Abstract
Systematic review with meta-analysis and meta-regression. 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. 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. 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.
Highlights
A multitude of hypothesized and confirmed risk factors for both the onset and chronification of nonspecific low back pain is available in the literature
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
From the 3,415 studies that were initially retrieved, 10 (2 controlled trials (CT) & 8 randomized controlled design (RCT)) on N = 1081 patients were included in the review and analyses
Summary
A multitude of hypothesized and confirmed risk factors for both the onset and chronification of nonspecific low back pain is available in the literature. Target-oriented interventions to improve neuromuscular deficits, in particular sensorimotor training, is one of the most established therapy form in low back pain treatment [4,5]. Proofed in a recent network meta-analysis on the direct comparison of exercise types [9] sensorimotor training is—regarding the outcome pain—one of the most, and—regarding physical function—the most effective active regimens for chronic low back pain treatment. Beyond these short or intermediate-term pre-to-post-intervention effects, motor control exercise is likewise superior to inactivity or minimal intervention in the long-term [5]. 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
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