Gilliam JR, George SZ, Norman KS, et al. Mind-Body Exercise Performed by Physical Therapists for Reducing Pain and Disability in Low Back Pain: A Systematic Review With Meta-analysis. Arch Phys Med Rehabil. 2022 Dec 17:S0003-9993(22)01674-4. doi: 10.1016/j.apmr.2022.10.004. (Systematic review)

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 December 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 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 1 reporting on yoga, were included. Short-term outcomes for pain (SMD: -0.93; 95% confidence interval [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.

CONCLUSIONS: 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 with an active intervention. Pilates interventions delivered by physical therapists represent a viable tool for the clinical management of chronic LBP.

Discipline Area Score
Rehab Clinician (OT/PT) 6 / 7
Physician 5 / 7
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Comments from MORE raters

Physician rater

These results are as expected. A well done systematic review, but the conclusions are imprecise. The evidence is statistically significant only in the short term, and the quality of the evidence is low or very low. So, no firm recommendations can be made from this body of evidence. In summary, mind-body exercises such as Pilates could be suggested in low-back pain and may have some effectiveness in the short-term.

Physician rater

Meta-analysis of articles that already share the same conclusions (i.e., note that all the individual points on the forest plots are on the same side of neutral!) does not add to our scientific knowledge base.

Physician rater

This study proves again that Pilates is not better than an exercise program and that even the short-term improvements are not clinically relevant. I wonder why this is not made clearer in the abstract.

Rehab Clinician (OT/PT) rater

As a physical therapist, I find it is good additional information that alternative exercise, such as pilates can have a positive effect on LBP.
Comments from PAIN+ CPN subscribers

Dr. Hélène Bertrand (2/27/2023 11:48 AM)

Most low back pain (90%) is "nonspecific." This study shows that "nonspecific" procedures such as Pilates, exercise, and yoga are marginally helpful. I have shown that almost all "nonspecific" low back pain is secondary to sacroiliac joint displacement and that once the direction of the displaced ileum is found, using a simple test (the sacroiliac forward flexion test, SIFFT), a two-minute exercise (SIFFT-E) can correct the displacement and eliminate the low back pain 90% of the time. Physicians could easily address the problem in their own office and witness their patients' gratitude.