Highlights
- •Mind-body exercise delivered by physical therapists consisted mostly of Pilates
- •Overall, mind-body exercise was more effective than control for pain and disability
- •Effects were moderated by type (non-exercise vs alternative exercise) of control
- •Larger effect estimates were observed in studies with non-exercise controls
- •Mind-body exercise treatment delivered by physical therapists is effective
Abstract
Objective
To assess the effectiveness of mind-body (MB) exercise interventions provided by physical
therapists for reducing pain and disability in people with low back pain (LBP).
Data Sources
MEDLINE, Embase, CINAHL, and the Cochrane Library were searched for articles published
in English between Dec. 2010 and June 2020.
Study Selection
Randomized controlled trials evaluating the effects of Pilates, yoga, and Tai Chi
interventions performed by physical therapists on pain or disability outcomes in adults
with musculoskeletal LBP were included.
Data Extraction
Data were extracted by 2 independent reviewers. Quality of evidence and risk of bias
were assessed using the Grading of Recommendations Assessment, Development, and Evaluation
(GRADE) framework and Cochrane risk of bias tools, respectively.
Data Synthesis
21,230 exercise trials were identified; 161 progressed to full-text review. Eight
trials, 7 reporting on Pilates and one reporting on yoga, were included. Short-term
outcomes for pain (SMD: -0.93; 95%CI: -1.65 to -0.021) and disability (SMD: -0.74
95%CI: -1.36 to -0.012) indicated MB exercise was more effective than control intervention.
Tests for subgroup differences between studies with exercise vs non-exercise control
groups revealed a moderating effect on short-term outcomes where larger effects were
observed in studies with non-exercise comparators. Long-term outcomes for pain (SMD:
-0.60; 95% CI:-1.43 to 0.23) and disability (SMD: -1.05; 95% CI:-3.51 to 1.41) suggested
that MB exercise is not more effective than control interventions for pain or disability.
Quality of the evidence ranged from very low to low.
Conclusion
Physical therapist-delivered MB exercise interventions, which overwhelmingly consisted
of Pilates, were more effective than control in the short and long-term for pain and
in the short-term for disability, with differences in the short-term effects lessened
when compared to an active intervention. Pilates interventions delivered by physical
therapists represent a viable tool for the clinical management of chronic LBP.
Key Words
List of abbreviations:
AOPT CPG (Academy of Orthopedic Physical Therapy's Clinical Practice Guideline), CIs (confidence intervals), GRADE (Grading of Recommendations Assessment, Development and Evaluation), LBP (low back pain), MB (mind-body), MD (mean difference), RCT (randomized controlled trials), SMD (standardized mean difference)To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Archives of Physical Medicine and RehabilitationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
Article info
Publication history
Accepted:
October 11,
2022
Received in revised form:
October 6,
2022
Received:
July 13,
2022
Publication stage
In Press Journal Pre-ProofFootnotes
This publication was made possible in part by Grant Number T32-GM081740 from NIH-NIGMS (JRG). Its contents are solely the responsibility of the authors and do not necessarily represent the official views of the NIGMS or NIH.
Disclosure: Dr. George disclosed financial relationships with Rehab Essentials and Med Risk Inc, outside the submitted work. The other authors have nothing to disclose.
Acknowledgements: Contributors to the AOPT CPG exercise team who screened and reviewed articles and extracted data: Courtney Butowicz PhD, Travis Pollen PhD, Eric Folkins DPT, Michael Roberto DPT, Won Sung PhD, DPT, and Michael Steimling DPT.
Identification
Copyright
© 2022 by the American Congress of Rehabilitation Medicine.
