Influence of isostretching on patients with chronic low back pain. A randomized controlled trial

Effectiveness of Isostretching on Pain and Disability in Individuals Diagnosed With Low Back Pain: A Systematic Review of Randomized Clinical Trials

OBJECTIVE

To systematically review the evidence on the effectiveness of Isostretching on pain, physical function and quality of life in individuals with Low Back Pain (LBP).

DATA SOURCES

We searched the following databases until November 11, 2024: PubMed, Embase, Cochrane CENTRAL, CINAHL, PEDro, Virtual Health Library Regional Portal, Scopus, Web of Science, SportDiscus and Rehabilitation and Sports Medicine. PRISMA-S was used to strengthen the reporting quality of our search strategy.

METHODS

This review followed the PRISMA checklist. Randomized clinical trials that investigated the effects of Isostretching against any control intervention in individuals with non-specific LBP were eligible. Literature screening and data extraction were performed independently by the authors. The PEDro scale, the GRADE approach and the TIDier checklist were used to assess the risk of bias, quality of the evidence and reporting quality of the intervention, respectively. Results were analysed and synthesised narratively.

RESULTS

Five articles were included (pooled n = 155). Only adults (76% female) between 19 and 60 years were included. The PEDro score ranged from 2-8 points (mean of 5.6). Very-low quality evidence suggests that isostretching may reduce pain and improve functional capacity in the short term when compared with no intervention. Also, very-low quality evidence suggests that isostretching is not superior to any active intervention to reduce pain and improve functional capacity and quality of life. The mean number of reported TIDier items was 6.4.

CONCLUSION

This review supports Isostretching to reduce pain and improve physical function and quality of life in patients with non-specific LBP.

Evaluation of Trunk Mobility in Spanish High-Level National Rhythmic Gymnastics Athletes with Low Back Pain: A Randomized Controlled Trial Comparing the Mézières Method and Isostretching Postures

Background/Objectives: Postural therapies have emerged as effective non-invasive approaches to managing and preventing LBP in athletes. These therapies focus on correcting muscular imbalances, enhancing body awareness, and promoting proper alignment. Therefore, the objective of this study was to evaluate the effectiveness of implementing the Mézières method and isostretching postures in Spanish high-level national rhythmic gymnasts with low back pain (LBP). Specifically, the study aims to assess the impact of these postural therapies on functional limitations associated with LBP. Methods: This study was a parallel group, randomized controlled trial implemented in 17 rhythmic gymnastics athletes with low back pain conducted at baseline, at 2, 4, and 6 weeks, and upon completion of the 12-week intervention period. The outcome measures included pain measurement, the Borg effort scale, and trunk movement as flexion, extension, inclination, and rotation assessed using a wearable device sensor. Results: The trial included eight participants in the Mézières group and nine in the isostretching group, with no significant age difference between the groups (p = 0.589). Significant differences were found for time (p = 0.000) and group (p = 0.001), indicating variations in left trunk inclination performance over time and between the groups. Both groups showed increased trunk flexion, with the Mézières group demonstrating higher values at all time points. Right trunk rotation fluctuated, with a notable increase in the Mézières group at 6 weeks. The Mézières group also showed higher left trunk rotation values, peaking at 6 weeks. Conclusions: Although the Mézières method showed certain advantages in right trunk rotation and left tilt, the results overall suggest that both approaches are effective in the specific context of this population.

Prognostic Factors in Patients Undergoing Physiotherapy for Chronic Low Back Pain: A Level I Systematic Review

Background: Low back pain is common. For patients with mechanic or non-specific chronic LBP (cLBP), the current guidelines suggest conservative, nonpharmacologic treatment as a first-line treatment. Among the available strategies, physiotherapy represents a common option offered to patients presenting with cLBP. The present systematic review investigates the prognostic factors of patients with mechanic or non-specific cLBP undergoing physiotherapy. Methods: In September 2024, the following databases were accessed: PubMed, Web of Science, Google Scholar, and Embase. All the randomised controlled trials (RCTs) which evaluated the efficacy of a physiotherapy programme in patients with LBP were accessed. All studies evaluating non-specific or mechanical LBP were included. Data concerning the following PROMs were collected: the pain scale, Roland Morris Disability Questionnaire (RMQ), and Oswestry Disability Index (ODI). A multiple linear model regression analysis was conducted using the Pearson Product-Moment Correlation Coefficient. Results: Data from 2773 patients were retrieved. The mean length of symptoms before the treatment was 61.2 months. Conclusions: Age and BMI might exert a limited influence on the outcomes of the physiotherapeutic management of cLBP. Pain and disability at baseline might represent important predictors of health-related quality of life at the six-month follow-up. Further studies on a larger population with a longer follow-up are required to validate these results.

Physiotherapeutic and non-conventional approaches in patients with chronic low-back pain: a level I Bayesian network meta-analysis

Chronic low back pain (cLBP) is a major cause of disability and healthcare expenditure worldwide. Its prevalence is increasing globally from somatic and psychosocial factors. While non-pharmacological management, and in particular physiotherapy, has been recommended as a first-line treatment for cLBP, it is not clear what type of physiotherapeutic approach is the most effective in terms of pain reduction and function improvement. This analysis is rendered more difficult by the vast number of available therapies and a lack of a widely accepted classification that can effectively highlight the differences in the outcomes of different management options. This study was conducted according to the PRISMA guidelines. In January 2024, the following databases were accessed: PubMed, Web of Science, Google Scholar, and Embase. All the randomised controlled trials (RCTs) which compared the efficacy of physiotherapy programs in patients with cLBP were accessed. Studies reporting on non-specific or mechanical cLPB were included. Data concerning the Visual Analogic Scale (VAS) or numeric rating scale (NRS), Roland Morris Disability Questionnaire (RMQ) and Oswestry Disability Index (ODI). Data from 12,773 patients were collected. The mean symptom duration was 61.2 ± 51.0 months and the mean follow-up was 4.3 ± 5.9 months. The mean age was 44.5 ± 9.4 years. The mean BMI was 25.8 ± 2.9 kg/m2. The Adapted Physical Exercise group evidenced the lowest pain score, followed by Multidisciplinary and Adapted Training Exercise/Complementary Medicine. The Adapted Physical Exercise group evidenced the lowest RMQ score followed by Therapeutic Exercises and Multidisciplinary. The Multidisciplinary group evidenced the lowest ODI score, followed by Adapted Physical Exercise and Physical Agent modalities. Within the considered physiotherapeutic and non-conventional approaches to manage nonspecific and/or mechanic cLBP, adapted physical exercise, physical agent modalities, and a multidisciplinary approach might represent the most effective strategy to reduce pain and disability.

Systematic Review to Inform a World Health Organization (WHO) Clinical Practice Guideline: Benefits and Harms of Structured Exercise Programs for Chronic Primary Low Back Pain in Adults

PURPOSE

Evaluate benefits and harms of structured exercise programs for chronic primary low back pain (CPLBP) in adults to inform a World Health Organization (WHO) standard clinical guideline.

METHODS

We searched for randomized controlled trials (RCTs) in electronic databases (inception to 17 May 2022). Eligible RCTs targeted structured exercise programs compared to placebo/sham, usual care, or no intervention (including comparison interventions where the attributable effect of exercise could be isolated). We extracted outcomes, appraised risk of bias, conducted meta-analyses where appropriate, and assessed certainty of evidence using GRADE.

RESULTS

We screened 2503 records (after initial screening through Cochrane RCT Classifier and Cochrane Crowd) and 398 full text RCTs. Thirteen RCTs rated with overall low or unclear risk of bias were synthesized. Assessing individual exercise types (predominantly very low certainty evidence), pain reduction was associated with aerobic exercise and Pilates vs. no intervention, and motor control exercise vs. sham. Improved function was associated with mixed exercise vs. usual care, and Pilates vs. no intervention. Temporary increased minor pain was associated with mixed exercise vs. no intervention, and yoga vs. usual care. Little to no difference was found for other comparisons and outcomes. When pooling exercise types, exercise vs. no intervention probably reduces pain in adults (8 RCTs, SMD = - 0.33, 95% CI - 0.58 to - 0.08) and functional limitations in adults and older adults (8 RCTs, SMD = - 0.31, 95% CI - 0.57 to - 0.05) (moderate certainty evidence).

CONCLUSIONS

With moderate certainty, structured exercise programs probably reduce pain and functional limitations in adults and older people with CPLBP.

Physical activity and education about physical activity for chronic musculoskeletal pain in children and adolescents

BACKGROUND

Chronic pain is a major health and socioeconomic burden, which is prevalent in children and adolescents. Among the most widely used interventions in children and adolescents are physical activity (including exercises) and education about physical activity.

OBJECTIVES

To evaluate the effectiveness of physical activity, education about physical activity, or both, compared with usual care (including waiting-list, and minimal interventions, such as advice, relaxation classes, or social group meetings) or active medical care in children and adolescents with chronic musculoskeletal pain.

SEARCH METHODS

We searched CENTRAL, MEDLINE, Embase, CINAHL, PsycINFO, PEDro, and LILACS from the date of their inception to October 2022. We also searched the reference lists of eligible papers, ClinicalTrials.gov, and the World Health Organization (WHO) International Clinical Trials Registry Platform.

SELECTION CRITERIA

We included randomised controlled trials (RCTs) that compared physical activity or education about physical activity, or both, with usual care (including waiting-list and minimal interventions) or active medical care, in children and adolescents with chronic musculoskeletal pain.

DATA COLLECTION AND ANALYSIS

Two review authors independently determined the eligibility of the included studies. Our primary outcomes were pain intensity, disability, and adverse events. Our secondary outcomes were depression, anxiety, fear avoidance, quality of life, physical activity level, and caregiver distress. We extracted data at postintervention assessment, and long-term follow-up. Two review authors independently assessed risk of bias for each study, using the RoB 1. We assessed the overall certainty of the evidence using the GRADE approach. We reported continuous outcomes as mean differences, and determined clinically important differences from the literature, or 10% of the scale.

MAIN RESULTS

We included four studies (243 participants with juvenile idiopathic arthritis). We judged all included studies to be at unclear risk of selection bias, performance bias, and detection bias, and at high risk of attrition bias. We downgraded the certainty of the evidence for each outcome to very low due to serious or very serious study limitations, inconsistency, and imprecision. Physical activity compared with usual care Physical activity may slightly reduce pain intensity (0 to 100 scale; 0 = no pain) compared with usual care at postintervention (standardised mean difference (SMD) -0.45, 95% confidence interval (CI) -0.82 to -0.08; 2 studies, 118 participants; recalculated as a mean difference (MD) -12.19, 95% CI -21.99 to -2.38; I² = 0%; very low-certainty evidence). Physical activity may slightly improve disability (0 to 3 scale; 0 = no disability) compared with usual care at postintervention assessment (MD -0.37, 95% CI -0.56 to -0.19; I² = 0%; 3 studies, 170 participants; very low-certainty evidence). We found no clear evidence of a difference in quality of life (QoL; 0 to 100 scale; lower scores = better QoL) between physical activity and usual care at postintervention assessment (SMD -0.46, 95% CI -1.27 to 0.35; 4 studies, 201 participants; very low-certainty evidence; recalculated as MD -6.30, 95% CI -18.23 to 5.64; I² = 91%). None of the included studies measured adverse events, depression, or anxiety for this comparison. Physical activity compared with active medical care We found no studies that could be analysed in this comparison. Education about physical activity compared with usual care or active medical care We found no studies that could be analysed in this comparison. Physical activity and education about physical activity compared with usual care or active medical care We found no studies that could be analysed in this comparison.

AUTHORS' CONCLUSIONS

We are unable to confidently state whether interventions based on physical activity and education about physical activity are more effective than usual care for children and adolescents with chronic musculoskeletal pain. We found very low-certainty evidence that physical activity may reduce pain intensity and improve disability postintervention compared with usual care, for children and adolescents with juvenile idiopathic arthritis. We did not find any studies reporting educational interventions; it remains unknown how these interventions influence the outcomes in children and adolescents with chronic musculoskeletal pain. Treatment decisions should consider the current best evidence, the professional's experience, and the young person's preferences. Further randomised controlled trials in other common chronic musculoskeletal pain conditions, with high methodological quality, large sample size, and long-term follow-up are urgently needed.

Best Exercise Options for Reducing Pain and Disability in Adults With Chronic Low Back Pain: Pilates, Strength, Core-Based, and Mind-Body. A Network Meta-analysis

OBJECTIVE

To determine which type of exercise is best for reducing pain and disability in adults with chronic low back pain (LBP).

DESIGN

Systematic review with a network meta-analysis (NMA) of randomized controlled trials (RCTs).

LITERATURE SEARCH

Six electronic databases were systematically searched from inception to July 2021.

STUDY SELECTION CRITERIA

RCTs testing the effects of exercise on reducing self-perceived pain or disability in adults (aged 18-65 years) with chronic LBP.

DATA SYNTHESIS

We followed the PRISMA-NMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses, incorporating NMAs of health care interventions) statement when reporting our NMA. A frequentist NMA was conducted. The probability of each intervention being the most effective was conducted according to surface under the cumulative ranking curve (SUCRA) values.

RESULTS

We included 118 trials (9710 participants). There were 28 head-to-head comparisons, 7 indirect comparisons for pain, and 8 indirect comparisons for disability. Compared with control, all types of physical exercises were effective for improving pain and disability, except for stretching exercises (for reducing pain) and the McKenzie method (for reducing disability). The most effective interventions for reducing pain were Pilates, mind-body, and core-based exercises. The most effective interventions for reducing disability were Pilates, strength, and core-based exercises. On SUCRA analysis, Pilates had the highest likelihood for reducing pain (93%) and disability (98%).

CONCLUSION

Although most exercise interventions had benefits for managing pain and disability in chronic LBP, the most beneficial programs were those that included (1) at least 1 to 2 sessions per week of Pilates or strength exercises; (2) sessions of less than 60 minutes of core-based, strength, or mind-body exercises; and (3) training programs from 3 to 9 weeks of Pilates and core-based exercises. J Orthop Sports Phys Ther 2022;52(8):505-521. Epub: 19 June 2022. doi:10.2519/jospt.2022.10671.