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BMC Medical Research Methodology
Published in: BMC Medical Research Methodology 1/2013

Open Access 01-12-2013 | Research article

Effectiveness of Pilates exercise in treating people with chronic low back pain: a systematic review of systematic reviews

Authors: Cherie Wells, Gregory S Kolt, Paul Marshall, Bridget Hill, Andrea Bialocerkowski

Published in: BMC Medical Research Methodology | Issue 1/2013

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Abstract

Background

Systematic reviews provide clinical practice recommendations that are based on evaluation of primary evidence. When systematic reviews with the same aims have different conclusions, it is difficult to ascertain which review reported the most credible and robust findings.

Methods

This study examined five systematic reviews that have investigated the effectiveness of Pilates exercise in people with chronic low back pain. A four-stage process was used to interpret findings of the reviews. This process included comparison of research questions, included primary studies, and the level and quality of evidence of systematic reviews. Two independent reviewers assessed the level of evidence and the methodological quality of systematic reviews, using the National Health and Medical Research Council hierarchy of evidence, and the Revised Assessment of Multiple Systematic Reviews respectively. Any disagreements were resolved by a third researcher.

Results

A high level of consensus was achieved between the reviewers. Conflicting findings were reported by the five systematic reviews regarding the effectiveness of Pilates in reducing pain and disability in people with chronic low back pain. Authors of the systematic reviews included primary studies that did not match their questions in relation to treatment or population characteristics. A total of ten primary studies were identified across five systematic reviews. Only two of the primary studies were included in all of the reviews due to different inclusion criteria relating to publication date and status, definition of Pilates, and methodological quality. The level of evidence of reviews was low due to the methodological design of the primary studies. The methodological quality of reviews varied. Those which conducted a meta-analysis obtained higher scores.

Conclusion

There is inconclusive evidence that Pilates is effective in reducing pain and disability in people with chronic low back pain. This is due to the small number and poor methodological quality of primary studies. The Revised Assessment of Multiple Systematic Reviews provides a useful method of appraising the methodological quality of systematic reviews. Individual item scores, however, should be examined in addition to total scores, so that significant methodological flaws of systematic reviews are not missed, and results are interpreted appropriately. (348 words)
Appendix
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Literature
1.
National Health and Medical Research Council: NHMRC levels of evidence and grades for recommendations for developers of guidelines. 2009, Canberra: National Health and Medical Research Council
2.
3.
4.
Evans D: Hierarchy of evidence: A framework for the ranking of evidence evaluating nursing interventions. J Clin Nurs. 2003, 12: 77-84. 10.1046/j.1365-2702.2003.00662.x.CrossRefPubMed
5.
Smith V, Devan D, Begley CM, Clarke M: Methodology in conducting a systematic review of systematic reviews of healthcare interventions. BMC Med Res Methodol. 2011, 11: 15-10.1186/1471-2288-11-15.CrossRefPubMedPubMedCentral
6.
La Touche R, Escalante K, Linares MT: Treating non-specific chronic low back pain through the Pilates Method. J Bodyw Mov Ther. 2008, 12: 364-370. 10.1016/j.jbmt.2007.11.004.CrossRefPubMed
7.
Lim ECW, Poh RLC, Low AY, Wong WP: Effects of Pilates-based exercises on pain and disability in individuals with persistent non specific low back pain: A systematic review with meta-analysis. J Orthop Sports Phys Ther. 2011, 41: 70-80.CrossRefPubMed
8.
Pereira LM, Obara K, Dias JM, Menacho MO, Guariglia DA, Schiavoni D, Pereira HM, Cardoso JR: Comparing the Pilates method with no exercise or lumbar stabilisation for pain and functionality in patients with chronic low back pain: Systematic review and meta-analysis. Clin Rehabil. 2012, 26: 10-20. 10.1177/0269215511411113.CrossRefPubMed
9.
Posadzki P, Lizis P, Hagner-Derengowska M: Pilates for low back pain: A systematic review. Complement Ther Clin Pract. 2011, 17: 85-89. 10.1016/j.ctcp.2010.09.005.CrossRefPubMed
10.
Aladro-Gonzalvo AR, Araya-Vargas GA, Machado-Diaz M, Salazar-Rojas W: Pilates-based exercise for persistent, non specific low back pain and associated functional disability: A meta-analysis with meta-regression. J Bodyw Mov Ther. 2012, http://​dx.​doi.​org/​10.​1016/​j.​jbmt.​2012.​08.​003
11.
Wells C, Bialocerkowski A, Kolt GS: Definition of Pilates: A systematic review. Complement Ther Med. 2012, 20: 253-262. 10.1016/j.ctim.2012.02.005.CrossRefPubMed
12.
Endleman I, Critchley DJ: Transversus abdominis and obliquus internus activity during pilates exercises: measurement with ultrasound scanning. Arch Phys Med Rehabil. 2008, 89: 2205-2212. 10.1016/j.apmr.2008.04.025.CrossRefPubMed
13.
Ferreira PH, Ferreira ML, Maher CG, Refshauge K, Herbert R, Hodges PW: Changes in recruitment of transversus abdominis correlate with disability in people with chronic low back pain. Br J Sports Med. 2010, 44: 1166-72. 10.1136/bjsm.2009.061515.CrossRefPubMed
14.
Wallwork T, Stanton W, Freke M, Hides J: The effect of chronic low back pain on size and contraction of the lumbar multifidus muscle. Man Ther. 2009, 14: 496-500. 10.1016/j.math.2008.09.006.CrossRefPubMed
15.
Kung J, Chiappelli F, Cajulis OO, Avezova R, Kossan G: From systematic reviews to clinical recommendations for evidence-based health care: Validation of revised assessment of multiple systematic reviews (R-AMSTAR) for grading of clinical relevance. Open Dent J. 2010, 4: 84-91.PubMedPubMedCentral
16.
Collins J, Fauser B, Bart CJM: Balancing the strengths of systematic and narrative reviews. Human Reprod Update. 2005, 11: 103-104.CrossRef
17.
Cook D, Mulrow C, Haynes R: Systematic reviews: Synthesis of best evidence for clinical decisions. Ann Intern Med. 1997, 126: 376-380.CrossRefPubMed
18.
Schlesselman JJ, Collins JA: Evaluating systematic reviews and meta-analyses. Semin Reprod Med. 2003, 21: 95-105.CrossRefPubMed
19.
Charlton JE: Core Curriculum for Professional Education in Pain. 2005, Seattle: International Association of the Study of Pain (IASP) Press, 3
20.
Steiner WA, Ryser L, Huber EO, Uebelhart D, Aeschlimann A, Stucki G: Use of the ICF model as a clinical problem-solving tool in physical therapy and rehabilitation medicine. Phys Ther. 2002, 82: 1098-1107.PubMed
21.
Shea B, Grimshaw J, Wells G, Boers M, Andersson N, Hamel C, Porter AC, Tugwell P, Moher D, Bouter LM: Development of AMSTAR: a measurement tool to assess the methodological quality of systematic reviews. BMC Med Res Methodol. 2007, 7: 10-10.1186/1471-2288-7-10.CrossRefPubMedPubMedCentral
22.
Shea BJ, Hamel C, Wells GA, Bouter LM, Kristjanson E, Grimshaw J, Henry DA, Boers M: AMSTAR is a reliable and valid measurement tool to assess the methodological quality of systematic reviews. J Clin Epidemiol. 2009, 62: 1013-1020. 10.1016/j.jclinepi.2008.10.009.CrossRefPubMed
23.
Baker WL, White CM, Cappelleri JC, Kluger J, Coleman C: Understanding heterogeneity in meta-analysis: The role of meta-regression. Int J Clin Practice. 2009, 63: 1426-1434. 10.1111/j.1742-1241.2009.02168.x.CrossRef
24.
Anderson B: Randomised clinical trial comparing active versus passive approaches to the treatment of recurrent and chronic low back pain. 2005, University of Miami, PhD thesis
25.
Rydeard R, Leger A, Smith D: Pilates-based therapeutic exercise: Effect on subjects with nonspecific chronic low back pain and functional disability: A randomized controlled trial. J Orthop Sports Phys Ther. 2006, 36: 472-484.CrossRefPubMed
26.
da Fonseca JL, Magini M, de Freitas TH: Laboratory Gait Analysis in Patients with Low Back Pain Before and After a Pilates Intervention. J Sport Rehabil. 2009, 18: 269-282.PubMed
27.
Donzelli S, Di Domenica F, Cova AM, Galletti R, Giunta N: Two different techniques in the rehabilitation treatment of low back pain: a randomized controlled trial. Europa Medicophysica. 2006, 42: 205-210.PubMed
28.
Gagnon LH: Efficacy of Pilates exercises as therapeutic intervention in treating patients with low back pain. 2005, University of Tennessee, PhD thesis
29.
MacIntyre L: The effect of Pilates on patients’ chronic low back pain: A pilot study. Master of Science in Physiotherapy thesis. 2006, Johannesburg: University of the Witwatersrand, Thesis
30.
Vad VB, Bhat AL, Tarabichi Y: The role of back rx exercise program in diskogenic low back pain: A prospective randomized trial. Arch Phys Med Rehabil. 2007, 88: 577-582. 10.1016/j.apmr.2007.02.008.CrossRefPubMed
31.
Gladwell V, Head S, Haggar M, Beneke R: Does a program of Pilates improve chronic non-specific low back pain?. J Sport Rehabil. 2006, 15: 338-350.
32.
O’Brien N, Hanlon N, Meldrum D: Randomised controlled trial comparing physiotherapy and Pilates in the treatment of ordinary low back pain[abstract]. Phys Ther Rev. 2006, 11: 224-225. 10.1179/174329306X84300.
33.
Roach K, Carreras K, Lee A, Reed L, Zimmerman G: Development and reliability of the Miami Back Index. JOSPT. 2001, 31: 97-CrossRef
34.
Chapman JR, Norvell DC, Hermsmeyer JT, Bransford RJ, DeVine J, McGirt MJ, Lee MJ: Evaluating common outcomes for measuring treatment success for chronic low back pain. Spine. 2011, 36 (Suppl): S54-68.CrossRefPubMed
35.
Quinn J: Influence of Pilates-based mat exercise on chronic lower back pain. 2005, Boca Raton, Florida: Florida Atlantic University, PhD thesis
36.
Furlan AD, Pennick V, Bombardier C, van Tulder M: Updated method guidelines for systematic reviews in the Cochrane Back Review Group. Spine. 2009, 34: 1929-1941. 10.1097/BRS.0b013e3181b1c99f.CrossRefPubMed
37.
Viera AJ, Garrett JM: Understanding interobserver agreement: The kappa statistic. Fam Med. 2005, 37: 360-363.PubMed
38.
Maher C: Effective physical treatment for chronic low back pain. Orthop Clin North Am. 2004, 35: 57-64. 10.1016/S0030-5898(03)00088-9.CrossRefPubMed
39.
Krismer M, van Tulder M: Strategies for prevention and management of musculoskeletal conditions. Low back pain (non-specific). Best Pract Res Clin Rheumatol. 2007, 21: 77-91. 10.1016/j.berh.2006.08.004.CrossRefPubMed
40.
Godwin M, Ruhland L, Casson I, MacDonald S, Delva D, Birtwhistle R, Lam M, Seguin R: Pragmatic controlled clinical trials in primary care: The struggle between external and internal validity. BMC Med Res Methodol. 2003, 3: 28-10.1186/1471-2288-3-28.CrossRefPubMedPubMedCentral
41.
Davidson M, Keating JL: A comparison of five low back disability questionnaires: Reliability and responsiveness. Phys Ther. 2002, 82: 8-24.PubMed
42.
Hopewell S, McDonald S, Clarke M, Egger M: Grey literature in meta-analyses of randomised trials of health care interventions. Cochrane Database Syst Rev. 2007, 10.1002/14651858.MR000010.pub3. Issue 2. Art No.: MR000010
43.
Dwan K, Altman DG, Arnaiz JA, Bloom J, Chan A-W, Cronin E, Decullier E, Easterbrook PJ, Von Elm E, Gamble C, Ghersi D, Ioannidis JPA, Simes J, Williamson PR: Systematic Review of the Empirical Evidence of Study Publication Bias and Outcome Reporting Bias. PLoS One. 2008, 3: e3081-10.1371/journal.pone.0003081.CrossRefPubMedPubMedCentral
44.
van Tulder MW, Suttorp M, Morton S, Bouter LM, Shekella P: Empirical evidence of an association between internal validity and effect size in randomized controlled trials of low-back pain. Spine. 2009, 34: 1685-1692. 10.1097/BRS.0b013e3181ab6a78.CrossRefPubMed
45.
Sterne JAC, Gavaghan D, Egger M: Publication and related bias in meta-analysis: Power of statistical tests and prevalence in the literature. J Clin Epidemiol. 2000, 53: 1119-1129. 10.1016/S0895-4356(00)00242-0.CrossRefPubMed
46.
Thomson SG, Higgins JP: How should meta-regression analyses be undertaken and interpreted?. Stat Med. 2002, 21: 15591573-
47.
Lambert PC, Sutton AJ, Abrams KR, Jones DR: A comparison of summary patient-level covariates in regression with individual patient data meta-analysis. J Clin Epidemiol. 2002, 55: 86-94. 10.1016/S0895-4356(01)00414-0.CrossRefPubMed
48.
Egger M, Bartlett C, Holenstein F, Sterne J: How important are comprehensive literature searches and the assessment of trial quality in systematic reviews? Empirical study. Health Technol Assess. 2003, 7: 1-76.PubMed
49.
Khad KS, Kunz R, Kleijnen J, Antes G: Five steps to conducting a systematic review. J R Soc Med. 2003, 96: 118-121. 10.1258/jrsm.96.3.118.CrossRef
50.
Slavin RE: Best evidence synthesis: An intelligent alternative to meta-analysis. Clin Epidemiol. 1995, 48: 9-18. 10.1016/0895-4356(94)00097-A.CrossRef
51.
Tobin MJ, Jabran A: Meta-analysis under the spotlight: Focused on a meta-analysis of ventilator weaning. Crit Care Med. 2008, 36: 1-7. 10.1097/01.CCM.0000297883.04634.11.CrossRefPubMed
52.
Noordzij M, Hooft L, Dekker FW, Zoccali C, Jager KJ: Systematic reviews and meta-analyses: When they are useful and when to be careful. Kidney Int. 2009, 76: 1130-1136. 10.1038/ki.2009.339.CrossRefPubMed
53.
Walker E, Hernandez AV, Kattan MW: Meta-analysis: Its strengths and limitations. Cleve Clin J Med. 2008, 75: 431-440. 10.3949/ccjm.75.6.431.CrossRefPubMed
Metadata
Title
Effectiveness of Pilates exercise in treating people with chronic low back pain: a systematic review of systematic reviews
Authors
Cherie Wells
Gregory S Kolt
Paul Marshall
Bridget Hill
Andrea Bialocerkowski
Publication date
01-12-2013
Publisher
BioMed Central
Published in
BMC Medical Research Methodology / Issue 1/2013
Electronic ISSN: 1471-2288
DOI
https://doi.org/10.1186/1471-2288-13-7

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