Bai DY, Yuan ZG, Shao JJ, et al. Unstable shoes for the treatment of lower back pain: a meta-analysis of randomized controlled trials. Clin Rehabil. 2019 Jul 22:269215519863840. doi: 10.1177/0269215519863840. (Systematic review)

OBJECTIVE: We aimed to perform a systematic review and meta-analysis to compare the treatment effects of unstable shoes and flat shoes on lower back pain patients.

DATA SOURCES: Literature databases, including PubMed, Web of Science, and EMBASE (up to June 2019), were searched systematically.

REVIEW METHODS: Two authors independently screened the retrieved records and identified the randomized controlled trials where patients with lower back pain who wore unstable shoes as intervention and wore flat shoes as a control. Relevant data were extracted for meta-analysis using Review Manager 5.3 software. The Grading of Recommendations Assessment, Development and Evaluation approach was used to assess the pooled outcome evidence levels.

RESULTS: Five randomized controlled trials and 251 patients were included in the analysis. The meta-analysis results showed that there was a tendency toward a reduction in the Roland-Morris disability questionnaire score (mean difference (MD) -2.16, 95% confidence interval (CI) -4.28 to -0.03, I2 = 53%) and pain score (MD -0.84, 95% CI -1.66 to -0.02, I2 = 84%) in patients wearing unstable shoes compared to those wearing flat shoes. There was no significant difference in the life quality scores between the unstable shoe and flat shoe groups (MD -0.59, 95% CI -6.18 to 5.01, I2 = 0%). Functional disability and pain scores were determined to have very low-quality evidence, and life quality scores were determined to have low-quality evidence according to the Grading of Recommendations Assessment, Development and Evaluation analysis.

CONCLUSION: Unstable shoes may be effective in treating lower back pain in the clinic, but the conclusion was limited by the current low-quality studies.

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

Rehab Clinician (OT/PT) rater

The article was important from a social media perspective. Social media often promotes wearing certain shoe types to reduce LBP; however this article reminds us that such promotion must be viewed cautiously. As a physical therapist, I was not surprised by the results. LBP especially chronic LBP, which was the predominant acuity included in the authors' sample, needs to be evaluated and managed according to a biopsychosocial model. Recommending RX for chronic LBP based solely on a mechanical assessment (in this case shoe type) most likely will result in ineffective treatment outcomes.
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