Comparing the Pilates method with no exercise or lumbar stabilization for pain and functionality in patients with chronic low back pain: systematic review and meta-analysis

The effect of pelvic clock exercises on pain reduction and lumbopelvic proprioception in middle-aged women with chronic nonspecific low back pain (CNSLBP)

INTRODUCTION

Low-back pain (LBP) is one of the most common causes of disability in adults. There are many non-invasive interventions to improve this condition, of which the use of exercise therapy is one of the most widely used. But there is contradictory evidence regarding the effectiveness of different types of exercise methods. Therefore, the current research aimed to investigate the effect of pelvic clock exercises on pain reduction and lumbopelvic proprioception in women with chronic nonspecific low back pain (CNSLBP).

MATERIALS AND METHODS

This was a quasi-experimental study with a controlled pre-test-post-test design. The study population included middle-aged women with CNSLBP with an age range of 35-50 years. A total of 30 eligible middle-aged women with CNSLBP were selected using purposive and convenience sampling. The pelvic clock exercise was carried out by the researcher in a gym for eight 45- min sessions each week (three sessions each week). A visual analog scale (VAS) and goniometer were used to measure pain and lumbopelvic proprioception, respectively. However, the control group only participated in the pre-test and post-test stages. For intra-group and inter-group comparisons, paired t-test and independent t-test were used at P < 0.05, respectively.

RESULTS

The results showed that eight-week pelvic clock exercises had an effect on decreased pain and increase lumbopelvic proprioception in middle-aged women with CNSLBP, but no effect was observed in the control group (P > 0.05).

CONCLUSION

According to the results of the present study, pelvic clock exercises should be used as a new and practical method to reduce pain and improve lumbopelvic proprioception in middle-aged women with CNSLBP.

Is Pilates effective in improving depressive disorders? A comprehensive overview

Depressive disorders are disabling conditions that account for high social costs. Pilates demonstrated to have several beneficial effects on health. Objective of this manuscript was to systematically review the literature about the effects of Pilates on depressive disorders. A bibliographic search was conducted in the main database sources (Pubmed, Medline, and Scopus). The inclusion criteria consisted of articles written in English language about the effectiveness of Pilates on depressive symptoms. Most of included studies are randomized controlled trials (10 out of 12). The available literature agrees in indicating that Pilates is effective in improving depressive symptoms especially when compared to inactivity and when this practice is administered for a medium-long period (8-16 weeks). In addition, Pilates seems to have at least comparable effectiveness than aerobic exercise. Pilates can be considered a reliable complementary treatment for people with depressive disorders. These findings should be interpreted considering the different types of practice administered as well as the different duration of the programs or rating scales used to assess mood symptoms. Studies with a more homogenous design are needed to confirm and make generalizable the results presented in this review.

Pilates and multiple health outcomes: an umbrella review

OBJECTIVES

To summarize the evidence of associations between Pilates and multiple health outcomes, and evaluate the strength and validity of these associations.

DESIGN

Unbrella review.

METHODS

PubMed, Embase, Web of Science, and the Cochrane Library were searched from inception to February, 2023. The methodological quality of included studies was assessed using A Measurement Tool to Assess Systematic Reviews, version 2 and the certainty of evidence was graded by the Grading of Recommendation, Assessment, Development and Evaluations. We recalculated each outcome using random-effects models with standardized mean difference.

RESULTS

We identified 27 systematic reviews with meta-analyses in this umbrella review. 1 was rated as high quality, 1 as moderate quality, 15 as low quality, and 10 as critically low quality. These studies focused on the populations with diseases of the circulatory system, endocrine, nutritional or metabolic diseases, genitourinary system diseases, mental, behavioral, or neurodevelopmental disorder, musculoskeletal system diseases, neoplasms, nervous system diseases, sleep-wake function disorder and others. Compared with inactive/active intervention, Pilates can reduce body mass index and body fat percentage, relieve pain and disability, and improve sleep quality and balance. The certainty of evidence was very low to moderate for these outcomes.

CONCLUSIONS

Pilates showed benefits on several health outcomes related with low back pain, neck pain and scoliosis. However, the certainty of the evidence was mostly low; further high quality randomized controlled trials are needed to elucidate and support these promising findings.

Effect of Trunk-Focused Exercises on Pain, Disability, Quality of Life, and Trunk Physical Fitness in Low Back Pain and How Potential Effect Modifiers Modulate Their Effects: A Systematic Review With Meta-analyses

OBJECTIVE: To analyze the effect of trunkfocused exercise programs (TEPs) and moderator factors on chronic nonspecific low back pain (LBP). DESIGN: Systematic review with meta-analyses. LITERATURE SEARCH: We searched the PubMed, Scopus, Embase, SPORTDiscus, and CENTRAL databases from their inception to June 2022. STUDY SELECTION CRITERIA: We included randomized controlled trials comparing TEPs to control or general exercises. DATA SYNTHESIS: We used random-effects models to calculate the standardized mean difference (SMD) plus confidence interval (CI) and heterogeneity (I²) for pain, disability, quality of life, and trunk performance. The impact of moderator factors was analyzed through meta-regression. RESULTS: Forty randomized controlled trials (n = 2391) were included. TEPs showed positive effects for all outcomes versus control (SMD 0.90-2.46; 95% CI, -0.04 to 4.96; I2 61%-98%). There were small effects in favor of TEPs versus general exercises for pain (SMD = 0.20; 95% CI, 0.03-0.37; I² = 13.4%) and disability (SMD = 0.20; 95% CI, 0.02-0.38; I² = 0%). Trunk and/or hip range-of-motion improvements were associated with greater reductions in pain (P<.01; β = 0.56; 95% CI, 0.25-0.87) and disability (P<.01; β = 0.66; 95% CI, 0.27-1.05). Low body mass was associated with higher pain reduction (P = .03; β = -0.17; 95% CI, -0.32 to -0.02). CONCLUSIONS: Trunk-focused exercise programs had positive effects on pain, disability, quality of life, and trunk performance compared to control groups, and on pain and disability compared to general exercises. Increasing trunk and/or hip range of motion was associated with greater pain and disability reduction, and lower body mass with higher pain reduction. J Orthop Sports Phys Ther 2023;53(2):64-93. Epub: 16 January 2023. doi:10.2519/jospt.2023.11091.

Cortical function and sensorimotor plasticity are prognostic factors associated with future low back pain after an acute episode: the Understanding persistent Pain Where it ResiDes prospective cohort study

ABSTRACT

Predicting the development of chronic low back pain (LBP) at the time of an acute episode remains challenging. The Understanding persistent Pain Where it ResiDes study aimed to identify neurobiological and psychological risk factors for chronic LBP. Individuals with acute LBP (N = 120) participated in a prospective cohort study with 6-month follow-up. Candidate predictors were selected from the neurobiological (eg, sensorimotor cortical excitability assessed by sensory and motor-evoked potentials and brain-derived neurotrophic factor genotype), psychological (eg, depression and anxiety), symptom-related (eg, LBP history), and demographic domains. Analyses involved multivariable linear regression models with pain intensity or disability degree as continuous variables. Secondary analyses involved a multivariable logistic model with the presence of LBP at 6 months (thresholding pain intensity and disability degree) as a dichotomous variable. Lower sensory cortex and corticomotor excitability, higher baseline pain intensity, higher depression, stress, and pain catastrophizing were the strongest predictors ( R2 = 0.47) of pain intensity at 6 months. Older age and higher pain catastrophizing were the strongest predictors ( R2 = 0.30) of disability at 6 months. When the LBP outcome was dichotomised, sensory cortex and corticomotor excitability, brain-derived neurotrophic factor genotype, depression and anxiety, LBP history and baseline pain intensity, discriminated between those who did and did not report LBP at 6 months (C-statistic 0.91). This study identifies novel risk factors for the development of future LBP. Neurobiological risk factors, when added to a multivariable linear regression model, explained a further 15% of the variance in the 6-month pain intensity.

Summarizing the effects of different exercise types in chronic low back pain - a systematic review of systematic reviews

Background

In chronic LBP (CLBP), guideline-endorsed treatment is to stay active, return to normal activity, and to exercise. Several reviews on various exercise types used in CLBP have been published. We aimed to identify systematic reviews of common exercise types used in CLBP, to appraise their quality, and to summarize and compare their effect on pain and disability.

Methods

We searched the databases OVID MEDLINE, EMBASE, COCHRANE LIBRARY, and WEB OF SCIENCE (Core collection) for systematic reviews and meta-analyses on adults between 18 and 70 years of age suffering from chronic or recurrent LBP for a period of at least 12 weeks, which investigated the effects of exercises on pain and disability. All searches were conducted without language restriction. The search was performed up until 2022–01-26. The included reviews were grouped into nine exercise types: aerobic training, aquatic exercises, motor control exercises (MCE), resistance training, Pilates, sling exercises, traditional Chinese exercises (TCE), walking, and yoga. The study quality was assessed with AMSTAR-2. For each exercise type, a narrative analysis was performed, and the level of evidence for the effects of exercise was assessed through GRADE.

Results

Our database search resulted in 3,475 systematic reviews. Out of the 253 full texts that were screened, we included 45 systematic reviews and meta-analyses. The quality of the included reviews ranged from high to critically low. Due to large heterogeneity, no meta-analyses were performed. We found low-to-moderate evidence of mainly short-term and small beneficial effects on pain and disability for MCE, Pilates, resistance training, TCE, and yoga compared to no or minimal intervention.

Conclusions

Our findings show that the effect of various exercise types used in CLBP on pain and disability varies with no major difference between exercise types. Many of the included systematic reviews were of low-to-moderate quality and based on randomized controlled trials with high risk of bias. The conflicting results seen, undermine the certainty of the results leading to very-low-to-moderate quality of evidence for our results. Future systematic reviews should be of higher quality to minimize waste of resources.

Trial registration

PROSPERO: Reg no 190409 Registration date 01AUG 2020.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12891-022-05722-x.

The Theoretical Framework of the Clinical Pilates Exercise Method in Managing Non-Specific Chronic Low Back Pain: A Narrative Review

Simple Summary

Exercise is important in helping people with chronic low back pain to regain wellness. General exercises such as cycling and strength training helps with the condition but require a longer time to achieve meaningful improvements in pain and function. Movement preference is potentially useful in exercise and can help an individual to achieve improvements faster. The Clinical Pilates exercise method uses movement preference and thus is a hybrid of two of the best exercise techniques in managing chronic low back pain. However, current studies in Clinical Pilates are lacking and thus challenge the translation of the technique into clinical practice. Hence, a narrative review of the theory of the Clinical Pilates exercise method is examined, and current literature is reviewed to provide a guide towards successful exercise prescription. A structured approach to physical assessment of human movement is proposed to guide clinicians or researchers involved in exercise prescription to design effective exercises. The structured assessment approach also helps with managing clinical cases with multiple episodes of injuries. Despite limited evidence, the Clinical Pilates exercise method is safe and provides faster and earlier recovery and the same longer term outcomes as general exercises.

Abstract

Exercise plays an important role in rehabilitating people with chronic low back pain. Aerobic exercise and resistance training are general exercise strategies to manage chronic low back pain, but these strategies require longer intervention period to achieve clinical outcomes in pain reduction and functional improvements. Directional preference is recognised as an important exercise strategy in managing low back pain. The Clinical Pilates exercise method leverages on the directional preference of an individual to achieve clinical outcomes faster. Clinical Pilates is a hybrid of two of the best exercise interventions for low back pain, which are general Pilates and the McKenzie method. Due to the scarcity of Clinical Pilates literature, a review of its theory and studies was undertaken to provide a structured guide to the technique in managing people with chronic low back pain. Hypothetical algorithms are developed to support translation into clinical practice and future research studies. These algorithms are useful in the management of complex cases involving multiple directional trauma. Although limited, current evidence suggests that the Clinical Pilates exercise method is safe and provides faster functional recovery in the early stage of rehabilitation and similar longer term outcomes as general exercises.

A systematic review of the effectiveness of Pilates on pain, disability, physical function, and quality of life in older adults with chronic musculoskeletal conditions

OBJECTIVES

This systematic review aims to evaluate the effectiveness and delivery of Pilates to reduce pain and disability and to improve physical function and quality of life in middle-aged to older adults with a range of chronic musculoskeletal conditions.

METHODS

Searches were conducted using CENTRAL, CINAHL, SCOPUS, Pubmed, PsycInfo, Web of Science Core Collection and Google Scholar. Inclusion criteria were controlled trials and observational studies, population mean age 50 years and over with chronic musculoskeletal conditions, using mat-based Pilates exercise. Outcomes included pain, disability, physical function and quality of life.

RESULTS

Seven studies were included, with a combined total sample of 397 participants (73% female). Pilates was significantly effective (p ≤ 0.05) for reducing back pain, neck pain and pain associated with knee osteoarthritis and osteoporosis. Additional significant disability, physical functioning and quality of life effects were found for back pain, osteoporosis, and knee OA. Overall Pilates was as effective as other exercise. Adherence to group exercise was good, but poor for home exercise. No significant adverse effects were reported.

CONCLUSION

Pilates is a safe and effective exercise intervention for adults over 50 with a diverse range of musculoskeletal conditions which may otherwise put them at risk of becoming sedentary. Although no overall significant superiority was found over other exercise, participants reported psychosocial benefits particular to the Pilates group exercise, with enjoyment a possible positive factor in adherence. Further research on Pilates exercises for various pathologies could inform teaching and improve engagement with older adults, including those with chronic conditions.

Effects of applied swan pilates motions on upper body muscle activities

BACKGROUND

There have been very few studies involving swan motion during pilates exercises, and there is also insufficient scientific evidence to support the fact that Pilates swan motion strengthens specific muscles.

OBJECTIVES

Firstly, the purpose of this study was to evaluate the effect of 5 types Pilates swan motion (swan basic (SB), swan push-up (SP), swan holding posture (SH), form roller-based swan (SF), and circle-based swan (SC)) on muscle activity of deltoideus p. acromialis (DA), infraspinatus (IP), trapezius (TP), latissimus dorsi (LD), and erector spinae (ES). Secondly, the purpose of this study was to suggest an effective Pilates swan motion for strengthening muscle strength of each targeted muscle.

METHODS

Twenty-four healthy men in their 20s participated and all participants were measured muscle activity in DA, IP, TP, LD, and ES muscles by electromyography (EMG) during 5 Pilates swan motions (SB, SP, SH, SF, & SC). The measured values were expressed as relative voluntary contraction (%RVC) values based on the SB.

RESULTS

The %RVC values representing the muscle activity of DA and TP were significantly higher in SH and SP than in SC, SF, and SB (p < .001). The %RVC values of IP and LD were significantly higher in SH and SC than in SF, SP, and SB (p < .001). The %RVC value of ES was were significantly higher in SH than in SP, SC, SF, and SB (p < .001).

CONCLUSION

The application of SP, SC, and SH Pilates swan motion is an effective method to activate the back muscles of the trunk.

The effect of pilates on metabolic control and oxidative stress of diabetics type 2 - A randomized controlled clinical trial

INTRODUCTION

The Pilates method is an approach to body and mind exercises that has as its foundation the gain of stability, strength and flexibility, and the work of muscular control, posture and breathing, which can generate repercussions on oxidative stress and ROS production, it is expected that Pilates can satisfactorily influence glycemic and oxidative stress reduction in elderly diabetes.

AIM

To analyze the effect of a Pilates protocol on variables indicative of metabolic control and oxidative stress in patients with Type 2 Diabetes Mellitus.

METHOD

Randomized clinical trial in type 2 diabetics enrolled in Hiperdia Parnaíba. A Pilates protocol was performed for 8 weeks, with 2 weekly consultations. The tested variables were: blood glucose, glycated hemoglobin, lipid profile, C-reactive protein and malondialdehyde. ANOVA tests, correlation of Wilcoxon, Friedman and Spearman, were used, with a significance level of 5%.

RESULTS

44 diabetics participated in the study (intervention group: 22; control: 22), with a mean age of 61.23 ± 8.49years, the majority being female (77.3%), married (59.1%), literate (31.8%), with an average BMI of 26.96 ± 4.35 kg/m². When analyzing the effects of the protocol, there was a significant reduction in glycated hemoglobin (p = 0.002) and oxidative stress (p = 0.004) in the intervention group, however, there were no differences in fasting glucose (p = 0.055) and in the profile lipid, expressed by the total cholesterol (p = 0.654), HDL (p = 0.591), LDL (p = 0.564) and triglycerides (0.192). There was a moderate positive correlation between oxidative stress and glycated hemoglobin (r = 0.44, p = 0.000).

CONCLUSION

The exercise protocol based on the Pilates method produced a reduction in glycated hemoglobin and oxidative stress.

The best treatment option(s) for adult and elderly patients with chronic primary musculoskeletal pain: a protocol for a systematic review and network meta-analysis

BACKGROUND

Chronic primary musculoskeletal pain (CPMP) is one subcategory of the new classification of chronic primary pain for the upcoming ICD-11, defined as chronic pain in the muscles, bones, joints, or tendons that persists or recurs for more than 3 months and is associated with significant emotional distress or functional disability. An array of pharmacological, psychological, physical, complementary, and rehabilitative interventions is available for CPMP, for which previous research has demonstrated varying effect sizes with regard to effectiveness in pain reduction and other main outcomes. This highlights the need for the synthesis of all available evidence. The proposed network meta-analysis will compare all available interventions for CPMP to determine the best treatment option(s) with a focus on efficacy and safety of interventions.

METHODS

We are interested in comparing interventions of the following types: psychological, pharmacological, physical, complementary, and rehabilitative interventions. We will include all randomized controlled trials that compare one intervention with another, or with a control group, in the treatment of CPMP. Primary efficacy outcomes will be pain intensity, emotional distress, and functional disability. Safety outcomes extracted will include proportion of patients with treatment-emergent adverse events, unwanted events, or drop-out rates due to side effects. Published and unpublished trials will be sought through the search of all relevant databases and trial registries. At least two independent reviewers of the team will select the references and extract data independently. We will assess the risk of bias of each individual study using the Cochrane risk of bias assessment tool. We will conduct a network meta-analysis to synthesize all evidence for each outcome. We will fit our model primarily within a Bayesian framework.

DISCUSSION

CPMP is a disabling condition for which several interventions exist. To our knowledge, this is the first network meta-analysis to systematically compare all available evidence. This is required by national health institutions to inform their decisions about the best available treatment option(s) with regard to efficacy and safety outcomes.

SYSTEMATIC REVIEW REGISTRATION

PROSPERO CRD42018096114.

Overall confidence in the results of systematic reviews on exercise therapy for chronic low back pain: a cross-sectional analysis using the Assessing the Methodological Quality of Systematic Reviews (AMSTAR) 2 tool

OBJECTIVE

To evaluate the overall confidence in the results of systematic reviews of exercise therapy for chronic non-specific low back pain using the AMSTAR 2 tool.

METHODS

PubMed, Embase, Cochrane Database of Systematic Reviews, PEDro and CINAHL was searched up to February 2017. Two independent reviewers selected systematic reviews of randomized controlled trials that investigated exercise therapy in patients with low back pain. AMSTAR 2 assessment was performed by pairs of reviewers, and the overall confidence in the results of the systematic reviews were rated as 'High', 'Moderate', 'Low' and 'Critically low'. Descriptive analysis was used to summarize the characteristics of included systematic reviews. The percentage of systematic reviews achieving each item from the AMSTAR 2 and the overall confidence in the results were tabulated.

RESULTS

The search identified 38 systematic reviews. Most of the reviews included a median of 10 clinical trials and total sample size of 813 participants per review. Five of 38 (13%) reviews were Cochrane reviews, and 8 (21%) systematic reviews had a protocol published or registered prospectively. The overall confidence in the results of 28 reviews (74%) was rated as 'Critically low', 6 (16%) as 'Low', 1 (2%) as Moderate, while 3 of 38 reviews (8%) were rated as 'High'.

CONCLUSION

The results demonstrate very low confidence in the results of most systematic reviews of exercise in chronic non-specific low back pain. Clinicians are more likely to deliver the most efficacious interventions to patients by critically appraising systematic reviews using AMSTAR 2 before making their decisions.

Core Training in Low Back Disorders: Role of the Pilates Method

The Pilates method is a system of exercises developed by Joseph Pilates, which emphasizes recruitment and strengthening of the core muscles, flexibility, and breathing, to promote stability and control of movement. Its focus bears similarity to current evidence-based exercise programs for low back disorders. Spinal stability is a function of three interdependent systems, osseoligamentous, muscular, and neural control; exercise addresses both the muscular and neural function. The "core" typically refers to the muscular control required to maintain functional stability. Prior research has highlighted the importance of muscular strength and recruitment, with debate over the importance of individual muscles in the wider context of core control. Though developed long before the current evidence, the Pilates method is relevant in this setting and clearly relates to current evidence-based exercise interventions. Current literature supports the Pilates method as a treatment for low back disorders, but its benefit when compared with other exercise is less clear.

The effects of selective Pilates versus extension-based exercises on rehabilitation of low back pain

INTRODUCTION

Chronic non-specific low back pain (LBP) may lead to functional impairment and physical disability. The aim of this study was to compare the effects of selective Pilates (SP) and extension-based (EB) exercises on pain, lumbar spine curvature, lumbar forward flexion range of motion (ROM), and physical disability in such individuals.

MATERIALS AND METHODS

In this randomized clinical trial, Forty-seven patients with chronic non-specific LBP (Mean of age: 39.7 years) were randomly allocated into either SP (N = 16), EB (N = 15), or control (N = 16) groups. The measurements included pain intensity, physical disability, lumbar forward bending ROM, and lumbar spine curvature at the baseline, after receiving the 6-week interventions, and also following one month of cessation of the exercises The analysis of co-variance (ANCOVA) and Post-hoc Bonferroni tests were administered to compare the three groups after the interventions and one month later (P < 0.05).

RESULTS

More significant improvement was observed in SP group compared to the subjects receiving EB exercises in terms of pain, ROM, and physical disability (P < 0.001), however, there was no significant difference between the two experimental groups for lumbar curvature (P > 0.05). Furthermore; in follow-up, the patients in SP group significantly achieved a higher level of pain intensity improvement and lumbar flexion ROM than the EB exercises (P < 0.001).

CONCLUSIONS

It is estimated that core muscles activation and improving lumbopelvic rhythm in SP training may play a role in decreasing pain and physical disability in chronic LBP patients. Further high-quality studies are required to investigate the details of this mechanism.

Comparative effectiveness of lumbar stabilization, dynamic strengthening, and Pilates on chronic low back pain: randomized clinical trial

The aim of the present study was to compare three different forms of exercises namely lumbar stabilization, dynamic strengthening, and Pilates on chronic low back pain (LBP) in terms of pain, range of motion, core strength and function. In this study, 44 subjects suffering from non-specific LBP for more than 3 months were randomly allocated into the lumbar stabilization group, the dynamic strengthening group, and the Pilates group. Ten sessions of exercises for 3 weeks were prescribed along with interferential current and hot moist pack. Pain was assessed by visual analog scale, functional affection by modified Oswestry Disability Questionnaire, range of motion by assessing lumbar flexion and extension by modified Schober test and core strength was assessed by pressure biofeedback on day 1 and day 10 of the treatment. There was reduction of pain, improvement in range of motion, functional ability and core strength in all the 3 exercise groups. The improvement was significantly greater in the lumbar stabilization group for all the outcome measures, when compared the posttreatment after 10th session. Pairwise comparison showed that there was greater reduction of disability in the Pilates group than the dynamic strengthening group. It was concluded that the lumbar stabilization is more superior compared to the dynamic strengthening and Pilates in chronic nonspecific LBP. However, long-term benefits need to be assessed and compared with prospective follow-up studies.

Effective treatment options for musculoskeletal pain in primary care: A systematic overview of current evidence

BACKGROUND & AIMS

Musculoskeletal pain, the most common cause of disability globally, is most frequently managed in primary care. People with musculoskeletal pain in different body regions share similar characteristics, prognosis, and may respond to similar treatments. This overview aims to summarise current best evidence on currently available treatment options for the five most common musculoskeletal pain presentations (back, neck, shoulder, knee and multi-site pain) in primary care.

METHODS

A systematic search was conducted. Initial searches identified clinical guidelines, clinical pathways and systematic reviews. Additional searches found recently published trials and those addressing gaps in the evidence base. Data on study populations, interventions, and outcomes of intervention on pain and function were extracted. Quality of systematic reviews was assessed using AMSTAR, and strength of evidence rated using a modified GRADE approach.

RESULTS

Moderate to strong evidence suggests that exercise therapy and psychosocial interventions are effective for relieving pain and improving function for musculoskeletal pain. NSAIDs and opioids reduce pain in the short-term, but the effect size is modest and the potential for adverse effects need careful consideration. Corticosteroid injections were found to be beneficial for short-term pain relief among patients with knee and shoulder pain. However, current evidence remains equivocal on optimal dose, intensity and frequency, or mode of application for most treatment options.

CONCLUSION

This review presents a comprehensive summary and critical assessment of current evidence for the treatment of pain presentations in primary care. The evidence synthesis of interventions for common musculoskeletal pain presentations shows moderate-strong evidence for exercise therapy and psychosocial interventions, with short-term benefits only from pharmacological treatments. Future research into optimal dose and application of the most promising treatments is needed.

Effects of pilates on patients with chronic non-specific low back pain: a systematic review

[Purpose] To evaluate the effects of Pilates on patients with chronic low back pain through a systematic review of high-quality articles on randomized controlled trials. [Subjects and Methods] Keywords and synonyms for “Pilates” and “Chronic low back pain” were used in database searches. The databases included PubMed, Physiotherapy Evidence Database (PEDro), Medline, and the Cochrane Library. Articles involving randomized controlled trials with higher than 5 points on the PEDro scale were reviewed for suitability and inclusion. The methodological quality of the included randomized controlled trials was evaluated using the PEDro scale. Relevant information was extracted by 3 reviewers. [Results] Eight randomized controlled trial articles were included. Patients with chronic low back pain showed statistically significant improvement in pain relief and functional ability compared to patients who only performed usual or routine health care. However, other forms of exercise were similar to Pilates in the improvement of pain relief and functional capacity. [Conclusion] In patients with chronic low back pain, Pilates showed significant improvement in pain relief and functional enhancement. Other exercises showed effects similar to those of Pilates, if waist or torso movement was included and the exercises were performed for 20 cumulative hours.

Muscle Activation During Pilates Exercises in Participants With Chronic Nonspecific Low Back Pain: A Cross-Sectional Case-Control Study

OBJECTIVE

To determine the amplitude of the electromyographic activity of trunk muscles during Pilates exercises in women with and without chronic low back pain (LBP).

DESIGN

Case-control study.

SETTING

University physical therapy clinic.

PARTICIPANTS

Women (N=60) divided into an LBP group and a control group.

INTERVENTIONS

Not applicable.

MAIN OUTCOME MEASURES

Amplitude of the electromyographic activity (root mean square values) of the gluteus maximus and external oblique muscles collected during 3 Pilates exercises: Shoulder Bridge performed on the mat, and Hip Roll and Breathing performed in equipment. Pain intensity was assessed in the LBP group.

RESULTS

The amplitude of the electromyographic activity was similar between groups (P≥.05). For both groups, the amplitude of the gluteus maximus was higher in the Shoulder Bridge exercise compared with the Hip Roll with 2 springs (control group: mean difference [MD]=.18; 95% confidence interval [CI], .05-.41; LBP group: MD=.29; 95% CI, .16-.31) and the Breathing exercise (control group: MD=-.40; 95% CI, -.55 to -.26; LBP group: MD=-.36; 95% CI, -.52 to -.20). The amplitude of the external oblique muscle was higher in the Shoulder Bridge compared with the Hip Roll with 2 springs (control group: MD=.13; 95% CI, .05-.21; LBP group: MD=.18; 95% CI, .03-.33). Pain intensity increased after exercises, but this increase was lower for the mat exercises.

CONCLUSIONS

Similar muscle activation between groups was found. The findings suggest that mat exercises caused less pain and a greater difference in the amplitude of muscle activation compared with the equipment-based exercises.

Stabilization exercise compared to general exercises or manual therapy for the management of low back pain: A systematic review and meta-analysis

AIM

We performed a systematic review with a meta-analysis to examine the efficacy of stabilization exercises versus general exercises or manual therapy in patients with low back pain.

DESIGN

We searched MEDLINE, Cochrane Controlled Trials, Scielo, and CINAHL (from the earliest date available to November 2014) for randomized controlled trials that examined the efficacy of stabilization exercises compared to general exercises or manual therapy on pain, disability, and function in patients with low back pain. Weighted mean differences (WMD) and 95% confidence intervals were calculated.

RESULTS

Eleven studies met the inclusion criteria (413 stabilization exercises patients, 297 general exercises patients, and 185 manual therapy patients). Stabilization exercises may provide greater benefit than general exercise for pain reduction and improvement in disability. Stabilization exercise improved pain with a WMD of -1.03 (95% CI: -1.29 to -0.27) and improved disability with a WMD of -5.41 (95% CI: -8.34 to -2.49). There were no significant differences in pain and disability scores among participants in the stabilization exercise group compared to those in the manual therapy group.

CONCLUSIONS

Stabilization exercises were as efficacious as manual therapy in decreasing pain and disability and should be encouraged as part of musculoskeletal rehabilitation for low back pain.

Results of a Pilates exercise program in patients with chronic non-specific low back pain: a randomized controlled trial

OBJECTIVE

To investigate the effects of a Pilates exercise program on disability, pain, lumbar mobility, flexibility and balance in patients with chronic non-specific low back pain.

DESIGN

Randomized controlled trial.

SETTING

University laboratory.

PARTICIPANTS

A total of 54 patients with chronic non-specific low back pain.

INTERVENTION

Patients were randomly allocated to an experimental group ( n=27) included in a Pilates exercise program or to a control group ( n=27) receiving information in a form of a leaflet.

MAIN OUTCOME MEASURES

Disability (Roland-Morris Disability Questionnaire and Oswestry Disability Index), current, average and pain at it least and at its worst (Visual Analogue Scales), lumbar mobility (modified Shober test), flexibility (finger-to-floor test) and balance (single limb stance test) were measured at baseline and after the intervention.

RESULTS

A between-group analysis showed significant differences in the intervention group compared to the control group for both disability scores, the Rolland-Morris questionnaire (mean change±standard deviation of 5.31±3.37 and 2.40±6.78 respectively and between-groups mean difference of 3.2 ± 4.12, p=0.003) and the Oswestry Disability Index ( p<0.001), current pain ( p=0.002) and pain at it least ( p=0.033), flexibility (0.032) and balance (0.043).

CONCLUSIONS

An 8-week Pilates exercise program is effective in improving disability, pain, flexibility and balance in patients with chronic non-specific low back pain.

Effectiveness and Cost-Effectiveness of Different Weekly Frequencies of Pilates for Chronic Low Back Pain: Randomized Controlled Trial

BACKGROUND

The Pilates method has been recommended to patients with low back pain, but the evidence on effectiveness is inconclusive. In addition, there is still no evidence for the cost-effectiveness of this method or for the ideal number of sessions to achieve the highest effectiveness.

OBJECTIVE

The aim of this study will be to investigate the effectiveness and cost-effectiveness of the Pilates method with different weekly frequencies in the treatment of patients with nonspecific low back pain.

DESIGN

This is a randomized controlled trial with blinded assessor.

SETTING

This study will be conducted at a physical therapy clinic in São Paulo, Brazil.

PARTICIPANTS

Two hundred ninety-six patients with nonspecific low back pain between the ages of 18 and 80 years will be assessed and randomly allocated to 4 groups (n=74 patients per group).

INTERVENTION

All groups will receive an educational booklet. The booklet group will not receive additional exercises. Pilates group 1 will follow a Pilates-based program once a week, Pilates group 2 will follow the same program twice a week, and Pilates group 3 will follow the same program 3 times a week. The intervention will last 6 weeks.

MEASUREMENTS

A blinded assessor will evaluate pain, quality-adjusted life-years, general and specific disability, kinesiophobia, pain catastrophizing, and global perceived effect 6 weeks, 6 months, and 12 months after randomization.

LIMITATIONS

Therapists and patients will not be blinded.

CONCLUSIONS

This will be the first study to investigate different weekly frequencies of treatment sessions for nonspecific low back pain. The results of this study will contribute to a better definition of treatment programs for this population.

Pain Perception and Stabilometric Parameters in People With Chronic Low Back Pain After a Pilates Exercise Program: A Randomized Controlled Trial

Various exercise interventions, such as Pilates exercises and traditional physical therapy methods, are employed to decrease low back pain (LBP). Nonspecific low back pain (NSLBP) is distinct from LBP, however, as the distribution of pain is restricted to the region between the costal margin and the inferior gluteal. The aim of our randomized controlled trial was to evaluate the effects of a program of Pilates exercises on pain perception and stabilometric parameters in patients with NSLBP.Thirty-eight participants were randomly allocated, using a 1:1 scheme, to either the experimental group (EG) or control group (CG). The EG completed a 14-week program of Pilates exercises, performed thrice per week under the supervision of an exercise specialist, while the CG was managed with a social program only. Measures of posturography and Oswestry Disability Index (ODI) for pain perception were obtained at baseline (T0) and after the 14 weeks of intervention (T)1.Posturography measures improved for patients in the EG, with both eyes open and eyes closed (P < 0.05). There were no statistical differences in posturography in the CG. ODI decreased significantly in both groups over the 14 weeks of the study protocol: EG, T0, 13.7 ± 5.0 compared with T1, 6.5 ± 4.0 (P < 0.001); and CG, T0, 10.7 ± 7.8 compared with T1, 8.4 ± 7.8 (P < 0.01). A greater extent of reduction in pain was achieved in the EG.The Pilates exercise program yielded improvements in pain and posturography outcomes. Our study also confirms the applicability of posturography in evaluating postural instability in patients with NSLBP. Due to our relatively small study group, future studies would be necessary to confirm our findings.

Impact of McKenzie Method Therapy Enriched by Muscular Energy Techniques on Subjective and Objective Parameters Related to Spine Function in Patients with Chronic Low Back Pain

Background

The high incidence and inconsistencies in diagnostic and therapeutic process of low back pain (LBP) stimulate the continuing search for more efficient treatment modalities. Integration of the information obtained with various therapeutic methods and a holistic approach to the patient seem to be associated with positive outcomes.

The aim of this study was to analyze the efficacy of combined treatment with McKenzie method and Muscle Energy Technique (MET), and to compare it with the outcomes of treatment with McKenzie method or standard physiotherapy in specific chronic lumbar pain.

Material/Methods

The study included 60 men and women with LBP (mean age 44 years). The patients were randomly assigned to 1 of 3 therapeutic groups, which were further treated with: 1) McKenzie method and MET, 2) McKenzie method alone, or 3) standard physiotherapy for 10 days. The extent of spinal movements (electrogoniometry), level of experienced pain (Visual Analogue Scale and Revised Oswestry Pain Questionnaire), and structure of the spinal discs (MRI) were examined prior to the intervention, immediately thereafter, and 3 months after the intervention.

Results

McKenzie method enriched with MET had the best therapeutic outcomes. The mobility of cervical, thoracic, and lumbar spine normalized at levels corresponding to 87.1%, 66.7%, and 95% of respective average normative values. Implementation of McKenzie method, both alone and combined with MET, was associated with a significant decrease in Oswestry Disability Index, significant alleviation of pain (VAS), and significantly reduced size of spinal disc herniation.

Conclusions

The combined method can be effectively used in the treatment of chronic LBP.

What are patient beliefs and perceptions about exercise for nonspecific chronic low back pain? A systematic review of qualitative studies

OBJECTIVES

The global burden of low back pain is the highest ranked condition contributing to years of living with disability. Exercise is moderately effective, and adherence to exercise may improve if participants are engaged. Identification of elements that enhance engagement would enable clinicians to prescribe appropriate interventions. The review objective was to identify and synthesize qualitative empirical studies that have explored beliefs about exercise therapy of people with nonspecific chronic low back pain.

METHODS

Two independent reviewers conducted a structured review and metasynthesis informed by Cochrane and Campbell Collaboration guidelines and the PRISMA statement. Fifteen papers were included for data extraction, method quality assessment, and thematic analysis.

RESULTS

Four key themes emerged: (1) perceptions and classification of exercise; (2) role and impact of the health professional; (3) exercise and activity enablers/facilitators; (4) exercise and activity barriers. Participants believed that there were distinctions between general activity, real/fitness exercise, and medical exercise. Levels of acquired skills and capability and participant experience with exercise culture require consideration in program design. People participating in exercise classes and group work may be more comfortable when matched for abilities and experience. When an intervention interferes with everyday life and appears to be ineffective or too difficult to implement, people make a reasoned decision to discontinue.

DISCUSSION

People are likely to prefer and participate in exercise or training programs and activities that are designed with consideration of their preferences, circumstances, fitness levels, and exercise experiences.

Efficacy of the Pilates method for pain and disability in patients with chronic nonspecific low back pain: a systematic review with meta-analysis

Objective

To systematically review the available evidence on the efficacy of the Pilates method in patients with chronic nonspecific low back pain.

Method

Searches were performed in MEDLINE, EMBASE, PEDro, SciELO, LILACS, CINAHL and CENTRAL in March 2013. Randomized controlled trials that tested the effectiveness of the Pilates method (against a nontreatment group, minimal intervention or other types of interventions) in adults with chronic low back pain were included regardless the language of publication. The outcome data were extracted from the eligible studies and were combined using a meta-analysis approach.

Results

The searches identified a total of 1,545 articles. From these, eight trials were considered eligible, and seven trials were combined in the meta-analysis. The comparison groups were as follows: Pilates versus other types of exercises (n=2 trials), and Pilates versus no treatment group or minimal intervention (n=4 trials) for short term pain; Pilates versus minimal intervention for short-term disability (n=4).We determined that Pilates was not better than other types of exercises for reducing pain intensity. However, Pilates was better than a minimal intervention for reducing short-term pain and disability (pain: pooled mean difference=1.6 points; 95% CI 1.4 to 1.8; disability: pooled mean difference=5.2 points; 95% CI 4.3 to 6.1).

Conclusions

Pilates was better than a minimal intervention for reducing pain and disability in patients with chronic low back pain. Pilates was not better than other types of exercise for short-term pain reduction.

Effects of Pilates exercise programs in people with chronic low back pain: a systematic review

The Pilates method has recently become a fast-growing popular way of exercise recommended for healthy individuals and those engaged in rehabilitation. Several published studies have examined the effects of Pilates method in people with chronic low back pain (LBP). The objective of this study is to describe and provide an extensive overview of the scientific literature comparing the effectiveness of the Pilates method on pain and disability in patients with chronic nonspecific LBP. The study is based on the data from the following sources: MEDLINE-NLM, MEDLINE-EBSCO, Scopus Elsevier, Cochrane, DOAJ, SciELO, and PLOSONE. Original articles and systematic reviews of adults with chronic nonspecific LBP that evaluated pain and/or disability were included in this study; studies in which the primary treatment was based on Pilates method exercises compared with no treatment, minimal intervention, other types of intervention, or other types of exercises. The Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) were adopted. The literature search included 7 electronic databases and the reference list of relevant systematic reviews and original articles to July 2014. Two independent investigators conducted the literature search and performed the synthesis as follows: Study Design; Sample (n); Disability measure; Intervention; and Main results. The searches identified a total of 128 articles. From these, 29 were considered eligible and were included in the analysis. The items were stratified as follows: Pilates method versus other kind of exercises (n = 6 trials) and Pilates method versus no treatment group or minimal intervention for short-term pain (n = 9 trials); the therapeutic effect of the Pilates method in randomized cohorts (n = 5); and analysis of reviews (n = 9). We found that there is a dearth of studies that clearly demonstrates the efficacy of a specific Pilates exercise program over another in the treatment of chronic pain. However, the consensus in the field suggests that Pilates method is more effective than minimal physical exercise intervention in reducing pain. These conclusions need to be supported by other proper investigations.

Pilates versus general exercise effectiveness on pain and functionality in non-specific chronic low back pain subjects

Low back pain (LBP) is one of the most common causes of disability, and the Pilates method has been associated with improvements in symptoms. The purpose of this study was to assess the effectiveness of the Pilates method, when compared to general exercises, on pain and functionality after eight weeks (16 sessions, 2×/week) and a follow-up of three months, in subjects with non-specific chronic low back pain (NSCLBP). A randomised controlled trial composed of 22 subjects was proposed. Subjects were allocated into two groups: the Pilates group (PG) (n = 11) and the general exercise group (GEG) (n = 11). The PG protocol was based on the Pilates method and the GEG performed exercises to manage NSCLBP. There were no differences between the groups. When analysed over time, the GEG demonstrated improvements in functionality between baseline and the end of treatment (P = .02; Cohen'sd¯ = 0.34) and baseline and follow-up (P = .04; Cohen'sd¯ = 0.31). There were no differences between the Pilates and general exercises with regard to pain and functionality in NSCLBP subjects but general exercises were better than Pilates for increasing functionality and flexibility.

The effectiveness of Pilates exercise in people with chronic low back pain: a systematic review

OBJECTIVE

To evaluate the effectiveness of Pilates exercise in people with chronic low back pain (CLBP) through a systematic review of randomised controlled trials (RCTs).

DATA SOURCES

A search for RCTs was undertaken using Medical Search Terms and synonyms for "Pilates" and "low back pain" within the maximal date range of 10 databases. Databases included the Cumulative Index to Nursing and Allied Health Literature; Cochrane Library; Medline; Physiotherapy Evidence Database; ProQuest: Health and Medical Complete, Nursing and Allied Health Source, Dissertation and Theses; Scopus; Sport Discus; Web of Science.

STUDY SELECTION

Two independent reviewers were involved in the selection of evidence. To be included, relevant RCTs needed to be published in the English language. From 152 studies, 14 RCTs were included.

DATA EXTRACTION

Two independent reviewers appraised the methodological quality of RCTs using the McMaster Critical Review Form for Quantitative Studies. The author(s), year of publication, and details regarding participants, Pilates exercise, comparison treatments, and outcome measures, and findings, were then extracted.

DATA SYNTHESIS

The methodological quality of RCTs ranged from "poor" to "excellent". A meta-analysis of RCTs was not undertaken due to the heterogeneity of RCTs. Pilates exercise provided statistically significant improvements in pain and functional ability compared to usual care and physical activity between 4 and 15 weeks, but not at 24 weeks. There were no consistent statistically significant differences in improvements in pain and functional ability with Pilates exercise, massage therapy, or other forms of exercise at any time period.

CONCLUSIONS

Pilates exercise offers greater improvements in pain and functional ability compared to usual care and physical activity in the short term. Pilates exercise offers equivalent improvements to massage therapy and other forms of exercise. Future research should explore optimal Pilates exercise designs, and whether some people with CLBP may benefit from Pilates exercise more than others.

Pilates improves pain, function and quality of life in patients with chronic low back pain: a randomized controlled trial

Objective:

To assess the effectiveness of pilates method on patients with chronic non-specific low back pain (LBP).

Method:

A randomized controlled trial was carried out in sixty patients with a diagnosis of chronic non-specific LBP. Patients were randomly assigned to one of two groups: Experimental Group (EG) that maintained medication treatment with use of NSAID and underwent treatment with the pilates method and Control Group (CG) that continue medication treatment with use of NSAID and did not undergo any other intervention. A blinded assessor performed all evaluations at baseline (T0), after 45, 90, and 180 days (T45, T90 and T180) for: pain (VAS), function (Roland Morris questionnaire), quality of life (SF-36), satisfaction with treatment (Likert scale), flexibility (sit and reach test) and NSAID intake.

Results:

The groups were homogeneous at baseline. Statistical differences favoring the EG were found with regard to pain ( P < 0.001), function ( P < 0.001) and the quality of life domains of functional capacity ( P < 0.046), pain ( P < 0.010) and vitality ( P < 0.029). Statistical differences were also found between groups regarding the use of pain medication at T45, T90 and T180 ( P < 0.010), with the EG taking fewer NSAIDs than the CG.

Conclusions:

The pilates method can be used by patients with LBP to improve pain, function and aspects related to quality of life (functional capacity, pain and vitality). Moreover, this method has no harmful effects on such patients.

The definition and application of Pilates exercise to treat people with chronic low back pain: a Delphi survey of Australian physical therapists

BACKGROUND

Pilates exercise is recommended for people with chronic low back pain (CLBP). In the literature, however, Pilates exercise is described and applied differently to treat people with CLBP. These differences in the definition and application of Pilates exercise make it difficult to evaluate its effectiveness.

OBJECTIVE

The aim of this study was to establish consensus regarding the definition and application of Pilates exercise to treat people with CLBP.

METHODS

A panel of Australian physical therapists who are experienced in treating people with CLBP using Pilates exercise were surveyed using the Delphi technique. Three electronic questionnaires were used to collect the respondents' opinions. Answers to open-ended questions were analyzed thematically, combined with systematic literature review findings, and translated into statements about Pilates exercise for people with CLBP. Participants then rated their level of agreement with these statements using a 6-point Likert scale. Consensus was achieved when 70% of the panel members strongly agreed, agreed, or somewhat agreed (or strongly disagreed, disagreed, or somewhat disagreed) with an item.

RESULTS

Thirty physical therapists completed all 3 questionnaires and reached consensus on the majority of items. Participants agreed that Pilates exercise requires body awareness, breathing, movement control, posture, and education. It was recommended that people with CLBP should undertake supervised sessions for 30 to 60 minutes, twice per week, for 3 to 6 months. Participants also suggested that people with CLBP would benefit from individualized assessment and exercise prescription, supervision and functional integration of exercises, and use of specialized equipment.

LIMITATIONS

Item consensus does not guarantee the accuracy of findings. This survey reflects the opinion of only 30 physical therapists and requires validation in future trials.

CONCLUSION

These findings contribute to a better understanding of Pilates exercise and how it is utilized by physical therapists to treat people with CLBP. This information provides direction for future research into Pilates exercise, but findings need to be interpreted within the context of study limitations.

Effectiveness of mat Pilates or equipment-based Pilates exercises in patients with chronic nonspecific low back pain: a randomized controlled trial

BACKGROUND

The Pilates method has been widely used to treat patients with chronic low back pain. Pilates exercises can be performed in 2 ways: by using specific equipment or without it (also known as mat Pilates). There are no studies, however, that have compared the effectiveness of mat Pilates with that of equipment-based Pilates.

OBJECTIVE

The aim of this study was to compare the effectiveness of mat Pilates and equipment-based Pilates in patients with chronic nonspecific low back pain.

DESIGN

A 2-arm randomized controlled trial with a blinded assessor was conducted.

SETTING

The study was conducted at a private physical therapy clinic in Brazil.

PATIENTS

Eighty-six patients with chronic nonspecific low back pain participated.

INTERVENTION

The patients were randomly allocated to 1 of 2 groups: a mat Pilates group (n=43) and an equipment-based Pilates group (n=43). The participants in both groups attended 12 Pilates sessions over a period of 6 weeks.

MEASUREMENTS

The primary outcomes were pain intensity and disability. The secondary outcomes were global perceived effect, patient's specific disability, and kinesiophobia. A blinded assessor evaluated the outcomes at baseline and 6 weeks and 6 months after randomization.

RESULTS

After 6 months, there was a statistically significant difference for disability (mean difference=3.0 points, 95% confidence interval [CI]=0.6 to 5.4), specific disability (mean difference=-1.1 points, 95% CI=-2.0 to -0.1), and kinesiophobia (mean difference=4.9 points, 95% CI=1.6 to 8.2) in favor of equipment-based Pilates. No differences were found for the remaining outcomes.

CONCLUSIONS

Equipment-based Pilates was superior to mat Pilates in the 6-month follow-up for the outcomes of disability and kinesiophobia. These benefits were not observed for pain intensity and global perceived effect in patients with chronic nonspecific low back pain.

24-weeks Pilates-aerobic and educative training to improve body fat mass in elderly Serbian women

Background

The purpose of this study was to examine the differences in anthropometric measurements using an aerobic and Pilates exercise program which lasted 24 weeks.

Method

This was a clinical intervention study of 303 women over the age of 60 living in Novi Sad, Serbia. Changes in body mass index and skinfold thickness were estimated through height, weight, and anthropometric measurements. The program comprised Pilates exercises for upper- and lower-body strength, agility, and aerobic capacity.

Results

Fat mass (FM) improved significantly (pre-test, 32.89%, 8.65; post-test, 28.25%, 6.58; P<0.01). Bone diameters and muscle perimeters showed no significant changes pre- and post-test (P>0.05), but there was a higher correlation between FM (%) and waist–hip ratio (rho, 0.80; P<0.01).

Conclusion

A mixed program of aerobics and Pilates, controls and improves baseline muscle mass and decreases FM values, without causing deterioration during practice and follow-up exercises.

Management options for patients with chronic back pain without an etiology

The treatment and management of low back pain is complex when there is no specific etiology such as cancer, fracture, or herniated disc. An organized approach to management that follows evidence based guidelines will facilitate care in a problem that reflects a lifetime prevalence of over 70 percent. The purpose of this review is to present a guideline to care for a common disabling process with a very heterogeneous etiology.

Efficacy of the addition of modified Pilates exercises to a minimal intervention in patients with chronic low back pain: a randomized controlled trial

BACKGROUND

The Pilates method has been used to improve function and reduce pain in patients with chronic nonspecific low back pain, although there is little scientific evidence that describes its efficacy.

OBJECTIVE

The purpose of this study was to investigate the effectiveness of the addition of modified Pilates exercises to minimal intervention in patients with chronic low back pain.

DESIGN

A randomized controlled trial was conducted.

SETTING

The study was done in an outpatient physical therapy department in Brazil.

PATIENTS

Eighty-six patients with chronic nonspecific low back pain participated in the study.

INTERVENTION

All participants received an education booklet containing information about low back pain and were randomly allocated to receive 12 sessions, over 6 weeks, of exercises based upon Pilates principles (n=43) or of education alone (n=43).

MEASUREMENTS

Primary outcomes were pain intensity and disability measured at 6 weeks and 6 months. Secondary outcomes were patient-specific functional disability, global impression of recovery, and kinesiophobia measured at 6 weeks and 6 months. All outcomes were measured by a blinded assessor in all time points.

RESULTS

There was no loss to follow-up at any of the time points. Improvements were observed in pain (mean difference=2.2 points, 95% confidence interval [CI]=1.1 to 3.2), disability (mean difference=2.7 points, 95% CI=1.0 to 4.4), and global impression of recovery (mean difference=-1.5 points, 95% CI=-2.6 to -0.4) in favor of the Pilates group after intervention, but these differences were no longer statistically significant at 6 months.

LIMITATIONS

Treatment provider and participants could not be blinded to the interventions.

CONCLUSIONS

The addition of modified Pilates exercises to an educational booklet provides small benefits compared with education alone in patients with chronic nonspecific low back pain; however, these effects were not sustained over time.

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

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).

Time course of 25(OH)D3 vitamin D3 as well as PTH (parathyroid hormone) during fracture healing of patients with normal and low bone mineral density (BMD)

BACKGROUND

Until now the exact biochemical processes during healing of metaphyseal fractures of healthy and osteoporotic bone remain unclear. Especially the physiological time courses of 25(OH)D(3) (Vitamin D) as well as PTH (Parathyroid Hormone) the most important modulators of calcium and bone homeostasis are not yet examined sufficiently. The purpose of this study was to focus on the time course of these parameters during fracture healing.

METHODS

In the presented study, we analyse the time course of 25(OH)D3 and PTH during fracture healing of low BMD level fractures versus normal BMD level fractures in a matched pair analysis. Between March 2007 and February 2009 30 patients older than 50 years of age who had suffered a metaphyseal fracture of the proximal humerus, the distal radius or the proximal femur were included in our study. Osteoporosis was verified by DEXA measuring. The time courses of 25(OH)D(3) and PTH were examined over an eight week period. Friedmann test, the Wilcoxon signed rank test and the Mann-Withney U test were used as post-hoc tests. A p-value ≤ 0.05 was considered significant.

RESULTS

Serum levels of 25(OH)D(3) showed no differences in both groups. In the first phase of fracture healing PTH levels in the low BMD level group remained below those of the normal BMD group in absolute figures. Over all no significant differences between low BMD level bone and normal BMD level bone could be detected in our study.

CONCLUSIONS

The time course of 25(OH)D(3) and PTH during fracture healing of patients with normal and low bone mineral density were examined for the first time in humans in this setting and allowing molecular biological insights into fracture healing in metaphyseal bones on a molecural level. There were no significant differences between patients with normal and low BMD levels. Hence further studies will be necessary to obtain more detailed insight into fracture healing in order to provide reliable decision criteria for therapy and the monitoring of fracture healing.