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01.12.2013 | Research article | Ausgabe 1/2013 Open Access

BMC Medical Research Methodology 1/2013

Effectiveness of Pilates exercise in treating people with chronic low back pain: a systematic review of systematic reviews

Zeitschrift:
BMC Medical Research Methodology > Ausgabe 1/2013
Autoren:
Cherie Wells, Gregory S Kolt, Paul Marshall, Bridget Hill, Andrea Bialocerkowski
Wichtige Hinweise

Electronic supplementary material

The online version of this article (doi:10.​1186/​1471-2288-13-7) contains supplementary material, which is available to authorized users.

Competing interests

There are no financial or non-financial competing interests for any of the authors of this review.

Authors’ contributions

CW designed, conducted, and drafted this systematic review with advice and guidance from AB, GSK, and PM. CW and BM evaluated the level of evidence and methodological quality of systematic reviews. AB acted as the third reviewer to obtain a consensus regarding methodological scores of reviews where there was disagreement. All authors reviewed the content of the manuscript prior to submission for its intellectual content. All authors read and approved the final manuscript.

Abstract

Background

Systematic reviews provide clinical practice recommendations that are based on evaluation of primary evidence. When systematic reviews with the same aims have different conclusions, it is difficult to ascertain which review reported the most credible and robust findings.

Methods

This study examined five systematic reviews that have investigated the effectiveness of Pilates exercise in people with chronic low back pain. A four-stage process was used to interpret findings of the reviews. This process included comparison of research questions, included primary studies, and the level and quality of evidence of systematic reviews. Two independent reviewers assessed the level of evidence and the methodological quality of systematic reviews, using the National Health and Medical Research Council hierarchy of evidence, and the Revised Assessment of Multiple Systematic Reviews respectively. Any disagreements were resolved by a third researcher.

Results

A high level of consensus was achieved between the reviewers. Conflicting findings were reported by the five systematic reviews regarding the effectiveness of Pilates in reducing pain and disability in people with chronic low back pain. Authors of the systematic reviews included primary studies that did not match their questions in relation to treatment or population characteristics. A total of ten primary studies were identified across five systematic reviews. Only two of the primary studies were included in all of the reviews due to different inclusion criteria relating to publication date and status, definition of Pilates, and methodological quality. The level of evidence of reviews was low due to the methodological design of the primary studies. The methodological quality of reviews varied. Those which conducted a meta-analysis obtained higher scores.

Conclusion

There is inconclusive evidence that Pilates is effective in reducing pain and disability in people with chronic low back pain. This is due to the small number and poor methodological quality of primary studies. The Revised Assessment of Multiple Systematic Reviews provides a useful method of appraising the methodological quality of systematic reviews. Individual item scores, however, should be examined in addition to total scores, so that significant methodological flaws of systematic reviews are not missed, and results are interpreted appropriately. (348 words)
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