OBJECTIVE: To analyze the effect of trunkfocused exercise programs (TEPs) and moderator factors on chronic nonspecific low back pain (LBP). DESIGN: Systematic review with meta-analyses. LITERATURE SEARCH: We searched the PubMed, Scopus, Embase, SPORTDiscus, and CENTRAL databases from their inception to June 2022. STUDY SELECTION CRITERIA: We included randomized controlled trials comparing TEPs to control or general exercises. DATA SYNTHESIS: We used random-effects models to calculate the standardized mean difference (SMD) plus confidence interval (CI) and heterogeneity (I2) for pain, disability, quality of life, and trunk performance. The impact of moderator factors was analyzed through meta-regression. RESULTS: Forty randomized controlled trials (n = 2391) were included. TEPs showed positive effects for all outcomes versus control (SMD 0.90-2.46; 95% CI, -0.04 to 4.96; I2 61%-98%). There were small effects in favor of TEPs versus general exercises for pain (SMD = 0.20; 95% CI, 0.03-0.37; I2 = 13.4%) and disability (SMD = 0.20; 95% CI, 0.02-0.38; I2 = 0%). Trunk and/or hip range-of-motion improvements were associated with greater reductions in pain (P<.01; ß = 0.56; 95% CI, 0.25-0.87) and disability (P<.01; ß = 0.66; 95% CI, 0.27-1.05). Low body mass was associated with higher pain reduction (P = .03; ß = -0.17; 95% CI, -0.32 to -0.02). CONCLUSIONS: Trunk-focused exercise programs had positive effects on pain, disability, quality of life, and trunk performance compared to control groups, and on pain and disability compared to general exercises. Increasing trunk and/or hip range of motion was associated with greater pain and disability reduction, and lower body mass with higher pain reduction. J Orthop Sports Phys Ther 2023;53(2):64-93. Epub: 16 January 2023. doi:10.2519/jospt.2023.11091.
|Rehab Clinician (OT/PT)|
Due to the huge heterogeneity of the interventions given for trunk training and the low level of evidence, it may give some ideas but not definitive conclusion for whether or not the TEP is better.
The grouping of range of motion, extensor endurance, or trunk strength in most analyses reduces the clinical applicability of these findings. I think most clinicians already consider exercise targeted at this region and would like evidence to inform which type of exercise should be selected.