Effects of Pilates versus other forms of exercise on chronic non-specific low back pain: A systematic review with meta-analysis

Keywords: Low back pain; Pilates; Exercise therapy Purpose: My primary aim of this paper was to compare the effect of Pilates exercise with other forms of exercise on pain reduction and disability improvement in individuals with chronic non-specific low back pain. The second aim was to inform clinical practice and future research by evaluating and synthesising the current evidence of exercise therapy in the management of chronic non-specific low back pain. Methods: Research design: systematic review with meta-analysis. Electronic databases were searched for relevant studies. Randomised controlled trials were eligible if they compared Pilates exercise with other forms of exercise for participants with chronic non-specific low back pain. The methodological quality, risk of bias of the trials and clinical relevance of the collected data were assessed. Meta-analysis with a subgroup analysis was performed. Pilates exercise was compared to General exercise, Direction-specific exercise and Spinal stabilisation exercise in terms of pain reduction and disability improvement. The certainty of the evidence was determined by the Grading of Recommendations, Assessment, Development and Evaluations (GRADE) tool. Results: Eleven RCTs were included in this review and nine of them were computed in meta-analysis. Two had a moderate level of risk of bias and eight of them were at high risk of bias. A low certainty of evidence supported the superiority of Pilates exercise over general exercise in both pain reduction and disability improvement. A very low certainty of evidence showed that Pilates exercise was more effective than direction-specific exercise in pain reduction but not in disability improvement. A very low certainty of evidence indicated that Pilates exercise and Spinal stabilisation exercise had a similar effect on pain reduction and disability improvement. Conclusion(s): The findings might be limited by the certainty of evidence and the methodological limitations from the primary studies. Future research should produce more high-quality RCTs on this topic. Future research should consider the adherence to the exercise principles underpinning different forms of exercises for low back pain. The use of classification systems and psychosocial screening to recruit a more homogenous subgroup of participants was recommended. Impact: In terms of clinical practice, this paper summarised the current evidence base of various forms of exercise intervention for chronic non-specific low back pain and inform the selection of appropriate exercise interventions for clinicians. This review critically highlighted the strengths and weaknesses of the current evidence and estimated the comparative effect with a quantitative comparison using meta-analysis. Even though the certainty of the findings is limited by the study quality of the primary studies, the finding of the review can provide preliminary support to the use of Pilates exercise or the integration of Pilates principles into exercise therapy for chronic non-specific low back pain. In terms of future research, this review critically discussed the methodological limitation of the included trials and attempted to explain the findings by reviewing the adherence and implementation of underpinning exercise principles of various exercise interventions used by the trials. It also highlighted the importance of using classification systems and psychosocial screening to enhance the homogeneity of participants in low back pain research. Funding acknowledgements: The work was not funded.