Background
Methods
Study design
Search strategy
Database | Date Range | Fields |
---|---|---|
Cumulative Index to Nursing and Allied Health Literature (CINAHL) | 1970–2012 | Title, Abstract, or Word in Subject Heading |
Cochrane Library | 1800–2012 | Title, Abstract or Keyword |
Medline | 1928–2012 | Title, Abstract or Keyword |
Physiotherapy Evidence Database (PEDro) | 1928–2012 | Title and Abstract |
Proquest | ||
Medical and Health Complete | 1928–2012 | Title, Abstract, or Subject Heading |
Nursing and Allied Health Source | ||
Research Library | ||
Scopus | 1960–2012 | Title, Abstract, or Keyword |
Sport Discus | 1975–2012 | Title, Abstract, or Keyword |
Web of Science | 1977–2012 | Topic or Title |
Selection procedures
Selection criteria
-
Be identified as a systematic review of 2 or more intervention studies. In a systematic review, a comprehensive search of the literature is undertaken to answer a focused research question; the search strategy, criterion for selection and critical appraisal of literature is defined; quantitative rather than qualitative results are reported and evidence-based inferences are made [16, 17]. Narrative reviews or expert commentaries did not meet inclusion requirements [17].
-
Be published in the English language. For ease of interpretation and access, reviews that were unpublished or published in another language were excluded.
-
Include human participants with chronic low back pain, that is, localised pain in the lumbar region that lasts for more than three months [19]. If reviews only included participants with low back pain lasting less than three months, they were excluded.
-
Assess the effectiveness of Pilates, where the term “Pilates” was used to describe the type of prescribed exercise being investigated. Exercises described as “motor control” or “lumbar stabilisation” did not suffice for Pilates. This is because Pilates may include features in addition to these exercise approaches [11].
-
Use outcome measures to evaluate disability, that is, impairments, activity limitations or participation restrictions according to the International Classification of Health, Functioning, and Disability (ICF) [20]. Pain is considered a functional impairment in the ICF.
Level of evidence
Level | Type of Intervention |
---|---|
I | Systematic Review of Randomised Controlled Trials |
II | Randomised Controlled Trial |
III | Pseudo-Randomised Controlled Trial, Comparative Study with or without Concurrent Controls |
IV | Case Series with either post-test or pre-test/post-test outcomes |
Methodological quality
Systematic Review | R-AMSTAR Scores Per Criterion (/4)* | R-AMSTAR Total (/44) | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
1 | 2 | 3 | 4 | 5 | 6 | 7 | 8 | 9 | 10 | 11 | ||
Aladro-Gonzalvo et al. 2012 [10] | 4 | 4 | 3 | 3 | 4 | 4 | 4 | 4 | 3 | 3 | 2 |
37
|
La Touche et al. (2008) [6] | 3 | 2 | 2 | 1 | 1 | 3 | 3 | 1 | 1 | 1 | 1 |
19
|
Lim et al. (2011) [7] | 4 | 2 | 4 | 3 | 4 | 4 | 3 | 4 | 3 | 3 | 1 |
35
|
Pereira et al. (2012) [8] | 3 | 4 | 4 | 3 | 2 | 2 | 4 | 2 | 4 | 2 | 2 |
32
|
Posadzki et al. (2011) [9] | 3 | 4 | 3 | 4 | 4 | 2 | 3 | 4 | 1 | 1 | 1 |
30
|
* Note:
| ||||||||||||
R-AMSTAR Item
|
Description
| |||||||||||
1. | Was an ‘a priori’ design provided? | |||||||||||
2. | Was there duplicate study selection and data extraction? | |||||||||||
3. | Was a comprehensive literature search performed? | |||||||||||
4. | Was the status of publication (i.e. grey literature) used as an inclusion criterion? | |||||||||||
5. | Was a list of studies (included and excluded) provided? | |||||||||||
6. | Were the characteristics of the included studies provided? | |||||||||||
7. | Was the scientific quality of the included studies assessed and documented? | |||||||||||
8. | Was the scientific quality of the included studies used appropriately in formulating conclusions? | |||||||||||
9. | Were the methods used to combine the findings of studies appropriate? | |||||||||||
10. | Was the likelihood of publication bias (a.k.a. “file drawer” effect) assessed? | |||||||||||
11. | Was the conflict of interest stated? | |||||||||||
R-AMSTAR Score
|
Interpretation
| |||||||||||
1 | Score if satisfied 0 of the criteria [Items 1,2,4,6,10,11] or 0 or 1 of the criteria [Items 3,5, 7–9] | |||||||||||
2 | Score if satisfied 1 of the criteria [Items 1,2,4,6,10,11] or 2 of the criteria [Items 3,5, 7–9] | |||||||||||
3 | Score if satisfied 2 of the criteria [Items 1,2,4,6,10,11] or 3 of the criteria [Items 3,5, 7–9] | |||||||||||
4 | Score if satisfies 3 of the criteria [Items 1,2,4,6,10,11] or 4 of the criteria [Items 3,5, 7–9] |
Data extraction and syntheses
Results
Findings of systematic reviews
Research questions
Systematic Review | Population | Intervention | Comparison | Outcome Measures |
---|---|---|---|---|
1. Aladro-Gonzalvo et al. (2012) [10] | Nonspecific low back pain greater than 6 weeks or recurrent (twice per year) | 60 minute sessions | Usual care, normal exercise or sports, back school exercise+, lumbar stabilisation exercise, massage, physiotherapy |
Pain: MBI–pain, NRS-101, VAS |
1–7 sessions/week |
Disability: ODQ, RMDQ | |||
10 days −12 weeks | ||||
2. La Touche et al. (2008) [6] | Nonspecific low back pain greater than 6 weeks or recurrent (twice/year) | 50–60 minute sessions | Usual care, back school exercise+
|
Pain: NRS–101, RMVAS, VAS |
1–7 sessions/week |
Disability: ODQ, RMDQ | |||
10 days–6 weeks | ||||
3. Lim et al. (2011) [7] | Non specific low back pain of any duration or recurrence rate | 30–60 minute sessions | Usual care, no exercise, back school exercise +, lumbar stabilisation exercise, massage, physiotherapy |
Pain: MBI–pain, NRS-101, RMVAS, VAS |
1–7 sessions/week | ||||
Disability: ODI, ODQ, RMDQ | ||||
10 days–12 weeks | ||||
4. Pereira et al. (2012) [8] | Non specific low back pain of any duration or recurrence rate | 30–60 minute sessions | Usual care, lumbar stabilisation exercise massage, physiotherapy |
Pain: SF-36 Pain, NRS–101, RMVAS, VAS |
1–3 sessions/week | ||||
Disability: ODI, ODQ, RMDQ | ||||
4–8 weeks | ||||
5. Posadzki et al. (2011) [9] | Nonspecific low back pain greater than 6 weeks or recurrent (twice/year); specific low back pain with disc pathology greater than 6 weeks | 15–60 minute sessions | Usual care, back school exercise+
|
Pain: NRS−11, NRS–101, RMVAS, VAS |
1–7 sessions/week |
Disability: ODQ, RMDQ | |||
10 days–12 months |
Included primary studies
Primary Studies | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|
Systematic Reviews
| Donzelli et al. 2006 [27] | Gladwell et al. 2006 [31] | da Fonseca et al. 2009 [26] | Rydeard et al. 2006 [25] | Vad et al. 2007 [30]+
| Anderson 2005 [24]* | Gagnon 2005 [28]* | MacIntyre 2006 [29]* | Quinn 2005 [35]* | O’Brien et al. 2006 [32] ** |
1. Aladro-Gonzalvo et al. 2012 [10] | √ | √ | √ | √ | √ | √ | √ | √ | √ | |
2. La Touche et al. 2008 [6] | √ | √ | √ | |||||||
3. Lim et al. 2011 [7] | √ | √ | √ | √ | √ | √ | √ | |||
4. Pereira et al. 2012 [8] | √ | √ | √ | √ | √ | |||||
5. Posadzki et al. 2011 [9] | √ | √ | √ | √ |
Level of evidence
NHMRC Level of Evidence | Methodological Design | Primary Studies |
---|---|---|
II | Randomised Controlled Trial (n=4) | Anderson (2005) [24]* |
Gagnon (2005) [28]* | ||
MacIntyre (2006) [29]* | ||
Rydeard et al. (2006) [25] | ||
III | Pseudo-Randomised Controlled Trial (n=5) | da Fonseca et al. (2009) [26] |
Gladwell et al. (2006) [31] | ||
O’Brien et al. (2006) [32]** | ||
Quinn (2005) [35]* | ||
Vad et al. (2007) [30] | ||
IV | Parallel Case Series (n=1) | Donzelli et al. (2006) [27] |
Methodological quality
Discussion
Research questions
Included primary studies
Systematic Review | Comparison to Pilates | Pain Levels | Disability |
---|---|---|---|
1. Aladro-Gonzalvo et al. [10] | a) Minimal intervention e.g. no treatment, usual care, exercise | a) Reduction is statistically significant (SMD=−0.44, 95% CI −0.09,–0.80) | a) Reduction is not statistically significant (SMD = −0.28, 95% CI 0.07, –0.62) |
b) Other physiotherapeutic treatment e.g. massage, physiotherapy | b) Reduction is not statistically significant (SMD = 0.14, 95% CI 0.27, –0.56) | b) Reduction is statistically significant (SMD = −0.55, 95% CI −0.08,–1.03) | |
2. La Touche et al. [6] | * Usual care, back school exercise+
| * Reduced | * Reduced |
3. Lim et al. [7] | a) Minimal intervention e.g.no treatment, usual care, massage, physiotherapy | a) Reduction is statistically significant (SMD = −2.72, 95% CI −5.33, –0.11) | a) Reduction is not statistically significant (SMD =−0.74, 95% CI −1.81, 0.33) |
b) Other forms of exercise e.g. back school exercise, lumbar stabilisation | b) Reduction is not statistically significant (SMD =0.03, 95% CI −0.52, 0.58) | b) Reduction is not statistically significant (SMD = −0.41, 95% CI =−0.96, 0.14) | |
4. Pereira et al. [8] | a) Variable treatment e.g. no treatment, usual care, massage, physiotherapy | a) Reduction is not statistically significant (SMD =−1.99, 95% CI –4.35, 0.37) | a) Reduction is not statistically significant (SMD =−1.34, 95% CI –2.80, 0.11) |
b) Lumbar stabilisation exercise | b) Reduction is not statistically significant (SMD =−0.11, 95% CI −0.74, 0.52) | b) Reduction is not statistically significant (SMD =−0.31, 95% CI −1.02, 0.40) | |
5. Posadzki et al. [9] | * Usual care, back school exercise | * Unknown, evidence is inconclusive | * Unknown, evidence is inconclusive |