE leads to statistically greater pain and disability reductions when compared to strengthening exercises among adults with MSKDs in the short term, but these effects might be clinically important only in conditions that do not involve osteoarthritis. Inclusion of new trials might modify these conclusions. IMPACT: These results suggest that MCE could be prioritized over strengthening exercises for adults with the included non-osteoarthritis MSKDs; however, results are unclear for OA disorders.

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