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ورزش‌های کنترل حرکت برای درمان کمردرد غیر‐اختصاصی حاد

Appendices

Appendix 1. Database Search Strategies

MEDLINE

Last searched 2 April 2015

  1. randomized controlled trial.pt.

  2. controlled clinical trial.pt.

  3. clinical trial.pt.

  4. exp clinical trial/

  5. Random Allocation/

  6. Double‐Blind Method/

  7. Single‐Blind Method/

  8. Comparative Study/

  9. evaluation studies/

  10. Follow‐Up Studies/

  11. cross‐over studies/

  12. Research Design/

  13. Placebos/

  14. (clinic$ adj25 trial$).tw.

  15. ((single$ or double$ or treble$ or triple$) adj (mask$ or blind$)).tw.

  16. (control$ or prospective$ or volunteer$).tw.

  17. (latin adj square).tw.

  18. placebo$.tw.

  19. random$.tw.

  20. or/1‐19

  21. (animals not (humans and animals)).sh.

  22. 20 not 21

  23. dorsalgia.ti,ab.

  24. exp Back Pain/

  25. backache.ti,ab.

  26. (lumbar adj pain).ti,ab.

  27. coccyx.ti,ab.

  28. coccydynia.ti,ab.

  29. sciatica.ti,ab.

  30. exp sciatic neuropathy/

  31. spondylosis.ti,ab.

  32. lumbago.ti,ab.

  33. low back pain.mp.

  34. or/23‐33

  35. 22 and 34

  36. exp Exercise/

  37. exercise$.mp.

  38. train$.mp.

  39. 36 or 37 or 38

  40. specific.mp.

  41. stabili$.mp.

  42. segment$.mp.

  43. multifidus.mp.

  44. transversus.mp.

  45. motor control.mp.

  46. or/40‐45

  47. 39 and 46

  48. 35 and 47

  49. limit 48 to yr=2014‐2015

  50. limit 48 to ed=20140516‐20150402

  51. 49 or 50

MEDLINE In‐Process & Other Non‐Indexed Citations

Searched 2 April 2015

  1. randomized controlled trial.pt.

  2. controlled clinical trial.pt.

  3. clinical trial.pt.

  4. exp clinical trial/

  5. Random Allocation/

  6. Double‐Blind Method/

  7. Single‐Blind Method/

  8. Comparative Study/

  9. evaluation studies/

  10. Follow‐Up Studies/

  11. cross‐over studies/

  12. Research Design/

  13. Placebos/

  14. (clinic$ adj25 trial$).tw.

  15. ((single$ or double$ or treble$ or triple$) adj (mask$ or blind$)).tw.

  16. (control$ or prospective$ or volunteer$).tw.

  17. (latin adj square).tw.

  18. placebo$.tw.

  19. random$.tw.

  20. or/1‐19

  21. (animals not (humans and animals)).sh.

  22. 20 not 21

  23. dorsalgia.ti,ab.

  24. exp Back Pain/

  25. backache.ti,ab.

  26. (lumbar adj pain).ti,ab.

  27. coccyx.ti,ab.

  28. coccydynia.ti,ab.

  29. sciatica.ti,ab.

  30. exp sciatic neuropathy/

  31. spondylosis.ti,ab.

  32. lumbago.ti,ab.

  33. low back pain.mp.

  34. or/23‐33

  35. 22 and 34

  36. exp Exercise/

  37. exercise$.mp.

  38. train$.mp.

  39. 36 or 37 or 38

  40. specific.mp.

  41. stabili$.mp.

  42. segment$.mp.

  43. multifidus.mp.

  44. transversus.mp.

  45. motor control.mp.

  46. or/40‐45

  47. 39 and 46

  48. 35 and 47

EMBASE

Last searched 2 April 2015

  1. randomi#ed controlled trial.mp.

  2. clinical trial/

  3. double blind.mp.

  4. single blind.mp.

  5. placebo/

  6. Controlled Study/

  7. Randomized Controlled Trial/

  8. Double Blind Procedure/

  9. Single Blind Procedure/

  10. crossover procedure/

  11. random$.mp.

  12. ((singl$ or doubl$ or trebl$ or tripl$) adj25 (blind$ or mask$)).mp.

  13. (versus or vs).mp.

  14. (clinic$ adj2 trial$).tw.

  15. or/1‐14

  16. limit 15 to human

  17. dorsalgia.mp.

  18. back pain.mp.

  19. exp BACKACHE/

  20. (lumbar adj pain).mp.

  21. coccyx.mp.

  22. coccydynia.mp.

  23. sciatica.mp.

  24. exp ISCHIALGIA/

  25. spondylosis.mp.

  26. lumbago.mp.

  27. low back pain.mp.

  28. or/17‐27

  29. 16 and 28

  30. exp exercise/

  31. exercise$.mp.

  32. train$.mp.

  33. 30 or 31 or 32

  34. motor control.mp.

  35. stabili$.mp.

  36. segment$.mp.

  37. multifidus.mp.

  38. transversus.mp.

  39. or/34‐38

  40. 33 and 39

  41. 29 and 40

  42. limit 41 to yr=2014‐2015

  43. limit 41 to em=201419‐201513

  44. 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

  1. randomized controlled trial.pt.

  2. controlled clinical trial.pt.

  3. clinical trial.pt.

  4. exp clinical trials/

  5. random allocation/

  6. double blind method/

  7. single blind method/

  8. comparative study/

  9. follow up studies/

  10. research design/

  11. placebos/

  12. (clinic$ adj25 trial$).tw.

  13. ((single$ or double$ or treble$ or triple$) adj (mask$ or blind$)).tw.

  14. (control$ or prospective$ or volunteer$).tw.

  15. (latin adj square).tw.

  16. placebo$.tw.

  17. random$.tw.

  18. or/1‐17

  19. (animals not (humans and animals)).sh.

  20. 18 not 19

  21. dorsalgia.mp.

  22. exp backache/

  23. sciatica/

  24. (lumbar adj pain).ti,ab.

  25. sciatica.mp.

  26. spondylosis.mp.

  27. coccyx.mp.

  28. lumbago.mp.

  29. low back pain.mp.

  30. or/21‐29

  31. 20 and 30

  32. exercise/

  33. exercise$.mp.

  34. train$.mp.

  35. or/32‐34

  36. specific.mp.

  37. stabili$.mp. [mp=abstract, heading words, title]

  38. segment$.mp.

  39. multifidus.mp.

  40. transversus.mp.

  41. motor control.mp.

  42. or/36‐41

  43. 35 and 42

  44. 31 and 43

  45. 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. Risk of bias criteria

Random sequence generation (selection bias)

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

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

Risk of selection bias is high if investigators describe a non‐random component in the sequence generation process such as sequence generation by odd or even date of birth, date (or day) of admission or 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 before assignment

Risk of selection bias is low if 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.

Risk of bias is high 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); using assignment envelopes without appropriate safeguards (e.g. envelopes were unsealed or non‐opaque or were 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 allocated interventions by participants during the study

Risk of performance bias is low if blinding of participants was ensured and it was unlikely that blinding could have been broken; or if no blinding or incomplete blinding was provided but review authors judged 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 allocated interventions by personnel/care providers during the study

Risk of performance bias is low if blinding of personnel was ensured and it was unlikely that blinding could have been broken; or if no blinding or incomplete blinding was provided but review authors judged that the outcome is not likely to be influenced by lack of blinding.

Blinding of outcome assessors (detection bias)

Detection bias due to knowledge of allocated interventions by outcome assessors

Risk of detection bias is low if blinding of the outcome assessment was ensured and it was unlikely that blinding could have been broken; or if no blinding or incomplete blinding was provided but review authors judged 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): low risk of bias for outcome assessors if 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: low risk of bias for outcome assessors if low risk of bias for care providers (Boutron 2005); and

  • for outcome criteria that are assessed from data from medical forms: low risk of bias if treatment or adverse effects of 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

Risk of attrition bias is low if no outcome data were missing; 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 were very large, imputation using even 'acceptable' methods may still suggest high risk of bias) (van Tulder 2003). Percentages 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 and are not supported by the literature) (van Tulder 2003).

Selective reporting (reporting bias)

Reporting bias due to selective outcome reporting

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

Risk of reporting bias is high if not all of the study's prespecified primary outcomes have been reported; one or more primary outcomes was reported using measurements, analysis methods or subsets of the data (e.g. subscales) that were not prespecified; one or more reported primary outcomes were not prespecified (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; or 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

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

Co‐interventions (performance bias)

Bias due to differences in co‐interventions across groups

Risk of bias is low if no co‐interventions were provided, or if interventions were similar between index and control groups (van Tulder 2003).

Compliance (performance bias)

Bias due to inappropriate compliance with interventions across groups

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

Intention‐to‐treat analysis

Risk of bias is low if all randomly assigned participants were reported/analysed in the groups to which they were allocated by randomisation.

Timing of outcome assessments (detection bias)

Bias due to different timing of important outcomes measurements across groups

Risk of bias is low 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

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

Study flow diagram.
Figuras y tablas -
Figure 1

Study flow diagram.

Risk of bias summary: review authors' judgements about each risk of bias item for each included study.
Figuras y tablas -
Figure 2

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

Forest plot of comparison: 2 Motor control exercise vs other exercises, outcome: 2.1 Pain.
Figuras y tablas -
Figure 3

Forest plot of comparison: 2 Motor control exercise vs other exercises, outcome: 2.1 Pain.

Forest plot of comparison: 2 Motor control exercise vs other exercises, outcome: 2.2 Disability.
Figuras y tablas -
Figure 4

Forest plot of comparison: 2 Motor control exercise vs other exercises, outcome: 2.2 Disability.

Comparison 1 Motor control exercise vs spinal manipulative therapy, Outcome 1 Pain.
Figuras y tablas -
Analysis 1.1

Comparison 1 Motor control exercise vs spinal manipulative therapy, Outcome 1 Pain.

Comparison 1 Motor control exercise vs spinal manipulative therapy, Outcome 2 Disability.
Figuras y tablas -
Analysis 1.2

Comparison 1 Motor control exercise vs spinal manipulative therapy, Outcome 2 Disability.

Comparison 2 Motor control exercise vs other exercises, Outcome 1 Pain.
Figuras y tablas -
Analysis 2.1

Comparison 2 Motor control exercise vs other exercises, Outcome 1 Pain.

Comparison 2 Motor control exercise vs other exercises, Outcome 2 Disability.
Figuras y tablas -
Analysis 2.2

Comparison 2 Motor control exercise vs other exercises, Outcome 2 Disability.

Comparison 3 Motor control exercise as a supplement to medical management, Outcome 1 Pain.
Figuras y tablas -
Analysis 3.1

Comparison 3 Motor control exercise as a supplement to medical management, Outcome 1 Pain.

Comparison 3 Motor control exercise as a supplement to medical management, Outcome 2 Disability.
Figuras y tablas -
Analysis 3.2

Comparison 3 Motor control exercise as a supplement to medical management, Outcome 2 Disability.

Comparison 3 Motor control exercise as a supplement to medical management, Outcome 3 Recurrence.
Figuras y tablas -
Analysis 3.3

Comparison 3 Motor control exercise as a supplement to medical management, Outcome 3 Recurrence.

Motor control exercise vs spinal manipulative therapy for acute low back pain

Patient or population: patients with acute low back pain

Settings: primary or tertiary care

Intervention: motor control exercise

Comparison: spinal manipulative therapy

Outcomes

Illustrative comparative risks* (95% CI)

Number of participants
(studies)

Quality of the evidence
(GRADE)

Assumed risk

Corresponding risk

Spinal manipulative therapy

Motor control exercise

Pain

VAS (0 to 100)

Follow‐up: short term (< 3 months from randomisation)

Mean pain in the control group was

15 points

Mean pain in the intervention group was

9 points higher

(1.56 lower to 19.56 higher)

58 participants

(1 study)

⊕⊕⊝⊝
Lowa,b

Disability

Oswestry Disability Index (0 to 100)

Follow‐up: short term (< 3 months from randomisation)

Mean disability in the control group was

17.9 points

Mean disability in the intervention group was

4 points higher

(3.38 lower to 11.38 higher)

85 participants
(1 study)

⊕⊕⊝⊝
Lowa,b

Disability

Oswestry Disability Index (0 to 100)

Follow‐up: intermediate term (> 3 months, < 12 months)

Mean disability in the control group was

16.8 points

Mean disability in the intervention group was

3.7 points higher

(4.10 lower to 11.50 higher)

85 participants
(1 study)

⊕⊕⊝⊝
Lowa,b

Adverse events

None of the included studies evaluated adverse events

Not reported

Not reported

*The basis for the assumed risk (e.g. 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

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate
Very low quality: We are very uncertain about the estimate

aDowngraded for imprecision

bDowngraded for inconsistency

Figuras y tablas -

Motor control exercise vs other exercises for acute low back pain

Patient or population: patients with acute low back pain

Settings: primary or tertiary care

Intervention: motor control exercise

Comparison: other exercises

Outcomes

Illustrative comparative risks* (95% CI)

Number of participants
(studies)

Quality of the evidence
(GRADE)

Assumed risk

Corresponding risk

Other exercises

Motor control exercise

Pain

VAS (0 to 100)

Follow‐up: short term (< 3 months from randomisation)

Mean pain ranged across control groups from
18 to 26.7 points

Mean pain in the intervention groups was

5.74 points higher

(3.34 lower to 14.82 higher)

89 participants
(2 studies)

⊕⊕⊕⊝
Moderatea

Pain

VAS (0 to 100)

Follow‐up: intermediate term (> 3 months, < 12 months)

Mean pain in the control group was
27.1 points

Mean pain in the intervention groups was

1.2 points lower

(18.24 lower to 15.84 higher)

33 participants
(1 study)

⊕⊕⊝⊝
Lowa,b

Disability

Multiple scales (transformed 0 to 100)

Follow‐up: short term (< 3 months from randomisation)

Mean disability ranged across control groups from
20.6 to 39.2 points

Mean disability in the intervention groups was

0.84 points lower

(8.72 lower to 7.04 higher)

116 participants
(2 studies)

⊕⊕⊕⊝
Moderatea

Disability

Roland Morris Disability Questionnaire (transformed 0 to 100)

Follow‐up: intermediate term (> 3 months, < 12 months)

Mean disability in the control group was
28.3 points

Mean disability in the intervention groups was

6.70 points lower

(22.80 lower to 9.40 higher)

33 participants
(1 study)

⊕⊕⊝⊝
Lowa,b

Disability

Oswestry Disability Index (0 to 100)

Follow‐up: long term (< 3 months after randomisation)

Mean disability in the control group was

20.5

Mean disability in the intervention groups was
5.70 points higher

(1.38 lower to 12.78 higher]

83 participants
(1 study)

⊕⊕⊝⊝
Lowa,b

Adverse events

None of the included studies evaluated adverse events

Not reported

not reported

*The basis for the assumed risk (e.g. 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

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate
Very low quality: We are very uncertain about the estimate

aDowngraded for imprecision

bDowngraded for inconsistency

Figuras y tablas -

Motor control exercise as a supplement to medical management for patients with acute low back pain

Patient or population: patients with acute LBP

Settings: primary or tertiary care

Intervention: motor control exercise

Comparison: medical management

Outcomes

Illustrative comparative risks* (95% CI)

Relative effect
(95% CI)

Number of participants
(studies)

Quality of the evidence
(GRADE)

Assumed risk

Corresponding risk

Medical management

Motor control exercise

Pain

VAS (0 to 100)

Follow‐up: short term (< 3 months from randomisation)

Mean pain in the control group was
10.4

Mean pain in the intervention group was

9.30 points lower

(20.41 lower to 1.81 higher)

41 participants
(1 study)

⊕⊕⊝⊝
Very lowa,b,c

Disability

Roland Morris Disability Questionnaire (transformed 0 to 100)

Follow‐up: short term (< 3 months from randomisation)

Mean disability in the control group was

2.4

Mean disability in the intervention group was
2.40 points lower

(4.87 lower to 0.07 higher)

41 participants
(1 study)

⊕⊕⊝⊝
Very lowa,b,c

Recurrence

Follow‐up: long term (1 year)

16 of 19

6 of 20

RR 0.36

(0.18 to 0.72)

39 participants

(1 study)

⊕⊕⊝⊝
Very lowa,b,c

Adverse events

None of the included studies evaluated adverse events

Not reported

Not reported

*The basis for the assumed risk (e.g. 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

GRADE Working Group grades of evidence
High quality: Further research is very unlikely to change our confidence in the estimate of effect
Moderate quality: Further research is likely to have an important impact on our confidence in the estimate of effect and may change the estimate
Low quality: Further research is very likely to have an important impact on our confidence in the estimate of effect and is likely to change the estimate
Very low quality: We are very uncertain about the estimate

aDowngraded for imprecision

bDowngraded for inconsistency

cDowngraded for high risk of bias

Figuras y tablas -
Comparison 1. Motor control exercise vs spinal manipulative therapy

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)

Subtotals only

1.1 Short term

1

58

Mean Difference (IV, Random, 95% CI)

9.0 [‐1.56, 19.56]

2 Disability Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Subtotals only

2.1 Short term

1

85

Mean Difference (IV, Random, 95% CI)

4.0 [‐3.38, 11.38]

2.2 Long term

1

85

Mean Difference (IV, Random, 95% CI)

3.70 [‐4.10, 11.50]

Figuras y tablas -
Comparison 1. Motor control exercise vs spinal manipulative therapy
Comparison 2. Motor control exercise vs other exercises

Outcome or subgroup title

No. of studies

No. of participants

Statistical method

Effect size

1 Pain Show forest plot

2

Mean Difference (IV, Random, 95% CI)

Subtotals only

1.1 Short term

2

89

Mean Difference (IV, Random, 95% CI)

5.74 [‐3.34, 14.82]

1.2 Intermediate term

1

33

Mean Difference (IV, Random, 95% CI)

‐1.20 [‐18.24, 15.84]

2 Disability Show forest plot

2

Mean Difference (IV, Random, 95% CI)

Subtotals only

2.1 Short term

2

116

Mean Difference (IV, Random, 95% CI)

‐0.84 [‐8.72, 7.04]

2.2 Intermediate term

1

33

Mean Difference (IV, Random, 95% CI)

‐6.70 [‐22.80, 9.40]

2.3 Long term

1

83

Mean Difference (IV, Random, 95% CI)

5.70 [‐1.38, 12.78]

Figuras y tablas -
Comparison 2. Motor control exercise vs other exercises
Comparison 3. Motor control exercise as a supplement to medical management

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)

Subtotals only

1.1 Short term

1

41

Mean Difference (IV, Random, 95% CI)

‐9.3 [‐20.41, 1.81]

2 Disability Show forest plot

1

Mean Difference (IV, Random, 95% CI)

Subtotals only

2.1 Short term

1

41

Mean Difference (IV, Random, 95% CI)

‐2.4 [‐4.87, 0.07]

3 Recurrence Show forest plot

1

Risk Ratio (M‐H, Random, 95% CI)

Subtotals only

3.1 Long term

1

39

Risk Ratio (M‐H, Random, 95% CI)

0.36 [0.18, 0.72]

Figuras y tablas -
Comparison 3. Motor control exercise as a supplement to medical management