The effects of Pilates exercise in comparison to other forms of exercise on pain and disability in individuals with chronic non-specific low back pain: A systematic review with meta-analysis.

OBJECTIVE

To compare the effects of Pilates exercise (PE) with other forms of exercise on pain and disability in individuals with chronic non-specific low back pain (CNSLBP) and to inform clinical practice and future research.

STUDY DESIGN

Systematic review with meta-analysis conducted and reported in line the Preferred Reporting Items for Systematic review and Meta-analysis.

LITERATURE SEARCH

Six electronic databases were searched from inception to April 2021.

STUDY SELECTION CRITERIA

Randomised controlled trials (RCTs) comparing the effect of PE with other forms of exercise for adults with CNSLBP on pain and disability.

DATA SYNTHESIS

Two reviewers assessed the risk of bias of the trials, guided by the Cochrane RoB2 tool. Available data were extracted for meta-analysis with subgroup analysis. Pilates exercise was compared to general exercise (GE), direction-specific exercise (DSE) and spinal stabilisation exercise (SSE). Certainty of evidence was interpreted following the Grading of Recommendations Assessment, Development and Evaluation approach.

RESULTS

Eleven RCTs were included. A low certainty of evidence supported PE was more effective than GE in pain reduction [Effect size (ES) 0.44]. Moreover, very low levels of certainty were revealed for effectiveness of PE compared with DSE for pain reduction (ES 0.65) and equivalence of PE and SSE for pain and disability.

CONCLUSIONS

This review found no strong evidence for using one type of exercise intervention over another when managing patients with CNSLBP. Existing evidence does not allow this review to draw definitive recommendations. In the absence of a superior exercise form clinicians should work collaboratively with the patient, using the individual's goals and preferences to guide exercise selection. Further appropriately designed research is warranted to explore this topic further.