Motor control exercise for chronic non‐specific low‐back pain

Bruno T Saragiotto; Christopher G Maher; Tiê P Yamato; Leonardo OP Costa; Luciola C Menezes Costa; Raymond WJG Ostelo; Luciana G Macedo

doi:10.1002/14651858.CD012004

Übungen für die Bewegungskontrolle bei chronischen, unspezifischen Kreuzschmerzen

Appendices

Appendix 1. Database search strategy

MEDLINE

Last searched 2 April 2015.

randomized controlled trial.pt.
controlled clinical trial.pt.
clinical trial.pt.
exp clinical trial/
Random Allocation/
Double‐Blind Method/
Single‐Blind Method/
Comparative Study/
evaluation studies/
Follow‐Up Studies/
cross‐over studies/
Research Design/
Placebos/
(clinic$ adj25 trial$).tw.
((single$ or double$ or treble$ or triple$) adj (mask$ or blind$)).tw.
(control$ or prospective$ or volunteer$).tw.
(latin adj square).tw.
placebo$.tw.
random$.tw.
or/1‐19
(animals not (humans and animals)).sh.
20 not 21
dorsalgia.ti,ab.
exp Back Pain/
backache.ti,ab.
(lumbar adj pain).ti,ab.
coccyx.ti,ab.
coccydynia.ti,ab.
sciatica.ti,ab.
exp sciatic neuropathy/
spondylosis.ti,ab.
lumbago.ti,ab.
low back pain.mp.
or/23‐33
22 and 34
exp Exercise/
exercise$.mp.
train$.mp.
36 or 37 or 38
specific.mp.
stabili$.mp.
segment$.mp.
multifidus.mp.
transversus.mp.
motor control.mp.
or/40‐45
39 and 46
35 and 47
limit 48 to yr=2014‐2015
limit 48 to ed=20140516‐20150402
49 or 50

MEDLINE In‐Process & Other Non‐Indexed Citations

Searched 2 April 2015.

randomized controlled trial.pt.
controlled clinical trial.pt.
clinical trial.pt.
exp clinical trial/
Random Allocation/
Double‐Blind Method/
Single‐Blind Method/
Comparative Study/
evaluation studies/
Follow‐Up Studies/
cross‐over studies/
Research Design/
Placebos/
(clinic$ adj25 trial$).tw.
((single$ or double$ or treble$ or triple$) adj (mask$ or blind$)).tw.
(control$ or prospective$ or volunteer$).tw.
(latin adj square).tw.
placebo$.tw.
random$.tw.
or/1‐19
(animals not (humans and animals)).sh.
20 not 21
dorsalgia.ti,ab.
exp Back Pain/
backache.ti,ab.
(lumbar adj pain).ti,ab.
coccyx.ti,ab.
coccydynia.ti,ab.
sciatica.ti,ab.
exp sciatic neuropathy/
spondylosis.ti,ab.
lumbago.ti,ab.
low back pain.mp.
or/23‐33
22 and 34
exp Exercise/
exercise$.mp.
train$.mp.
36 or 37 or 38
specific.mp.
stabili$.mp.
segment$.mp.
multifidus.mp.
transversus.mp.
motor control.mp.
or/40‐45
39 and 46
35 and 47

EMBASE

Last searched 2 April 2015.

randomi#ed controlled trial.mp.
clinical trial/
double blind.mp.
single blind.mp.
placebo/
Controlled Study/
Randomized Controlled Trial/
Double Blind Procedure/
Single Blind Procedure/
crossover procedure/
random$.mp.
((singl$ or doubl$ or trebl$ or tripl$) adj25 (blind$ or mask$)).mp.
(versus or vs).mp.
(clinic$ adj2 trial$).tw.
or/1‐14
limit 15 to human
dorsalgia.mp.
back pain.mp.
exp BACKACHE/
(lumbar adj pain).mp.
coccyx.mp.
coccydynia.mp.
sciatica.mp.
exp ISCHIALGIA/
spondylosis.mp.
lumbago.mp.
low back pain.mp.
or/17‐27
16 and 28
exp exercise/
exercise$.mp.
train$.mp.
30 or 31 or 32
motor control.mp.
stabili$.mp.
segment$.mp.
multifidus.mp.
transversus.mp.
or/34‐38
33 and 39
29 and 40
limit 41 to yr=2014‐2015
limit 41 to em=201419‐201513
42 or 43

CENTRAL

Last searched 2 April 2015.

#1 MeSH descriptor: [Back Pain] explode all trees

#2 dorsalgia

#3 backache

#4 MeSH descriptor: [Low Back Pain] explode all trees

#5 lumbar next pain OR coccyx OR coccydynia OR sciatica OR spondylosis

#6 MeSH descriptor: [Sciatica] explode all trees

#7 MeSH descriptor: [Spine] explode all trees

#8 MeSH descriptor: [Spinal Diseases] explode all trees

#9 lumbago OR discitis OR disc near degeneration OR disc near prolapse OR disc near herniation

#10 spinal fusion

#11 spinal neoplasms

#12 facet near joints

#13 MeSH descriptor: [Intervertebral Disk] explode all trees

#14 postlaminectomy

#15 arachnoiditis

#16 failed near back

#17 MeSH descriptor: [Cauda Equina] explode all trees

#18 lumbar near vertebra*

#19 spinal near stenosis

#20 slipped near (disc* or disk*)

#21 degenerat* near (disc* or disk*)

#22 stenosis near (spine or root or spinal)

#23 displace* near (disc* or disk*)

#24 prolap* near (disc* or disk*)

#25 #1 or #2 or #3 or #4 or #5 or #6 or #7 or #8 or #9 or #10 or #11 or #12 or #13 or #14 or #15 or #16 or #17 or #18 or #19 or #20 or #21 or #22 or #23 or #24

#26 MeSH descriptor: [Exercise] explode all trees

#27 exercis*

#28 train*

#29 #26 or #27 or #28

#30 motor control

#31 transversus

#32 multifidus

#33 segment*

#34 stabili*

#35 #31 or #32 or #33 or #34

#36 #25 and #29 and #35 Publication Year from 2014 to 2015, in Trials

CINAHL

Last searched 2 April 2015.

S62 S61 Limiters ‐ Published Date: 20130501‐20150431

S61 S49 AND S56 AND S60

S60 S57 OR S58 OR S59

S59 "train*"

S58 "exercise*"

S57 (MH "Exercise+")

S56 S50 OR S51 OR S52 OR S53 OR S54 OR S55

S55 specific W2 stabili?ation

S54 "stabili?ation"

S53 "multifidus"

S52 (MH "Multifidus Muscles")

S51 "transversus"

S50 "motor control"

S49 S28 and S48

S48 S35 or S43 or S47

S47 S44 or S45 or S46

S46 "lumbago" 33

S45 (MH "Spondylolisthesis") OR (MH "Spondylolysis")

S44 (MH "Thoracic Vertebrae")

S43 S36 or S37 or S38 or S39 or S40 or S41 or S42

S42 lumbar N2 vertebra

S41 (MH "Lumbar Vertebrae")

S40 "coccydynia"

S39 "coccyx"

S38 "sciatica"

S37 (MH "Sciatica")

S36 (MH "Coccyx")

S35 S29 or S30 or S31 or S32 or S33 or S34

S34 lumbar N5 pain

S33 lumbar W1 pain 282

S32 "backache"

S31 (MH "Low Back Pain")

S30 (MH "Back Pain+")

S29 "dorsalgia"

S28 S26 NOT S27

S27 (MH "Animals")

S26 S7 or S12 or S19 or S25

S25 S20 or S21 or S22 or S23 or S24

S24 volunteer*

S23 prospectiv*

S22 control*

S21 followup stud*

S20 follow‐up stud*

S19 S13 or S14 or S15 or S16 or S17 or S18

S18 (MH "Prospective Studies+")

S17 (MH "Evaluation Research+")

S16 (MH "Comparative Studies")

S15 latin square

S14 (MH "Study Design+")

S13 (MH "Random Sample")

S12 S8 or S9 or S10 or S11

S11 random*

S10 placebo*

S9 (MH "Placebos")

S8 (MH "Placebo Effect")

S7 S1 or S2 or S3 or S4 or S5 or S6

S6 triple‐blind 94

S5 single‐blind 6,829

S4 double‐blind 24,437

S3 clinical W3 trial 14,324

S2 "randomi?ed controlled trial*"

S1 (MH "Clinical Trials+")

AMED

Last searched 2 April 2015.

randomized controlled trial.pt.
controlled clinical trial.pt.
clinical trial.pt.
exp clinical trials/
random allocation/
double blind method/
single blind method/
comparative study/
follow up studies/
research design/
placebos/
(clinic$ adj25 trial$).tw.
((single$ or double$ or treble$ or triple$) adj (mask$ or blind$)).tw.
(control$ or prospective$ or volunteer$).tw.
(latin adj square).tw.
placebo$.tw.
random$.tw.
or/1‐17
(animals not (humans and animals)).sh.
18 not 19
dorsalgia.mp.
exp backache/
sciatica/
(lumbar adj pain).ti,ab.
sciatica.mp.
spondylosis.mp.
coccyx.mp.
lumbago.mp.
low back pain.mp.
or/21‐29
20 and 30
exercise/
exercise$.mp.
train$.mp.
or/32‐34
specific.mp.
stabili$.mp. [mp=abstract, heading words, title]
segment$.mp.
multifidus.mp.
transversus.mp.
motor control.mp.
or/36‐41
35 and 42
31 and 43
limit 44 to yr=2014‐2015

SPORTDiscus

Last searched 2 April 2015.

S28 S27 Limiters ‐ Published Date: 20140501‐20150431

S27 S16 AND S20 AND S26

S26 S21 OR S22 OR S23 OR S24 OR S25

S25 specific W2 stabili?ation

S24 stabili?ation

S23 multifidus

S22 transversus

S21 motor control

S20 S17 OR S18 OR S19

S19 train*

S18 exercise*

S17 DE "EXERCISE" or DE "BACK exercises" or DE "EXERCISE therapy" or DE "PHYSICAL education & training" or DE "PHYSICAL fitness"

S16 S10 AND S15

S15 S11 OR S12 OR S13 OR S14

S14 DE "LUMBAR vertebrae" or DE "LUMBOSACRAL region"

S13 DE "SCIATICA"

S12 low back pain

S11 DE "BACKACHE"

S10 S1 OR S2 OR S3 OR S4 OR S5 OR S6 OR S7 OR S8 OR S9

S9 single blind

S8 random allocation

S7 SU randomized controlled trial

S6 SU clinical trials

S5 clinical trials

S4 placebo

S3 controlled clinical trial

S2 double blind

S1 randomi?ed controlled trial

PEDro

Last searched 2 April 2015.

Abstract & Title: Exercise

AND

Problem: pain

AND

Body Part: lumbar spine, sacro‐iliac joint or pelvis

AND

Method: clinical trial

New records added since: 15/05/2014

LILACS

Last searched 2 April 2015.

back pain AND exercise, all indexes on the homepage

Filter: Type of study: clinical Trial OR guidelines

dor lombar AND exercicio, all indexes on the homepage

Filter: Type of study: clinical trial OR guidelines

ClinicalTrials.gov

Last searched 2 April 2015.

Condition: back pain

Intervention: exercise

received on or after 05/15/2014

WHO ICTRP

Last searched 2 April 2015.

Condition: back pain

Intervention: exercise

Date of registration is between 15/05/2014‐02/04/2015

PubMed

Searched 2 April 2015.

((dorsalgia OR back pain OR backache OR lumbar pain OR coccydynia OR sciatica OR lumbago OR spondylosis) AND ((exercise* OR train*) AND (specific* OR stabili* OR segment* OR multifidus OR transverses OR motor control)) AND (pubstatusaheadofprint OR publisher[sb] or pubmednotmedline[sb]))

From 2014/05/01 to 2015/12/31

Appendix 2. Criteria for assessing risk of bias for internal validity

Random sequence generation (selection bias)

Selection bias (biased allocation to interventions) due to inadequate generation of a randomised sequence

There is a low risk of selection bias if the investigators describe a random component in the sequence generation process such as: referring to a random number table, using a computer random number generator, coin tossing, shuffling cards or envelopes, throwing dice, drawing of lots, minimisation (minimisation may be implemented without a random element, and this is considered to be equivalent to being random).

There is a high risk of selection bias if the investigators describe a non‐random component in the sequence generation process, such as: sequence generated by odd or even date of birth, date (or day) of admission, hospital or clinic record number; or allocation by judgement of the clinician, preference of the participant, results of a laboratory test or a series of tests, or availability of the intervention.

Allocation concealment (selection bias)

Selection bias (biased allocation to interventions) due to inadequate concealment of allocations prior to assignment

There is a low risk of selection bias if the participants and investigators enrolling participants could not foresee assignment because one of the following, or an equivalent method, was used to conceal allocation: central allocation (including telephone, web‐based and pharmacy‐controlled randomisation); sequentially numbered drug containers of identical appearance; or sequentially numbered, opaque, sealed envelopes.

There is a high risk of bias if participants or investigators enrolling participants could possibly foresee assignments and thus introduce selection bias, such as allocation based on: using an open random allocation schedule (e.g. a list of random numbers); assignment envelopes were used without appropriate safeguards (e.g. if envelopes were unsealed or non‐opaque or not sequentially numbered); alternation or rotation; date of birth; case record number; or other explicitly unconcealed procedures.

Blinding of participants

Performance bias due to knowledge of the allocated interventions by participants during the study

There is a low risk of performance bias if blinding of participants was ensured and it was unlikely that the blinding could have been broken; or if there was no blinding or incomplete blinding, but the review authors judge that the outcome is not likely to be influenced by lack of blinding.

Blinding of personnel/care providers (performance bias)

Performance bias due to knowledge of the allocated interventions by personnel/care providers during the study

There is a low risk of performance bias if blinding of personnel was ensured and it was unlikely that the blinding could have been broken; or if there was no blinding or incomplete blinding, but the review authors judge that the outcome is not likely to be influenced by lack of blinding.

Blinding of outcome assessor (detection bias)

Detection bias due to knowledge of the allocated interventions by outcome assessors

There is low risk of detection bias if the blinding of the outcome assessment was ensured and it was unlikely that the blinding could have been broken; or if there was no blinding or incomplete blinding, but the review authors judge that the outcome is not likely to be influenced by lack of blinding, or:

for patient‐reported outcomes in which the patient was the outcome assessor (e.g. pain, disability): there is a low risk of bias for outcome assessors if there is a low risk of bias for participant blinding (Boutron 2005);
for outcome criteria that are clinical or therapeutic events that will be determined by the interaction between patients and care providers (e.g. co‐interventions, length of hospitalisation, treatment failure), in which the care provider is the outcome assessor: there is a low risk of bias for outcome assessors if there is a low risk of bias for care providers (Boutron 2005);
for outcome criteria that are assessed from data from medical forms: there is a low risk of bias if the treatment or adverse effects of the treatment could not be noticed in the extracted data (Boutron 2005).

Incomplete outcome data (attrition bias)

Attrition bias due to amount, nature or handling of incomplete outcome data

There is a low risk of attrition bias if there were no missing outcome data; reasons for missing outcome data were unlikely to be related to the true outcome (for survival data, censoring unlikely to be introducing bias); missing outcome data were balanced in numbers, with similar reasons for missing data across groups; for dichotomous outcome data, the proportion of missing outcomes compared with the observed event risk was not enough to have a clinically relevant impact on the intervention effect estimate; for continuous outcome data, the plausible effect size (difference in means or standardised difference in means) among missing outcomes was not enough to have a clinically relevant impact on observed effect size, or missing data were imputed using appropriate methods (if dropouts are very large, imputation using even 'acceptable' methods may still suggest a high risk of bias) (van Tulder 2003). The percentage of withdrawals and dropouts should not exceed 20% for short‐term follow‐up and 30% for long‐term follow‐up and should not lead to substantial bias (these percentages are commonly used but arbitrary, not supported by literature) (van Tulder 2003).

Selective reporting (reporting bias)

Reporting bias due to selective outcome reporting

There is low risk of reporting bias if the study protocol is available and all of the study's pre‐specified (primary and secondary) outcomes that are of interest in the review have been reported in the pre‐specified way, or if the study protocol is not available but it is clear that the published reports include all expected outcomes, including those that were pre‐specified (convincing text of this nature may be uncommon).

There is a high risk of reporting bias if not all of the study's pre‐specified primary outcomes have been reported; one or more primary outcomes is reported using measurements, analysis methods or subsets of the data (e.g. subscales) that were not pre‐specified; one or more reported primary outcomes were not pre‐specified (unless clear justification for their reporting is provided, such as an unexpected adverse effect); one or more outcomes of interest in the review are reported incompletely so that they cannot be entered in a meta‐analysis; the study report fails to include results for a key outcome that would be expected to have been reported for such a study.

Group similarity at baseline (selection bias)

Bias due to dissimilarity at baseline for the most important prognostic indicators.

There is low risk of bias if groups are similar at baseline for demographic factors, value of main outcome measure(s) and important prognostic factors (examples in the field of back and neck pain are duration and severity of complaints, vocational status, percentage of patients with neurological symptoms) (van Tulder 2003).

Co‐interventions (performance bias)

Bias because co‐interventions were different across groups

There is low risk of bias if there were no co‐interventions or they were similar between the index and control groups (van Tulder 2003).

Compliance (performance bias)

Bias due to inappropriate compliance with interventions across groups

There is low risk of bias if compliance with the interventions was acceptable, based on the reported intensity/dosage, duration, number and frequency for both the index and control intervention(s). For single‐session interventions (e.g. surgery), this item is irrelevant (van Tulder 2003).

Intention‐to‐treat‐analysis

There is low risk of bias if all randomised patients were reported/analysed in the group to which they were allocated by randomisation.

Timing of outcome assessments (detection bias)

Bias because important outcomes were not measured at the same time across groups

There is low risk of bias if all important outcome assessments for all intervention groups were measured at the same time (van Tulder 2003).

Other bias

Bias due to problems not covered elsewhere in the table

There is a low risk of bias if the study appears to be free of other sources of bias not addressed elsewhere (e.g. study funding).

Figure 1

Study flow diagram.

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Figure 2

'Risk of bias' summary: review authors' judgements about each risk of bias item for each included study.

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Figure 3

'Risk of bias' graph: review authors' judgements about each risk of bias item presented as percentages across all included studies.

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Figure 4

Funnel plot of comparison: motor control exercise versus other exercises, outcome: Pain.

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Figure 5

Funnel plot of comparison: Motor control exercise versus other exercises, outcome: Disability.

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Analysis 1.1

Comparison 1 Motor control exercise versus other exercises, Outcome 1 Pain.

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Analysis 1.2

Comparison 1 Motor control exercise versus other exercises, Outcome 2 Disability.

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Analysis 1.3

Comparison 1 Motor control exercise versus other exercises, Outcome 3 Function.

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Analysis 1.4

Comparison 1 Motor control exercise versus other exercises, Outcome 4 Global impression of recovery.

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Analysis 1.5

Comparison 1 Motor control exercise versus other exercises, Outcome 5 Quality of life (physical component summary).

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Analysis 1.6

Comparison 1 Motor control exercise versus other exercises, Outcome 6 Quality of life (mental component summary).

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Analysis 2.1

Comparison 2 Motor control exercise versus manual therapy, Outcome 1 Pain.

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Analysis 2.2

Comparison 2 Motor control exercise versus manual therapy, Outcome 2 Disability.

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Analysis 2.3

Comparison 2 Motor control exercise versus manual therapy, Outcome 3 Function.

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Analysis 2.4

Comparison 2 Motor control exercise versus manual therapy, Outcome 4 Global impression of recovery.

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Analysis 3.1

Comparison 3 Motor control exercise versus minimal intervention, Outcome 1 Pain.

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Analysis 3.2

Comparison 3 Motor control exercise versus minimal intervention, Outcome 2 Disability.

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Analysis 3.3

Comparison 3 Motor control exercise versus minimal intervention, Outcome 3 Function.

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Analysis 3.4

Comparison 3 Motor control exercise versus minimal intervention, Outcome 4 Global impression of recovery.

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Analysis 4.1

Comparison 4 Motor control exercise versus exercise and EPA, Outcome 1 Pain.

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Analysis 4.2

Comparison 4 Motor control exercise versus exercise and EPA, Outcome 2 Disability.

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Analysis 4.3

Comparison 4 Motor control exercise versus exercise and EPA, Outcome 3 Global impression of recovery.

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Analysis 4.4

Comparison 4 Motor control exercise versus exercise and EPA, Outcome 4 Quality of life (physical component summary).

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Analysis 4.5

Comparison 4 Motor control exercise versus exercise and EPA, Outcome 5 Quality of life (mental component summary).

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Analysis 5.1

Comparison 5 Motor control exercise versus telerehabilitation, Outcome 1 Pain.

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Analysis 5.2

Comparison 5 Motor control exercise versus telerehabilitation, Outcome 2 Disability.

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Analysis 5.3

Comparison 5 Motor control exercise versus telerehabilitation, Outcome 3 Quality of life (mental component summary).

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Analysis 5.4

Comparison 5 Motor control exercise versus telerehabilitation, Outcome 4 Quality of life (physical component summary).

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Analysis 6.1

Comparison 6 Sensitivity analysis 1: motor control exercise versus other exercises, Outcome 1 Pain.

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Analysis 6.2

Comparison 6 Sensitivity analysis 1: motor control exercise versus other exercises, Outcome 2 Disability.

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Analysis 7.1

Comparison 7 Sensitivity analysis 2: motor control exercise versus minimal intervention, Outcome 1 Pain.

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Analysis 7.2

Comparison 7 Sensitivity analysis 2: motor control exercise versus minimal intervention, Outcome 2 Disability.

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Analysis 8.1

Comparison 8 Sensitivity analysis 3: motor control exercise versus manual therapy, Outcome 1 Pain.

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Analysis 8.2

Comparison 8 Sensitivity analysis 3: motor control exercise versus manual therapy, Outcome 2 Disability.

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Motor control exercise compared with other exercises for chronic low back pain
Patient or population: patients with non‐specific chronic low back pain Settings: primary or tertiary care Intervention: motor control exercise Comparison: other exercises
Outcomes	*Illustrative comparative risks (95% CI)**		No of participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Other exercises	Motor control exercise
Pain VAS (0 to 100) Short‐term follow‐up (< 3 months from randomisation)	The mean pain ranged across control groups from 10.5 to 48 points	The mean pain in the intervention groups was 7.43 points lower (10.47 to 4.40 lower)	872 participants (13 studies)	⊕⊕⊝⊝ low^1,2	—
Pain VAS (0 to 100) Intermediate follow‐up (> 3 months and < 12 months)	The mean pain ranged across control groups from 17.8 to 48 points	The mean pain in the intervention groups was 4.88 points lower (8.14 to 1.62 lower)	588 participants (6 studies)	⊕⊕⊕⊕ high	—
Pain VAS (0 to 100) Long‐term follow‐up (> 12 months from randomisation)	The mean pain ranged across control groups from 26.6 to 52 points	The mean pain in the intervention groups was 2.69 points lower (6.90 lower to 1.53 higher)	643 participants (5 studies)	⊕⊕⊕⊕ high	—
Disability Multiple scales (0 to 100) Short‐term follow‐up (< 3 months from randomisation)	The mean disability ranged across control groups from 11 to 40.4 points	The mean disability in the intervention groups was 4.84 points lower (7.02 to 2.65 lower)	794 participants (11 studies)	⊕⊝⊝⊝ low^1,2	—
Disability Multiple scales (0 to 100) Intermediate follow‐up (> 3 months and < 12 months)	The mean disability ranged across control groups from 8 to 42.1 points	The mean disability in the intervention groups was 4.17 points lower (8.12 to 0.23 lower)	588 participants (6 studies)	⊕⊕⊕⊕ high	—
Disability Multiple scales (0 to 100) Long‐term follow‐up (> 12 months from randomisation)	The mean disability ranged across control groups from 27.1 to 40 points	The mean disability in the intervention groups was 0.71 points lower (4.87 lower to 3.45 higher)	570 participants (4 studies)	⊕⊕⊕⊕ high	—
Adverse events	See comment	See comment	—	See comment	2 trials reported mild adverse events
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: Confidence interval; VAS: visual analogue scale
GRADE Working Group grades of evidence High quality: We are very confident that the true effect lies close to that of the estimate of the effect. Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect. Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect.
¹Downgraded due to risk of bias (> 25% of the participants from trials with a high risk of bias). ²Downgraded due to publication bias.

Ir a la tabla de la revisión

Motor control exercise compared with manual therapy for chronic low back pain
Patient or population: patients with non‐specific chronic low back pain Settings: primary or tertiary care Intervention: motor control exercise Comparison: manual therapy
Outcomes	*Illustrative comparative risks (95% CI)**		No of participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Manual therapy	Motor control exercise
Pain VAS (0 to 100) Short‐term follow‐up (< 3 months from randomisation)	The mean pain ranged across control groups from 27.2 to 41 points	The mean pain in the intervention groups was 4.36 points lower (9.52 lower to 0.81 higher)	282 participants (3 studies)	⊕⊕⊕⊝ moderate¹	—
Pain VAS (0 to 100) Intermediate follow‐up (> 3 months and < 12 months)	The mean pain ranged across control groups from 26.7 to 43 points	The mean pain in the intervention groups was 7.05 points lower (14.20 lower to 0.11 higher)	485 participants (4 studies)	⊕⊕⊕⊝ moderate²	—
Pain VAS (0 to 100) Long‐term follow‐up (> 12 months from randomisation)	The mean pain ranged across control groups from 26.2 to 49 points	The mean pain in the intervention groups was 3.67 points lower (9.28 lower to 1.94 higher)	406 participants (4 studies)	⊕⊕⊕⊕ high	—
Disability Multiple scales (0 to 100) Short‐term follow‐up (< 3 months from randomisation)	The mean disability ranged across control groups from 14 to 32.9 points	The mean disability in the intervention groups was 2.79 points lower (6.60 lower to 1.02 higher)	282 participants (3 studies)	⊕⊕⊕⊝ moderate¹	—
Disability Multiple scales (0 to 100) Intermediate follow‐up (> 3 months and < 12 months)	The mean disability ranged across control groups from 14 to 33.3 points	The mean disability in the intervention groups was 3.28 points lower (6.97 lower to 0.40 higher)	485 participants (4 studies)	⊕⊕⊕⊕ high	—
Disability Multiple scales (0 to 100) Long‐term follow‐up (> 12 months from randomisation)	The mean disability ranged across control groups from 14.3 to 38.3 points	The mean disability in the intervention groups was 3.40 points lower (7.87 lower to 1.07 higher)	406 participants (4 studies)	⊕⊕⊕⊕ high	—
Adverse events	See comment	See comment	—	See comment	None of the included trials reported any relevant adverse events
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; VAS: visual analogue scale
GRADE Working Group grades of evidence High quality We are very confident that the true effect lies close to that of the estimate of the effect. Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect. Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect.
¹Downgraded due to imprecision. ²Downgraded due to inconsistency.

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Motor control exercise compared with minimal intervention for chronic low back pain
Patient or population: patients with non‐specific chronic low back pain Settings: primary or tertiary care Intervention: motor control exercise Comparison: minimal intervention
Outcomes	*Illustrative comparative risks (95% CI)**		No of participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Minimal intervention	Motor control exercise
Pain VAS (0 to 100) Short‐term follow‐up (< 3 months from randomisation)	The mean pain ranged across control groups from 9.4 to 56 points	The mean pain in the intervention groups was 10.01 points lower (15.67 to 4.35 lower)	291 participants (4 studies)	⊕⊕⊕⊝ moderate¹	—
Pain VAS (0 to 100) Intermediate follow‐up (> 3 months and < 12 months)	The mean pain ranged across control groups from 30.3 to 56 points	The mean pain in the intervention groups was 12.61 points lower (20.53 to 4.69 lower)	348 participants (4 studies)	⊕⊕⊝⊝ low^1,2	—
Pain VAS (0 to 100) Long‐term follow‐up (> 12 months from randomisation)	The mean pain ranged across control groups from 26.6 to 50.9 points	The mean pain in the intervention groups was 12.97 points lower (18.51 to 7.42 lower)	279 participants (3 studies)	⊕⊕⊕⊝ moderate¹	—
Disability Multiple scales (0 to 100) Short‐term follow‐up (< 3 months from randomisation)	The mean disability ranged across control groups from 17.5 to 49.6 points	The mean disability in the intervention groups was 8.63 points lower (14.78 to 2.47 lower)	332 participants (5 studies)	⊕⊝⊝⊝ very low^1,2,3	—
Disability Multiple scales (0 to 100) Intermediate follow‐up (> 3 months and < 12 months)	The mean disability ranged across control groups from 0.1 to 50.8 points	The mean disability in the intervention groups was 5.47 points lower (9.17 to 1.77 lower)	348 participants (4 studies)	⊕⊕⊕⊝ moderate¹	—
Disability Multiple scales (0 to 100) Long‐term follow‐up (> 12 months from randomisation)	The mean disability ranged across control groups from 14.9 to 51.3 points	The mean disability in the intervention groups was 5.96 points lower (9.81 to 2.11 lower)	279 participants (3 studies)	⊕⊕⊕⊝ moderate¹	—
Adverse events	See comment	See comment	—	See comment	One trial reported mild adverse events
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; VAS: visual analogue scale
GRADE Working Group grades of evidence High quality We are very confident that the true effect lies close to that of the estimate of the effect. Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect. Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect.
¹Downgraded due to imprecision. ²Downgraded due to inconsistency. ³Downgraded due to risk of bias (> 25% of the participants from trials with a high risk of bias).

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Motor control exercise compared with a combination of exercise and electrophysical agents (EPA) for chronic low back pain
Patient or population: patients with non‐specific chronic low back pain Settings: primary or tertiary care Intervention: motor control exercise Comparison: exercise and EPA
Outcomes	*Illustrative comparative risks (95% CI)**		No of Participants (studies)	Quality of the evidence (GRADE)	Comments
	Assumed risk	Corresponding risk
	Exercise and EPA	Motor control exercise
Pain VAS (0 to 100) Short‐term follow‐up (< 3 months from randomisation)	The mean pain ranged across control groups from 43.3 to 57.1 points	The mean pain in the intervention groups was 30.18 points lower (35.32 to 25.05 lower)	68 participants (2 studies)	⊕⊕⊝⊝ low^1,2	—
Pain VAS (0 to 100) Intermediate follow‐up (> 3 months and < 12 months)	The mean pain ranged across control groups from 28.7 to 58.1 points	The mean pain in the intervention groups was 19.39 points lower (36.83 to 1.96 lower)	179 participants (2 studies)	⊕⊝⊝⊝ very low^1,2,3	—
Disability Multiple scales (0 to 100) Short‐term follow‐up (< 3 months from randomisation)	The mean disability in the control group was 34.54 points	The mean disability in the intervention group was 20.83 points lower (28.07 to 13.59 lower)	38 participants (1 study)	⊕⊝⊝⊝ very low^1,2,3	—
Disability Multiple scales (0 to 100) Intermediate follow‐up (> 3 months and < 12 months)	The mean disability in the control group was 26.79 points	The mean disability in the intervention group was 11.50 points lower (20.69 to 2.31 lower)	38 participants (1 study)	⊕⊕⊝⊝ low^1,3	—
Adverse events	See comment	See comment	—	See comment	None of the included trials reported any relevant adverse events
The basis for the assumed risk* (e.g. the median control group risk across studies) is provided in footnotes. The corresponding risk (and its 95% confidence interval) is based on the assumed risk in the comparison group and the relative effect of the intervention (and its 95% CI). CI: confidence interval; EPA: electrophysical agents; VAS: visual analogue scale
GRADE Working Group grades of evidence High quality We are very confident that the true effect lies close to that of the estimate of the effect. Moderate quality: We are moderately confident in the effect estimate: The true effect is likely to be close to the estimate of the effect, but there is a possibility that it is substantially different. Low quality: Our confidence in the effect estimate is limited: The true effect may be substantially different from the estimate of the effect. Very low quality: We have very little confidence in the effect estimate: The true effect is likely to be substantially different from the estimate of effect.
¹Downgraded due to imprecision. ²Downgraded due to indirectness. ³Downgraded due to inconsistency.

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Comparison 1. Motor control exercise versus other exercises

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Pain Show forest plot	16		Mean Difference (IV, Random, 95% CI)	Subtotals only

1.1 Short‐term (< 3 months from randomisation)	13	872	Mean Difference (IV, Random, 95% CI)	‐7.53 [‐10.54, ‐4.52]
1.2 Intermediate (≥ 3 to 12 months)	6	588	Mean Difference (IV, Random, 95% CI)	‐2.98 [‐6.96, 0.99]
1.3 Long‐term (> 12 months)	5	643	Mean Difference (IV, Random, 95% CI)	‐2.69 [‐6.90, 1.53]
2 Disability Show forest plot	14		Mean Difference (IV, Random, 95% CI)	Subtotals only

2.1 Short‐term (< 3 months from randomisation)	11	794	Mean Difference (IV, Random, 95% CI)	‐4.82 [‐6.95, ‐2.68]
2.2 Intermediate (≥ 3 to 12 months)	6	588	Mean Difference (IV, Random, 95% CI)	‐2.88 [‐6.92, 1.15]
2.3 Long‐term (> 12 months)	4	570	Mean Difference (IV, Random, 95% CI)	‐0.71 [‐4.87, 3.45]
3 Function Show forest plot	3		Mean Difference (IV, Random, 95% CI)	Subtotals only

3.1 Short‐term (< 3 months from randomisation)	3	361	Mean Difference (IV, Random, 95% CI)	7.29 [1.53, 13.04]
3.2 Intermediate (≥ 3 to 12 months)	2	332	Mean Difference (IV, Random, 95% CI)	0.31 [‐0.83, 1.44]
3.3 Long‐term (> 12 months)	2	332	Mean Difference (IV, Random, 95% CI)	0.52 [‐1.36, 2.41]
4 Global impression of recovery Show forest plot	2		Mean Difference (IV, Random, 95% CI)	Subtotals only

4.1 Short‐term (< 3 months from randomisation)	2	332	Mean Difference (IV, Random, 95% CI)	0.88 [‐0.88, 2.65]
4.2 Intermediate (≥ 3 to 12 months)	2	332	Mean Difference (IV, Random, 95% CI)	0.30 [‐0.22, 0.82]
4.3 Long‐term (> 12 months)	2	332	Mean Difference (IV, Random, 95% CI)	0.53 [‐0.03, 1.08]
5 Quality of life (physical component summary) Show forest plot	2		Mean Difference (IV, Random, 95% CI)	Subtotals only

5.1 Short‐term (< 3 months from randomisation)	1	172	Mean Difference (IV, Random, 95% CI)	0.0 [‐3.80, 3.80]
5.2 Intermediate (≥ 3 to 12 months)	1	172	Mean Difference (IV, Random, 95% CI)	1.40 [‐2.61, 5.41]
5.3 Long‐term (> 12 months)	2	269	Mean Difference (IV, Random, 95% CI)	0.08 [‐3.14, 3.30]
6 Quality of life (mental component summary) Show forest plot	2		Mean Difference (IV, Random, 95% CI)	Subtotals only

6.1 Short‐term (< 3 months from randomisation)	1	172	Mean Difference (IV, Random, 95% CI)	0.20 [‐3.39, 3.79]
6.2 Intermediate (≥ 3 to 12 months)	1	172	Mean Difference (IV, Random, 95% CI)	‐2.0 [‐5.32, 1.32]
6.3 Long‐term (> 12 months)	2	269	Mean Difference (IV, Random, 95% CI)	‐0.75 [‐3.33, 1.83]

Comparison 1. Motor control exercise versus other exercises

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Comparison 2. Motor control exercise versus manual therapy

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Pain Show forest plot	5		Mean Difference (IV, Random, 95% CI)	Subtotals only

1.1 Short‐term (< 3 months from randomisation)	3	282	Mean Difference (IV, Random, 95% CI)	‐4.36 [‐9.52, 0.81]
1.2 Intermediate (≥ 3 to 12 months)	4	485	Mean Difference (IV, Random, 95% CI)	‐7.05 [‐14.20, 0.11]
1.3 Long‐term (> 12 months)	4	406	Mean Difference (IV, Random, 95% CI)	‐3.67 [‐9.28, 1.94]
2 Disability Show forest plot	5		Mean Difference (IV, Random, 95% CI)	Subtotals only

2.1 Short‐term (< 3 months from randomisation)	3	282	Mean Difference (IV, Random, 95% CI)	‐2.79 [‐6.60, 1.02]
2.2 Intermediate (≥ 3 to 12 months)	4	485	Mean Difference (IV, Random, 95% CI)	‐3.28 [‐6.97, 0.40]
2.3 Long‐term (> 12 months)	4	406	Mean Difference (IV, Random, 95% CI)	‐3.40 [‐7.87, 1.07]
3 Function Show forest plot	1		Mean Difference (IV, Random, 95% CI)	Subtotals only

3.1 Short‐term (< 3 months from randomisation)	1	160	Mean Difference (IV, Random, 95% CI)	0.20 [‐1.82, 2.22]
3.2 Intermediate (≥ 3 to 12 months)	1	160	Mean Difference (IV, Random, 95% CI)	‐0.90 [‐3.01, 1.21]
3.3 Long‐term (> 12 months)	1	160	Mean Difference (IV, Random, 95% CI)	0.5 [‐1.61, 2.61]
4 Global impression of recovery Show forest plot	1		Mean Difference (IV, Random, 95% CI)	Subtotals only

4.1 Short‐term (< 3 months from randomisation)	1	160	Mean Difference (IV, Random, 95% CI)	0.5 [‐0.12, 1.12]
4.2 Intermediate (≥ 3 to 12 months)	1	160	Mean Difference (IV, Random, 95% CI)	0.20 [‐0.58, 0.98]
4.3 Long‐term (> 12 months)	1	160	Mean Difference (IV, Random, 95% CI)	0.60 [‐0.24, 1.44]

Comparison 2. Motor control exercise versus manual therapy

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Comparison 3. Motor control exercise versus minimal intervention

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Pain Show forest plot	6		Mean Difference (IV, Random, 95% CI)	Subtotals only

1.1 Short‐term (< 3 months from randomisation)	4	291	Mean Difference (IV, Random, 95% CI)	‐10.01 [‐15.67, ‐4.35]
1.2 Intermediate (≥ 3 to 12 months)	4	348	Mean Difference (IV, Random, 95% CI)	‐12.61 [‐20.53, ‐4.69]
1.3 Long‐term (> 12 months)	3	279	Mean Difference (IV, Random, 95% CI)	‐12.97 [‐18.51, ‐7.42]
2 Disability Show forest plot	7		Mean Difference (IV, Random, 95% CI)	Subtotals only

2.1 Short‐term (< 3 months from randomisation)	5	332	Mean Difference (IV, Random, 95% CI)	‐8.63 [‐14.78, ‐2.47]
2.2 Intermediate (≥ 3 to 12 months)	4	348	Mean Difference (IV, Random, 95% CI)	‐5.47 [‐9.17, ‐1.77]
2.3 Long‐term (> 12 months)	3	279	Mean Difference (IV, Random, 95% CI)	‐5.96 [‐9.81, ‐2.11]
3 Function Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

3.1 Short‐term (< 3 months from randomisation)	1	154	Mean Difference (IV, Fixed, 95% CI)	1.10 [0.36, 1.84]
3.2 Intermediate (≥ 3 to 12 months)	1	154	Mean Difference (IV, Fixed, 95% CI)	1.0 [0.16, 1.84]
3.3 Long‐term (> 12 months)	1	154	Mean Difference (IV, Fixed, 95% CI)	1.50 [0.68, 2.32]
4 Global impression of recovery Show forest plot	1		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

4.1 Short‐term (< 3 months from randomisation)	1	154	Mean Difference (IV, Fixed, 95% CI)	1.3 [0.30, 2.30]
4.2 Intermediate (≥ 3 to 12 months)	1	154	Mean Difference (IV, Fixed, 95% CI)	1.2 [0.31, 2.09]
4.3 Long‐term (> 12 months)	1	154	Mean Difference (IV, Fixed, 95% CI)	1.5 [0.61, 2.39]

Comparison 3. Motor control exercise versus minimal intervention

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Comparison 4. Motor control exercise versus exercise and EPA

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Pain Show forest plot	3		Mean Difference (IV, Random, 95% CI)	Subtotals only

1.1 Short‐term (< 3 months from randomisation)	2	68	Mean Difference (IV, Random, 95% CI)	‐30.18 [‐35.32, ‐25.05]
1.2 Intermediate (≥ 3 to 12 months)	2	179	Mean Difference (IV, Random, 95% CI)	‐19.39 [‐36.83, ‐1.96]
2 Disability Show forest plot	1		Mean Difference (IV, Random, 95% CI)	Subtotals only

2.1 Short‐term (< 3 months from randomisation)	1	38	Mean Difference (IV, Random, 95% CI)	‐20.83 [‐28.07, ‐13.59]
2.2 Intermediate (≥ 3 to 12 months)	1	38	Mean Difference (IV, Random, 95% CI)	‐11.5 [‐20.69, ‐2.31]
3 Global impression of recovery Show forest plot	1		Mean Difference (IV, Random, 95% CI)	Subtotals only

3.1 Short‐term (< 3 months from randomisation)	1	38	Mean Difference (IV, Random, 95% CI)	1.85 [1.09, 2.61]
3.2 Intermediate (≥ 3 to 12 months)	1	38	Mean Difference (IV, Random, 95% CI)	1.67 [0.89, 2.45]
4 Quality of life (physical component summary) Show forest plot	1		Mean Difference (IV, Random, 95% CI)	Subtotals only

4.1 Short‐term (< 3 months from randomisation)	1	38	Mean Difference (IV, Random, 95% CI)	8.40 [2.68, 14.12]
4.2 Intermediate (≥ 3 to 12 months)	1	38	Mean Difference (IV, Random, 95% CI)	8.0 [2.25, 13.75]
5 Quality of life (mental component summary) Show forest plot	1		Mean Difference (IV, Random, 95% CI)	Subtotals only

5.1 Short‐term (< 3 months from randomisation)	1	38	Mean Difference (IV, Random, 95% CI)	2.48 [‐2.17, 7.13]
5.2 Intermediate (≥ 3 to 12 months)	1	38	Mean Difference (IV, Random, 95% CI)	1.64 [‐2.95, 6.23]

Comparison 4. Motor control exercise versus exercise and EPA

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Comparison 5. Motor control exercise versus telerehabilitation

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Pain Show forest plot	1		Mean Difference (IV, Random, 95% CI)	Totals not selected

1.1 Intermediate (≥ 3 to 12 months)	1		Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
2 Disability Show forest plot	1		Mean Difference (IV, Random, 95% CI)	Totals not selected

2.1 Intermediate (≥ 3 to 12 months)	1		Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
3 Quality of life (mental component summary) Show forest plot	1		Mean Difference (IV, Random, 95% CI)	Totals not selected

3.1 Intermediate (≥ 3 to 12 months)	1		Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]
4 Quality of life (physical component summary) Show forest plot	1		Mean Difference (IV, Random, 95% CI)	Totals not selected

4.1 Intermediate (≥ 3 to 12 months)	1		Mean Difference (IV, Random, 95% CI)	0.0 [0.0, 0.0]

Comparison 5. Motor control exercise versus telerehabilitation

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Comparison 6. Sensitivity analysis 1: motor control exercise versus other exercises

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Pain Show forest plot	12		Mean Difference (IV, Random, 95% CI)	Subtotals only

1.1 High quality (≥ 6 'Risk of bias' items) ‐ Short‐term (< 3 months from randomisation)	10	652	Mean Difference (IV, Random, 95% CI)	‐7.80 [‐11.97, ‐3.63]
1.2 High quality (≥ 6 'Risk of bias' items) ‐ Intermediate (≥ 3 to 12 months)	5	558	Mean Difference (IV, Random, 95% CI)	‐2.53 [‐6.65, 1.59]
2 Disability Show forest plot	10		Mean Difference (IV, Random, 95% CI)	Subtotals only

2.1 High quality (≥ 6 'Risk of bias' items) ‐ Short‐term (< 3 months from randomisation)	8	574	Mean Difference (IV, Random, 95% CI)	‐4.27 [‐6.58, ‐1.96]
2.2 High quality (≥ 6 'Risk of bias' items) ‐ Intermediate (≥ 3 to 12 months)	5	558	Mean Difference (IV, Random, 95% CI)	‐2.64 [‐6.37, 1.09]

Comparison 6. Sensitivity analysis 1: motor control exercise versus other exercises

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Comparison 7. Sensitivity analysis 2: motor control exercise versus minimal intervention

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Pain Show forest plot	3		Mean Difference (IV, Random, 95% CI)	Subtotals only

1.1 High quality (≥ 6 'Risk of bias' items) ‐ Short‐term (< 3 months from randomisation)	2	225	Mean Difference (IV, Random, 95% CI)	‐12.11 [‐17.98, ‐6.25]
1.2 High quality (≥ 6 'Risk of bias' items) ‐ Intermediate (≥ 3 to 12 months)	3	323	Mean Difference (IV, Random, 95% CI)	‐9.15 [‐14.89, ‐3.41]
2 Disability Show forest plot	3		Mean Difference (IV, Random, 95% CI)	Subtotals only

2.1 High quality (≥ 6 'Risk of bias' items) ‐ Short‐term (< 3 months from randomisation)	2	225	Mean Difference (IV, Random, 95% CI)	‐7.84 [‐12.07, ‐3.61]
2.2 High quality (≥ 6 'Risk of bias' items) ‐ Intermediate (≥ 3 to 12 months)	3	323	Mean Difference (IV, Random, 95% CI)	‐4.82 [‐10.96, 1.32]

Comparison 7. Sensitivity analysis 2: motor control exercise versus minimal intervention

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Comparison 8. Sensitivity analysis 3: motor control exercise versus manual therapy

Outcome or subgroup title	No. of studies	No. of participants	Statistical method	Effect size
1 Pain Show forest plot	4		Mean Difference (IV, Random, 95% CI)	Subtotals only

1.1 High quality (≥ 6 'Risk of bias' items) ‐ Short‐term (< 3 months from randomisation)	2	241	Mean Difference (IV, Random, 95% CI)	‐3.49 [‐9.54, 2.55]
1.2 High quality (≥ 6 'Risk of bias' items) ‐ Intermediate (≥ 3 to 12 months)	3	452	Mean Difference (IV, Random, 95% CI)	‐5.51 [‐13.94, 2.92]
1.3 High quality (≥ 6 'Risk of bias' items) ‐ Long‐term (> 12 months)	3	375	Mean Difference (IV, Random, 95% CI)	‐2.60 [‐8.71, 3.50]
2 Disability Show forest plot	4		Mean Difference (IV, Fixed, 95% CI)	Subtotals only

2.1 High quality (≥ 6 'Risk of bias' items) ‐ Short‐term (< 3 months from randomisation)	2	241	Mean Difference (IV, Fixed, 95% CI)	‐2.54 [‐7.20, 2.13]
2.2 High quality (≥ 6 'Risk of bias' items) ‐ Intermediate (≥ 3 to 12 months)	3	452	Mean Difference (IV, Fixed, 95% CI)	‐2.51 [‐6.74, 1.72]
2.3 High quality (≥ 6 'Risk of bias' items) ‐ Long‐term (> 12 months)	3	375	Mean Difference (IV, Fixed, 95% CI)	‐2.07 [‐7.44, 3.30]

Comparison 8. Sensitivity analysis 3: motor control exercise versus manual therapy

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Appendices

Appendix 1. Database search strategy

MEDLINE

MEDLINE In‐Process & Other Non‐Indexed Citations

EMBASE

CENTRAL

CINAHL

AMED

SPORTDiscus

PEDro

LILACS

ClinicalTrials.gov

WHO ICTRP

PubMed

Appendix 2. Criteria for assessing risk of bias for internal validity

Random sequence generation (selection bias)

Selection bias (biased allocation to interventions) due to inadequate generation of a randomised sequence

Allocation concealment (selection bias)

Selection bias (biased allocation to interventions) due to inadequate concealment of allocations prior to assignment

Blinding of participants

Performance bias due to knowledge of the allocated interventions by participants during the study

Blinding of personnel/care providers (performance bias)

Performance bias due to knowledge of the allocated interventions by personnel/care providers during the study

Blinding of outcome assessor (detection bias)

Detection bias due to knowledge of the allocated interventions by outcome assessors

Incomplete outcome data (attrition bias)

Attrition bias due to amount, nature or handling of incomplete outcome data

Selective reporting (reporting bias)

Reporting bias due to selective outcome reporting

Group similarity at baseline (selection bias)

Co‐interventions (performance bias)

Bias because co‐interventions were different across groups

Compliance (performance bias)

Bias due to inappropriate compliance with interventions across groups

Intention‐to‐treat‐analysis

Timing of outcome assessments (detection bias)

Bias because important outcomes were not measured at the same time across groups

Other bias

Bias due to problems not covered elsewhere in the table

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