Mind-Body Exercise Performed by Physical Therapists for Reducing Pain and Disability in Low Back Pain: A Systematic Review with Meta-Analysis.

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.