Background
Aims of this review
Methods
Data sources
Study selection: inclusion and exclusion criteria
Types of outcome measures
Data extraction
Assessment of method quality
Data synthesis and analysis
Results
Search yield
Quality assessment
PEDro criteria* | Akbari 2008 | Da Fonesca 2009 | Ferreira 2010 | Haugstad 2006 | Hides 1996&2001 | Lalanne 2009 | Magnussen 2008 | Mannion 1999&2001 | Marshall 2008 | O’Sullivan 1997&1998 | Ritaven 2007 | Vasseljen 2010 , 2012 & Unsgaard-Tonsel 2010 |
---|---|---|---|---|---|---|---|---|---|---|---|---|
1. Eligibility criteria were specified | ✓ | ✓ | X | ✓ | ✓ | X | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
2. Random allocation of subjects | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
3. Allocation was concealed | X | X | X | X | ✓ | X | X | X | X | ✓ | ✓ | ✓ |
4. Groups similar at baseline | ✓ | X | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
5. There was blinding of all subjects | X | X | X | X | X | X | X | X | X | X | X | X |
6. Blinding of therapists | X | X | X | ✓ | X | X | X | X | X | X | X | X |
7. Blinding of assessors | ✓ | X | ✓ | ✓ | ✓ | X | X | X | X | ✓ | ✓ | ✓ |
8. >1 key outcome was obtained for more than 85% of subjects initially allocated to groups | X | ✓ | ✓ | X | ✓ | X | X | ✓ | ✓ | ✓ | ✓ | ✓ |
9. All subjects … received the treatment or control condition as allocated or, where this was not the case, data for at least one key outcome was analysed by ‘intention to treat’ | X | ✓ | X | X | X | X | X | X | X | X | X | ✓ |
10. The results of between-group statistical comparisons are reported for at least one key outcome | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ | ✓ |
11. The study provides both point measures and measures of variability for at least one key outcome | X | ✓ | ✓ | ✓ | ✓ | ✓ | X | ✓ | ✓ | ✓ | ✓ | ✓ |
Total score | 4 | 5 | 6 | 6 | 7 | 4 | 3 | 5 | 5 | 7 | 7 | 8 |
Assessor | PEDro | RL &PK | PEDro | PEDro | PEDro | PEDro | PEDro | PEDro | PEDro | PEDro | PEDro | RL &PK |
Types of trials found
Type of pattern | Author | Components of movement pattern assessed | Measurement details | Health outcomes | ||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|---|---|
TA thickness | TA slide | TA + IO timing | LM thickness | Ratio muscle activitiy | FRR | Movement | Posture | Method of measurement | Characteristics of movement pattern measured | Pain | Activity limitation | |||
Muscle activation patterns
|
Specific muscle activity
|
Akbari 2008
Motor control vs general exercise
| ✓ | ✓ | Ultrasound | Muscle size - thickness at rest (mm) | ✓ | |||||||
Hides 1996 & 2001
Motor control exercise vs medical treatment
| ✓ | Ultrasound | Muscle size – cross sectional area (mm2) | ✓ | ||||||||||
Ferreira 2010 motor control exercise vs general ex vs spinal manipulative therapy | ✓ | Ultrasound | Muscle thickness -% change from resting thickness | ✓ | ✓ | |||||||||
Marshall 2008
Swiss ball vs general exercise
| ✓ | Surface EMG | Feed forward activation | ✓ | ✓ | |||||||||
O’Sullivan 1997
Motor control vs GP management
| ✓ | Surface EMG | Internal Oblique and Rectus Abdominus electrical acitivity & ratio | ✓ | ✓ | |||||||||
Vasseljen 2010, 2012 & Unsgaard-Tonsel 2010
Motor control (low load) vs motor control (high load) vs general exercise
| ✓ | ✓ | Ultrasound | Size of muscle on contraction vs size of muscle at rest (ratio), Lateral slide (mm) | ✓ | ✓ | ||||||||
Flexion relaxation response
|
Lalanne 2009
Manipulation vs manual therapy
| ✓ | ✓ | Surface EMG and Optoelectronic recording | Angle and intensity of onset and cessation of electrical activity | ✓ | ✓ | |||||||
Mannion 1999 & 2001
Physiotherapy vs aerobics vs devices
| ✓ | Surface EMG | Intensity, onset and cessation of electrical activity | ✓ | ✓ | |||||||||
Marshall 2008
Swiss ball vs general exercise
| ✓ | Surface EMG | Intensity, onset and cessation of electrical activity | ✓ | ✓ | |||||||||
Ritvanen 2007
Traditional bone setting vs physiotherapy
| ✓ | Surface EMG | Intensity, onset and cessation of electrical activity | ✓ | ✓ | |||||||||
Movement patterns
|
Da Fonesca 2009
Pilates vs no Pilates control
| ✓ | Force plate and treadmill | Gait related forces and rates | ✓ | |||||||||
Magnusson 2008
Postural biofeedback vs standardized rehab
| ✓ | Triaxial computerised goniometer | Circumduction area and velocity | ✓ | ✓ | |||||||||
Postural patterns
|
Haugstad 2006 & 2008
Mensendieck therapy vs standard gynaelogical treatment
| ✓ | Visual observation | Posture, upper and lower limb movement, gait, sitting posture and respiration | ✓ | ✓ |
Trials measuring muscle activity patterns - intervention effects
Muscle activity patterns (specific muscle activity) | |||||||||||
---|---|---|---|---|---|---|---|---|---|---|---|
Study and intervention type (experimental vs comparison) | Movement pattern characteristics assessed Was there a statistically significant difference (p < 0.05) in physical parametersbetweengroups at the end of the intervention period?(blank cell = not measured)
| ||||||||||
No. of Subjects
| TA thickness | TA slide* | TA & IO feedfoward timing | Multifidus (LM) thickness | Ratio of specific muscle activitiy |
Baseline differences between groups?
| SMD and 95%CIs (negative values favour experimental/motor control group)
| Pain | Activity | SMD and 95%CIs (negative values favour experimental group)
| |
Akbari 2008
Motor control exercise vs general exercise
| 49 |
No
|
No
| No (TA & LM) Pain: Yes‡ Activity: Yes‡
| Multifidus thickness −0.21 (−0.74 to 0.33) TA thickness −0.30 (−0.86 to 0.26) |
Yes
‡
|
Yes
‡
| Pain −1.06 (−1.66 to −0.46) Activity −0.70 (−1.27 to −0.12) | |||
Hides 1996
Motor control exercise vs control
| 39 |
Yes
†,||
| Insufficient data | Insufficient data |
No
†
|
No
†
| Insufficient data | ||||
Ferreira 2010
Motor control exercise(MCE) vs general ex (GE) vs spinal manipulative therapy (SMT)
|
34
|
Yes
††
|
No
| TA thickness ratio (contraction vs rest) MCE vs GE −0.29 (−0.44 to 0.57)†† MCE vs SMT −0.70 (−0.42 to 0.12)††
|
No
|
No
| Pain −0.32 (−0.44 to 0.54) MCE vs GE −0.51 (−0.42 to 0.30)MCE vs SMT Activity −0.25 (−1.11 to 0.61)MCE vs GE −0.63 (−0.42 to 0.19)MCE vs SMT | ||||
Marshall 2008
Swiss ball vs general exercise
| 50 |
No
| No | Right feedforward activation of TA + IO −0.77 (−1.59 to 0.04 ) Left feedforward activation of TA + IO −0.46 (−1.25 to 0.34) |
No
|
Yes
| Activity −0.77 (−1.34 to −0.19) | ||||
O’Sullivan 1997
Motor control exercise vs general exercise
| 44 |
Yes
| No | Ratio of TA + IO to RA −0.84 (−1.47 to −0.21) |
Yes
|
No** | Pain −1.29 (−1.96 to −0.62) Activity −0.56 (−1.18 to 0.06) | ||||
Vasseljen 2010, 2012 & Unsgaard-Tonsel 2010
Motor control (ultrasound guided exercise (US)) vs motor control (high load, sling exercise (SE)) vs general exercise (GE)
| 109 |
No
|
No
|
No
| No§
| TA slide* 0.47 (−0.18 to 0.75) TA thickness ratio (contraction vs rest)#: TA 0.16 (−0.53 to 0.85) US vs GE IO 0.13 (−0.55 to 0.80) US vs GE EO 0.23 (−0.48 to 0.95) US vs GE TA feedforward timing:§§ Minimal or no effect size for most comparisons No significant feedforward differences of clinical relevance |
No
|
No
| Pain −0.46 (−1.09 to 0.18) US vs GE −0.28 (−0.90 to 0.35) US vs SE Activity −0.54 (−1.16 to 0.10) US vs GE-0.34 -0.98 to 0.30-0.01) US vs SE |
Trials measuring muscle activity patterns - relationship between changes in muscle activity and changes in pain or activity levels
Trials measuring the flexion relaxation response - intervention effects
Trials measuring the FRR - the relationship between changes to muscle activity patterns and changes to pain or activity level
Muscle activity patterns of FRR (electrical patterns of activity in extensor muscles during flexion and return from flexion) (Standardised mean difference and 95% confidence intervals, negative values favour experimental group) | ||||||||
---|---|---|---|---|---|---|---|---|
Study and intervention type | Study details | Movement pattern Was there a statistically significant difference (p > 0.05) in physical parametersbetweengroups? | Health outcomes Was there a statistically significant difference (p < 0.05) in health outcomes between groups? groups? | |||||
No. of subjects |
Baseline differences between groups?
|
FRR* Upper lumbar (T12-L3/4)
|
FRR* Lower lumbar (L4-S1)
|
Angle of onset and cessation for FRR
|
Extension vs flexion EMG ratio
|
Pain
|
Activity
| |
Lalanne 2009
‡
Manipulation vs sham
| 27 | No |
Yes ↑ -1.40 (−2.24, -0.56) |
No
|
No
| Not measured |
No
| Not measured |
Mannion 1999 & 2001
Physiotherapyvs aerobics Physiotherapy vs device strength training
| 99 | No |
No
†
Insufficient data
|
No
†
Insufficient data
| Not measured | Not measured |
No
|
No
|
Marshall 2008
Swiss ball vs general exercise
| 50 | No |
No
|
Yes ↑ FRR in favour of intervention group −1.60 (−2.25, -0.94) | Not measured | Not measured |
No
|
Yes Activity −0.77 (−1.34 to −0.19) |
Ritvanen 2007
Traditional bone setting vs physiotherapy
| 61 | (Intervention group had right vs left differences pre and post treatment) |
No
|
No (both groups showed ↓ FRR post intervention | Not measured |
No Trend towards increase for both groups |
No
|
No
|
Trials measuring lumbo-pelvic kinematics and postural patterns – intervention effects
Trials measuring lumbo-pelvic kinematics and postural patterns – relationship between changes in kinematic and postural patterns, and pain or activity levels
Lumbo-pelvic kinematic and posture patterns (Standardised mean difference and 95% confidence intervals, values favour experimental group) | |||||||||
---|---|---|---|---|---|---|---|---|---|
Study and intervention type | No of subjects | Movement pattern Was there a statistically significant difference (p > 0.05) in physical parametersbetweengroups? | Health outcomes Was there a statistically significant difference (p > 0.05) in health outcomes between groups? | ||||||
Baseline differences between groups? | Movement control | Gait | Standing posture | Respiration | Sitting posture | Pain | Activity | ||
Da Fonesca 2009
(Pilates vs No Rx group
| 17 |
No
| Not measured |
No* | Not measured | Not measured | Not measured |
No −0.61, (−1.59-0.37) | Not measured |
Haugstad 2006
(Mensendieck somatocognitive therapy vs gynaecological management)
| 40 |
No
|
No −0.15 (−1.29,0.98) |
No −0.47 (−1.12,0.17), |
No −0.20 (−0.84,0.44) |
Yes −0.99 (−1.67, -0.31) |
Yes −0.69 (−1.35, -0.03) |
Yes
§ −1.58 (−2.31,-0.85) |
Yes
†
|
Haugstad 2008
(Mensendieck somatocognitive therapy vs gynaecological management) 12-month post intervention from Haugstad 2006
| 38 |
No
|
Yes −1.07 (−1.75,-0.39) |
Yes − 0.89 (−1.56,-0.23) |
No −0.56 (−1.20,0.09)
|
Yes −1.64 (−2.38,-0.91) |
Yes −0.99 (−1.66,-0.31) |
Yes −1.71 (−2.46,-0.97) |
Yes
†
|
Magnusson 2008
(Postural biofeedback vs standardised rehabilitation)
| 47 |
No
|| Insufficient data |
Yes
‡ Insufficient data | Not measured | Not measured | Not measured | Not measured |
Yes −3.45 (−4.8 to −2.1) |
Yes −0.97 (−0.43 to −0.12) |