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Referencias

References to studies included in this review

Aluko 2013 {published data only}

Aluko A, DeSouza L, Peacock J. The effect of core stability exercises on variations in acceleration of trunk movement, pain, and disability during an episode of acute non specific low back pain: a pilot clinical trial. Journal of Manipulative and Physiological Therapeutics 2013;36:497.

Brennan 2006 {published data only}

Brennan GP, Fritz JM, Hunter SJ, Thackeray A, Delitto A, Erhard RE. Identifying subgroups of patients with acute/subacute nonspecific low back pain: results of a randomized clinical trial. Spine 2006;31:623‐31.

Hides 1996 {published data only}

Hides JA, Jull GA, Richardson CA. Long‐term effects of specific stabilizing exercises for first‐episode low back pain. Spine 2001;26:E243‐8.
Hides JA, Richardson CA, Jull GA. Multifidus muscle recovery is not automatic after resolution of acute, first‐episode low back pain. Spine 1996;21:2763‐9.

References to studies excluded from this review

Aasa 2015 {published data only}

Aasa B, Berglund L, Michaelson P, Aasa U. Individualized low‐load motor control exercises and education versus a high‐load lifting exercise and education to improve activity, pain intensity, and physical performance in patients with low back pain: a randomized controlled trial. Journal of Orthopaedic & Sports Physical Therapy 2015;45:77‐85.

ACTRN12609000293268 {published data only}

ACTRN12609000293268. Effects of advice versus physiotherapy functional restoration on pain and function for people with multi‐factorial persistent low back pain: a randomised controlled trial. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=83875 (accessed 25 June 2015).

ACTRN12609000334202 {published data only}

ACTRN12609000334202. Effects of physiotherapy manual therapy on pain and function for people with subacute low back pain with or without leg pain: a randomised controlled trial. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12609000334202 (accessed 26 June 2015).

ACTRN12609000343202 {published data only}

ACTRN12609000343202. Effects of specific physiotherapy treatment and advice versus advice alone on pain and function for people with sub‐acute reducible discogenic low back pain: a randomised controlled trial. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12609000343202 (accessed 25 June 2015).

ACTRN12611000971932 {published data only}

ACTRN12611000971932. A comparison of mechanical diagnosis & therapy and motor control exercises on the thickness of the trunk muscle in patients with chronic low back pain. https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?ACTRN=12611000971932 (accessed 25 June 2015).

Aggarwal 2010 {published data only}

Aggarwal A, Kumar S, Kumar D. Effect of core stabilization training on the lower back endurance in recreational active individuals. Journal of Musculoskeletal Research 2010;13:167‐76.

Ahmed 2014 {published data only}

Ahmed R, Shakil‐ur‐Rehman S, Sibtain F. Comparison between specific lumber mobilization and core‐stability exercises with core‐stability exercises alone in mechanical low back pain. Pakistan Journal of Medical Sciences 2014;30:157‐60.

Akbari 2008 {published data only}

Akbari A, Khorashadizadeha S, Abdi G. The effect of motor control exercise versus general exercise on lumbar local stabilizing muscles thickness: randomized controlled trial of patients with chronic low back pain. Journal of Back and Musculoskeletal Rehabilitation 2008;21:105‐12.

Ali 2006 {published data only}

Ali TA. Stabilization exercises for patients with low back pain. Dissertation.. Texas Woman's University, Denton, Texas; Texas Woman's University; 2006.

Allison 2012 {published data only}

Allison GT. Abdominal muscle feedforward activation in patients with chronic low back pain is largely unaffected by 8 weeks of core stability training. Journal of Physiotherapy 2012;58:200.

Alp 2011 {published data only}

Alp A, Mengi G, Atik T, Mert M, Avsarotlu H. The evaluation of the efficacy of core stabilization exercises on female patients with chronic low back pain [Kronik bel atrili kadin hastalarda core‐stabilizasyon egzersizi etkinlitinin deterlendirilmesi]. Turkiye Fiziksel Tip ve Rehabilitasyon Dergisi 2011;57:249.

Alp 2014 {published data only}

Alp A, Mengi G, Avsaroglu AH, Mert M, Sigirli D. Efficacy of core‐stabilization exercise and its comparison with home‐based conventional exercise in low back pain patients. Turkiye Fiziksel Tip ve Rehabilitasyon Dergisi 2014;60:S36‐42.

Ammar 2011 {published data only}

Ammar TA, Mitchell K, Saleh A. Stabilization exercises in postnatal low back pain. Indian Journal of Physiotherapy and Occupational Therapy 2011;5:122‐4.

Andrusaitis 2011 {published data only}

Andrusaitis SF, Brech GC, Vitale GF, Greve JM. Trunk stabilization among women with chronic lower back pain: a randomized, controlled, and blinded pilot study. Clinics 2011;66:1645‐50.

Appling 2009 {published data only}

Appling SA, Chalona A, Edwards P, Green T, Jones C, LaVigne W. Effect of a progressive core stabilization exercise program on lumbar stability and abdominal strength. Journal of Orthopaedic & Sports Physical Therapy 2009;39:A83‐4.

Areeudomwong 2012 {published data only}

Areeudomwong P, Puntumetakul R, Jirarattanaphochai K, Wanpen S, Kanpittaya J, Chatchawan U, et al. Core stabilization exercise improves pain intensity, functional disability and trunk muscle activity of patients with clinical lumbar instability: a pilot randomized controlled study. Journal of Physical Therapy Science 2012;24:1007‐12.

Barbosa 2013 {published data only}

Barbosa AC, Martins FL, Barbosa MC, Dos Santos RT. Manipulation and selective exercises decrease pelvic anteversion and low‐back pain: a pilot study. Journal of Back & Musculoskeletal Rehabilitation 2013;26:33‐6.

Bayraktar 2013 {published data only}

Bayraktar D, Guclu‐Gunduz A, Lambeck J, Yazici G, Aykol S, Demirci H, et al. Core stability exercises: In water or on land? Comparison of the effects of two different core stabilization training. Annals of the Rheumatic Diseases 2013;72:1.

Belcher 1998 {published data only}

Belcher MA. Pelvic stabilization exercise versus conventional weight training exercise during resistance training: its effect on the development of lumbar extension strength. Dissertation.. University of Southern Mississippi, Hattiesburg, Mississippi: University of Southern Mississippi; 1998.

Bentsen 1997 {published data only}

Bentsen H, Lindgarde F, Manthorpe R. The effect of dynamic strength back exercise and/or a home training program in 57‐year‐old women with chronic low back pain. Results of a prospective randomized study with a 3‐year follow‐up period. Spine 1997;22:1494‐5000.

Bi 2013 {published data only}

Bi X, Zhao J, Zhao L, Liu Z, Zhang J, Sun D, et al. Pelvic floor muscle exercise for chronic low back pain. Journal of International Medical Research 2013;41:146‐52.

Bilgin 2013 {published data only}

Bilgin S, Temucin CM, Nurlu G, Kaya DO, Kose N, Gunduz AG. Effects of exercise and electrical stimulation on lumbar stabilization in asymptomatic subjects: a comparative study. Journal of Back and Musculoskeletal Rehabilitation 2013;26:261‐6.

Bordiak 2012 {published data only}

Bordiak FC, Silva EB. Electrical stimulation and core training on pain and range of motion in low back pain [Eletroestimulação e core training sobre dor e arco de movimento na lombalgia]. Fisioterapia em Movimento 2012;25:759‐66.

Bronfort 1996 {published data only}

Bronfort G, Goldsmith CH, Nelson CF, Boline PD, Anderson AV. Trunk exercise combined with spinal manipulative or NSAID therapy for chronic low back pain: a randomized, observer‐blinded clinical trial. Journal of Manipulative and Physiological Therapeutics 1996;19:570‐82.

Bronfort 2011 {published data only}

Bronfort G, Maiers MJ, Evans RL, Schulz CA, Bracha Y, Svendsen KH, et al. Supervised exercise, spinal manipulation, and home exercise for chronic low back pain: a randomized clinical trial. The Spine Journal 2011;11:585‐98.

Brooks 2012 {published data only}

Brooks C, Kennedy S, Marshall PWM. Specific trunk and general exercise elicit similar changes in anticipatory postural adjustments in patients with chronic low back pain: a randomized controlled trial [with consumer summary]. Spine 2012;37:E1543‐50.

Brox 2003 {published data only}

Brox JI, Sørensen R, Friis A, Nygaard Ø, Indahl A, Keller A, et al. Randomized clinical trial of lumbar instrumented fusion and cognitive intervention and exercises in patients with chronic low back pain and disc degeneration. Spine 2003;28:1913‐21.

Buchbinder 2002 {published data only}

Buchbinder R, Hoving J. Specific spinal exercise substantially reduces the risk of low back pain recurrence. Australian Journal of Physiotherapy 2002;48:55.

Byuon 2012 {published data only}

Byuon S, Son H. The effects of proprioceptive neuromuscular facilitation and stabilizing exercise on trunk repositioning errors. Journal of Physical Therapy Science 2012;24:1017‐20.

Cairns 2003 {published data only}

Cairns M. Manipulation Association of Chartered Physiotherapists (UK) Research Presentation Award: a pragmatic randomized controlled trial of stabilization exercises in the management of recurrent low back pain. Manual Therapy 2003;8:185.

Cairns 2006 {published data only}

Cairns MC, Foster NE, Wright C. Randomized controlled trial of specific spinal stabilization exercises and conventional physiotherapy for recurrent low back pain. Spine 2006;31:E670‐81.

Carmo 2013 {published data only}

Carmo CM, Jacob MFA, Takara KS, Santos FG, Caromano FA, Tanaka C. Trunk stabilizing exercise and strengthening exercises in patients with non‐specific chronic low back pain: a pilot blinded randomized trial. Annals of the Rheumatic Diseases 2012;71(Suppl 3):745.

Chan 2011 {published data only}

Chan CW, Mok NW, Yeung EW. Aerobic exercise training in addition to conventional physiotherapy for chronic low back pain: a randomized controlled trial. Archives of Physical Medicine and Rehabilitation 2011;92:1681‐5.

Childs 2009 {published data only}

Childs JD, Teyhen DS, Benedict TM, Morris JB, Fortenberry AD, McQueen RM, et al. Effects of sit‐up training versus core stabilization exercises on sit‐up performance. Medicine & Science in Sports & Exercise 2009;41:2072‐83.

Childs 2010 {published data only}

Childs JD, Teyhen DS, Casey PR, McCoy‐Singh KA, Feldtmann AW, Wright AC, et al. Effects of traditional sit‐up training versus core stabilization exercises on short‐term musculoskeletal injuries in US army soldiers: a cluster randomized trial. Physical Therapy 2010;90:1404‐12.

Cho 2014 {published data only}

Cho HY, Kim EH, Kim J. Effects of the CORE exercise program on pain and active range of motion in patients with chronic low back pain. Journal of Physical Therapy Science 2014;26:1237‐40.

Chung 2013 {published data only}

Chung S, Lee J, Yoon J. Effects of stabilization exercise using a ball on multifidus cross‐sectional area in patients with chronic low back pain. Journal of Sports Science & Medicine 2013;12:533‐41.

Costa 2009 {published data only}

Costa LO, Maher CG, Latimer J, Hodges PW, Herbert RD, Refshauge KM, et al. Motor control exercise for chronic low back pain: a randomized placebo‐controlled trial. Physical Therapy 2009;89:1275‐86.
Costa LO, Maher CG, McAuley JH, Hancock MJ, Herbert RD, Refshauge KM, et al. Prognosis for patients with chronic low back pain: inception cohort study. BMJ 2009;339:b3829.

Critchley 2007 {published data only}

Critchley DJ, Ratcliffe J, Noonan S, Jones RH, Hurley MV. Effectiveness and cost‐effectiveness of three types of physiotherapy used to reduce chronic low back pain disability: a pragmatic randomized trial with economic evaluation. Spine 2007;32:1474‐81.

Croft 1999 {published data only}

Croft PR, Papageorgiou AC, Thomas E, Macfarlane GJ, Silman AJ. Short‐term physical risk factors for new episodes of low back pain. Prospective evidence from the South Manchester Back Pain Study. Spine 1999;24:1556‐61.

Dehner 2009 {published data only}

Dehner C, Schmelz A, Valker H, Krischak G, Kramer M. Low back pain intensity, microcirculation and muscle performance of the multifidus following back muscle strengthening in young elite oarsmen (Editor's Selection). International Sports Medicine Journal 2009;10:163‐75.

Descarreaux 2002 {published data only}

Descarreaux M, Normand MC, Laurencelle L, Dugas C. Evaluation of a specific home exercise program for low back pain. Journal of Manipulative & Physiological Therapeutics 2002;25:497‐503.

Donzelli 2006 {published data only}

Donzelli S, Di Domenica E, Cova AM, Galletti R, Giunta N. Two different techniques in the rehabilitation treatment of low back pain: a randomized controlled trial. Europa Medicophysica 2006;42:205‐10.

Dufour 2010 {published data only}

Dufour N, Thamsborg G, Oefeldt A, Lundsgaard C, Stender S. Treatment of chronic low back pain: a randomized, clinical trial comparing group‐based multidisciplinary biopsychosocial rehabilitation and intensive individual therapist‐assisted back muscle strengthening exercises. Spine 2010;35:469‐76.

Durante 2010 {published data only}

Durante H, Vasconcelos ECLM. Comparison between Isostretching method and conventional kinesiotherapy in low back pain treatment [Comparação do método Isostretching e cinesioterapia convencional no tratamento da lombalgia]. Semina: Ciências Biológicas e da Saúde 2010;30:83‐90.

Dvorak 2011 {published data only}

Dvorak H, Kujat C, Brumitt J. Effect of therapeutic exercise versus manual therapy on athletes with chronic low back pain. Journal of Sport Rehabilitation 2011;20:494‐504.

Earde 2014 {published data only}

Earde P, Vongsirinavarat M, Sakulsriprasert P, Vachalathiti R. Immediate effects of trunk stabilizer muscles training on muscle response time in individuals with non‐specific chronic low back pain. Journal of the Medical Association of Thailand 2014;97(Suppl 7):S89‐94.

Ewert 2009 {published data only}

Ewert T, Limm H, Wessels T, Rackwitz B, von Garnier K, Freumuth R, et al. The comparative effectiveness of a multimodal program versus exercise alone for the secondary prevention of chronic low back pain and disability. PM & R: The Journal of Injury, Function, and Rehabilitation 2009;1:798‐808.

Faas 1993 {published data only}

Faas A, Chavannes AW, van Eijk JT, Gubbels JW. A randomized, placebo‐controlled trial of exercise therapy in patients with acute low back pain. Spine 1993;18:1388‐95.

Faas 1995 {published data only}

Faas A, van Eijk JT, Chavannes AW, Gubbels JW. A randomized trial of exercise therapy in patients with acute low back pain. Efficacy on sickness absence. Spine 1995;20:941‐7.

Ferreira 2007 {published data only}

Ferreira ML, Ferreira PH, Latimer J, Herbert RD, Hodges PW, Jennings MD, et al. Comparison of general exercise, motor control exercise and spinal manipulative therapy for chronic low back pain: a randomized trial. Pain 2007;131:31‐7.

Franca 2010 {published data only}

Franca FR, Burke TN, Hanada ES, Marques AP. Segmental stabilization and muscular strengthening in chronic low back pain: a comparative study. Clinics 2010;65:1013‐7.

Franca 2012 {published data only}

Franca FR, Burke TN, Caffaro RR, Ramos LA, Marques AP. Effects of muscular stretching and segmental stabilization on functional disability and pain in patients with chronic low back pain: a randomized controlled trial. Journal of Manipulative and Physiological Therapeutics 2012;35:279‐85.

Freitas 2008 {published data only}

Freitas CD, D'Andrea JM. Comparison between isokinetic dynamometer and therapeutic ball exercise in chronic low back pain of mechanical origin [Estudo comparativo entre exercícios com dinamômetro isocinético e bola terapêutica na lombalgia crônica de origem mecânica]. Revista Fisioterapia & Pesquisa 2008;15:380‐6.

Gagnon 2005 {published data only}

Gagnon LH. Efficacy of Pilates exercises as therapeutic intervention in treating patients with low back pain. Dissertation.. University of Tennessee, Knoxville, Tennessee; University of Tennessee; 2005.

Gatti 2011 {published data only}

Gatti R, Faccendini S, Tettamanti A, Barbero M, Balestri A, Calori G. Efficacy of trunk balance exercises for individuals with chronic low back pain: a randomized clinical trial. Journal of Orthopaedic & Sports Physical Therapy 2011;41:542‐52.

George 2011 {published data only}

George SZ, Childs JD, Teyhen DS, Wu SS, Wright AC, Dugan JL, et al. Brief psychosocial education, not core stabilization, reduced incidence of low back pain: results from the Prevention of Low Back Pain in the Military (POLM) cluster randomized trial. BMC Medicine 2011;9:128.

Goldby 2006 {published data only}

Goldby LJ, Moore AP, Doust J, Trew ME. A randomized controlled trial investigating the efficiency of musculoskeletal physiotherapy on chronic low back disorder. Spine 2006;31:1083‐93.

Gustafsson 2008 {published data only}

Gustafsson J, Nilsson‐Wikmar L. Influence of specific muscle training on pain, activity limitation and kinesiophobia in women with back pain post‐partum: a single‐subject research design. Physiotherapy Research International 2008;13:18‐30.

Guven 2003 {published data only}

Guven Z, Marangozoglu I, Gunduz OH. Effectiveness of lumbopelvic stabilization exercise education in patients with chronic mechanical low back pain [Kronik mekanik bel agrili hastalarda lumbopelvik stabilizasyon egzersiz egitiminin etkinligi]. Turkiye Fiziksel Tip ve Rehabilitasyon Dergisi 2003;49:17.

Hagen 2010 {published data only}

Hagen EM, Odelien KH, Lie SA, Eriksen HR. Adding a physical exercise programme to brief intervention for low back pain patients did not increase return to work. Scandinavian Journal of Public Health 2010;38:731‐8.

Hansen 1993 {published data only}

Hansen FR, Bendix T, Skov P, Jensen CV, Kristensen JH, Krohn L, et al. Intensive, dynamic back‐muscle exercises, conventional physiotherapy, or placebo‐control treatment of low‐back pain. A randomized, observer‐blind trial. Spine 1993;18:98‐108.

Harkapaa 1989 {published data only}

Harkapaa K, Jarvikoski A, Mellin G, Hurri H. A controlled study on the outcome of inpatient and outpatient treatment of low back pain. Part I. Pain, disability, compliance, and reported treatment benefits three months after treatment. Scandinavian Journal of Rehabilitation Medicine 1989;21:81‐9.

Harringe 2007 {published data only}

Harringe ML, Nordgren JS, Arvidsson I, Werner S. Low back pain in young female gymnasts and the effect of specific segmental muscle control exercises of the lumbar spine: a prospective controlled intervention study. Knee Surgery, Sports Traumatology, Arthroscopy 2007;15:1264‐71.

Harts 2008 {published data only}

Harts CC, Helmhout PH, de Bie RA, StaaI JB. A high‐intensity lumbar extensor strengthening program is little better than a low‐intensity program or a waiting list control group for chronic low back pain: a randomised clinical trial. Australian Journal of Physiotherapy 2008;54:23‐31.

Helewa 1999 {published data only}

Helewa A, Goldsmith CH, Lee P, Smythe HA, Forwell L. Does strengthening the abdominal muscles prevent low back pain: a randomized controlled trial. The Journal of Rheumatology 1999;26:1808‐15.

Helmhout 2004 {published data only}

Helmhout PH, Harts CC, Staal JB, Candel MJ, de Bie RA. Comparison of a high‐intensity and a low‐intensity lumbar extensor training program as minimal intervention treatment in low back pain: a randomized trial. European Spine Journal 2004;13:537‐47.

Hemmati 2011 {published data only}

Hemmati S, Rajabi R, Karimi N, Jahandideh AA. Effects of consecutive supervised core stability training on pain and disability in women with nonspecific chronic low back pain [Persian]. Koomesh 2011;12:244‐52.

Henchoz 2010 {published data only}

Henchoz Y, Pinget C, Wasserfallen JB, Paillex R, de Goumoens P, Norberg M, et al. Cost‐utility analysis of a three‐month exercise programme versus usual care following multidisciplinary rehabilitation for chronic low back pain. Journal of Rehabilitation Medicine 2010;42:846‐52.

Hides 2008 {published data only}

Hides JA, Stanton WR, McMahon S, Sims K, Richardson CA. Effect of stabilization training on multifidus muscle cross‐sectional area among young elite cricketers with low back pain. Journal of Orthopaedic & Sports Physical Therapy 2008;38:101‐8.

Hosseinifar 2013 {published data only}

Hosseinifar M, Akbari M, Behtash H, Amiri M, Sarrafzadeh J. The effects of stabilization and Mckenzie exercises on transverse abdominis and multifidus muscle thickness, pain, and disability: a randomized controlled trial in nonspecific chronic low back pain. Journal of Physical Therapy Science 2013;25:1541‐5.

Hunter 2012 {published data only}

Hunter RF, McDonough SM, Bradbury I, Liddle SD, Walsh DM, Dhamija S, et al. Exercise and auricular acupuncture for chronic low‐back pain: a feasibility randomized‐controlled trial. The Clinical Journal of Pain 2012;28:259‐67.

Hurwitz 2005 {published data only}

Hurwitz EL, Morgenstern H, Chiao C. Effects of recreational physical activity and back exercises on low back pain and psychological distress: findings from the UCLA Low Back Pain Study. American Journal of Public Health 2005;95:1817‐24.

Hwang 2013 {published data only}

Hwang JA, Bae SH, Do Kim G, Kim KY. The effects of sensorimotor training on anticipatory postural adjustment of the trunk in chronic low back pain patients. Journal of Physical Therapy Science 2013;25:1189‐92.

Inani 2013 {published data only}

Inani SB, Selkar SP. Effect of core stabilization exercises versus conventional exercises on pain and functional status in patients with non‐specific low back pain: a randomized clinical trial. Journal of Back and Musculoskeletal Rehabilitation 2013;26:37‐43.

ISRCTN80064281 {published data only}

ISRCTN80064281. Movement control exercise for low back pain. http://www.isrctn.com/ISRCTN80064281 (accessed 25 June 2015).

Jang 2013 {published data only}

Jang S, Lee J, Bang H. The effect of trunk control exercises performed on unstable surfaces on the spinal stability of low back pain patients. Journal of Physical Therapy Science 2013;25:459‐62.

Javadian 2012 {published data only}

Javadian Y, Behtash H, Akbari M, Taghipour‐Darzi M, Zekavat H. The effects of stabilizing exercises on pain and disability of patients with lumbar segmental instability. Journal of Back and Musculoskeletal Rehabilitation 2012;25:149‐55.

Javadian 2015 {published data only}

Javadian Y, Akbari M, Talebi G, Taghipour‐Darzi M, Janmohammadi N. Influence of core stability exercise on lumbar vertebral instability in patients presented with chronic low back pain: a randomized clinical trial. Caspian Journal of Internal Medicine 2015;6(2):98–102.

Johannsen 1995 {published data only}

Johannsen F, Remvig L, Kryger P, Beck P, Warming S, Lybeck K, et al. Exercises for chronic low back pain: a clinical trial. The Journal of Orthopaedic and Sports Physical Therapy 1995;22:52‐9.

Johnson 2007 {published data only}

Johnson RE, Jones GT, Wiles NJ, Chaddock C, Potter RG, Roberts C, et al. Active exercise, education, and cognitive behavioral therapy for persistent disabling low back pain: a randomized controlled trial. Spine 2007;32:1578‐85.

Jones 2007 {published data only}

Jones M, Stratton G, Reilly T, Unnithan V. The efficacy of exercise as an intervention to treat recurrent nonspecific low back pain in adolescents. Pediatric Exercise Science 2007;19:349‐59.

Kaapa 2006 {published data only}

Kaapa EH, Frantsi K, Sarna S, Malmivaara A. Multidisciplinary group rehabilitation versus individual physiotherapy for chronic nonspecific low back pain: a randomized trial. Spine 2006;31:371‐6.

Kachanathu 2012 {published data only}

Kachanathu SJ, Zakaria AR, Sahni A, Jaiswal P. Chronic low back pain in fast bowlers: a comparative study of core spinal stabilization and conventional exercises. Journal of Physical Therapy Science 2012;24:821‐5.

Karimi 2009 {published data only}

Karimi N, Ebrahimi I, Ezzati K, Kahrizi S, Torkaman G, Arab AM. The effects of consecutive supervised stability training on postural balance in patients with chronic low back pain. Pakistan Journal of Medical Sciences 2009;25:181.

Kladny 2003 {published data only}

Kladny B, Fischer F C, Haase I. [Evaluation of specific stabilizing exercise in the treatment of low back pain and lumbar disk disease in outpatient rehabilitation]. [German]. Zeitschrift fur Orthopadie und Ihre Grenzgebiete 2003;141:401‐5.

Kline 2013 {published data only}

Kline JB, Krauss JR, Maher SF, Qu X. Core strength training using a combination of home exercises and a dynamic sling system for the management of low back pain in pre‐professional ballet dancers: a case series. Journal of Dance Medicine & Science 2013;17:24‐33.

Kofotolis 2008 {published data only}

Kofotolis ND, Vlachopoulos SP, Kellis E. Sequentially allocated clinical trial of rhythmic stabilization exercises and TENS in women with chronic low back pain. Clinical Rehabilitation 2008;22:99‐111.

Koldas 2008 {published data only}

Koldas Dogan S, Sonel Tur B, Kurtais Y, Atay MB. Comparison of three different approaches in the treatment of chronic low back pain. Clinical Rheumatology 2008;27:873‐81.

Koumantakis 2005 {published data only}

Koumantakis GA, Watson PJ, Oldham JA. Trunk muscle stabilization training plus general exercise versus general exercise only: randomized controlled trial of patients with recurrent low back pain. Physical Therapy 2005;85:209‐25.

Kumar 2009 {published data only}

Kumar S, Sharma VP, Negi MPS. Efficacy of dynamic muscular stabilization techniques (DMST) over conventional techniques in rehabilitation of chronic low back pain. Journal of Strength and Conditioning Research 2009;23:2651‐9.

Kumar 2010 {published data only}

Kumar S, Sharma VP, Shukla R, Dev R. Comparative efficacy of two multimodal treatments on male and female sub‐groups with low back pain (part II). Journal of Back and Musculoskeletal Rehabilitation 2010;23:1‐9.

Kumar 2011 {published data only}

Kumar SP. Efficacy of segmental stabilization exercise for lumbar segmental instability in patients with mechanical low back pain: a randomized placebo controlled crossover study. North American Journal of Medical Sciences 2011;3:461.

Kumar 2012 {published data only}

Kumar S, Sharma VP, Aggarwal A, Shukla R, Dev R. Effect of dynamic muscular stabilization technique on low back pain of different durations. Journal of Back & Musculoskeletal Rehabilitation 2012;25:73‐9.

Kuukkanen 1996 {published data only}

Kuukkanen T, Malkia E. Muscular performance after a 3 month progressive physical exercise program and 9 month follow‐up in subjects with low back pain. A controlled study. Spine 1996;6:112‐21.

Lee 2015 {published data only}

Lee JS, Kim TH, Kim DY, Shim JH, Lim JY. Effects of selective exercise for the deep abdominal muscles and lumbar stabilization exercise on the thickness of the transversus abdominis and postural maintenance. Journal of Physical Therapy Science 2015;27:367‐70.

Lewis 2005 {published data only}

Lewis JS, Hewitt JS, Billington L, Cole S, Byng J, Karayiannis S. A randomized clinical trial comparing two physiotherapy interventions for chronic low back pain. Scandinavian Journal of Medicine & Science in Sports 2005;30:711‐21.

Lie 1999 {published data only}

Lie H, Frey S. [Mobilizing or stabilizing exercise in degenerative disk disease in the lumbar region?]. [Norwegian]. Tidsskrift for Den Norske Laegeforening 1999;119:2051‐3.

Lomond 2015 {published data only}

Lomond KV, Jacobs JV, Hitt JR, DeSarno MJ, Bunn JY, Henry SM. Effects of low back pain stabilization or movement system impairment treatments on voluntary postural adjustments: a randomized controlled trial. Spine Journal 2015;15:596‐606.

Long 2004 {published data only}

Long A, Donelson R, Fung T. Does it matter which exercise? A randomized control trial of exercise for low back pain. Spine 2004;29:2593‐602.

Macedo 2008 {published data only}

Macedo LG, Latimer J, Maher CG, Hodges PW, Nicholas M, Tonkin L, et al. Motor control or graded activity exercises for chronic low back pain? A randomised controlled trial. BMC Musculoskeletal Disorders 2008;5:65.

Macedo 2012 {published data only}

Macedo LG, Latimer J, Maher CG, Hodges PW, McAuley JH, Nicholas MK, et al. Effect of motor control exercises versus graded activity in patients with chronic nonspecific low back pain: a randomized controlled trial. Physical Therapy 2012;93:1‐15.

Magalhaes 2013 {published data only}

Magalhaes MO, França FJR, Burke TN, Ramos LAV, Carvalho e Silva APMC, Almeida GPL, et al. Efficacy of graded activity versus supervised exercises in patients with chronic non‐specific low back pain: protocol of a randomised controlled trial. BMC Musculoskeletal Disorders 2013;14:36. [DOI: 10.1186/1471‐2474‐14‐36]

Magnusson 2008 {published data only}

Magnusson ML, Chow DH, Diamandopoulos Z, Pope MH. Motor control learning in chronic low back pain. Spine 2008;33:E532‐8.

Maher 2005 {published data only}

Maher CG, Latimer J, Hodges PW, Refshauge KM, Moseley L, Herbert RD, et al. The effect of motor control exercise versus placebo in patients with chronic low back pain. BMC Musculoskeletal Disorders 2005;6:54.

Mannion 1999 {published data only}

Mannion AF, Muntener M, Taimela S, Dvorak J. A randomized clinical trial of three active therapies for chronic low back pain. Spine 1999;24:2435‐48.

Mannion 2009 {published data only}

Mannion AF, Helbling D, Pulkovski N, Sprott H. Spinal segmental stabilisation exercises for chronic low back pain: programme adherence and its influence on clinical outcome. European Spine Journal 2009;18:1881‐91.

Mannion 2012 {published data only}

Mannion AF, Caporaso F, Pulkovski N, Sprott H. Spine stabilisation exercises in the treatment of chronic low back pain: a good clinical outcome is not associated with improved abdominal muscle function. European Spine Journal 2012;21:1301‐10.

Marshall 2008 {published data only}

Marshall PW, Murphy BA. Muscle activation changes after exercise rehabilitation for chronic low back pain. Archives of Physical Medicine & Rehabilitation 2008;89:1305‐13.

Meira 2013 {published data only}

Meira DM. Functional reeducation program associated with back school improves functional disability and pain in workers with chronic low back pain: a pilot study. Annals of the Rheumatic Diseases 2013;72:A1095.

Miller 2005 {published data only}

Miller ER, Schenk RJ, Karnes JL, Rousselle JG. A comparison of the McKenzie approach to a specific spine stabilization program for chronic low back pain. The Journal of Manual & Manipulative Therapy 2005;13:103‐12.

Mohseni‐Bandpei 2011 {published data only}

Mohseni‐Bandpei MA, Rahmani N, Behtash H, Karimloo M. The effect of pelvic floor muscle exercise on women with chronic non‐specific low back pain. Journal of Bodywork & Movement Therapies 2011;15:75‐81.

Monteiro 2009 {published data only}

Monteiro FC, Kirkwood RN, Magalhaes CMB. Lumbar stabilization exercises and manual therapy for treatment of non‐specific and chronic low back pain [Exercícios de estabilizaçao lombar e terapia manual no tratamento da dor lombar crônica inespecífica]. Revista Fisioterapia Brasil 2009;10:442‐7.

Monticone 2004 {published data only}

Monticone M, Barbarino A, Testi C, Arzano S, Moschi A, Negrini S. Symptomatic efficacy of stabilizing treatment versus laser therapy for sub‐acute low back pain with positive tests for sacroiliac dysfunction: a randomised clinical controlled trial with 1 year follow‐up. Europa Medicophysica 2004;40:263‐8.

Moon 2013 {published data only}

Moon HJ, Choi KH, Kim DH, Kim HJ, Cho YK, Lee KH, et al. Effect of lumbar stabilization and dynamic lumbar strengthening exercises in patients with chronic low back pain. Annals of Rehabilitation Medicine 2013;37:110‐7.

Moseley 2002 {published data only}

Moseley L. Combined physiotherapy and education is efficacious for chronic low back pain. Australian Journal of Physiotherapy 2002;48:297‐302.

Moseley 2003 {published data only}

Moseley GL. Joining forces ‐ combining cognition ‐ targeted motor control training with group or individual pain physiology education: a successful treatment for chronic low back pain. Journal of Manual & Manipulative Therapy 2003;11:88‐94.

Moussouli 2014 {published data only}

Moussouli M, Vlachopoulos SP, Kofotolis ND, Theodorakis Y, Malliou P, Kellis E. Effects of stabilization exercises on health‐related quality of life in women with chronic low back pain. Journal of Physical Activity & Health 2014;11:1295‐303.

Navalgund 2009 {published data only}

Navalgund A. Evaluating the effect of a 10‐week stabilization exercise program on the postural stability and the neuromuscular control of the spine in subjects with subacute recurrent low back pain. Dissertation.. Ohio State University, Columbus, Ohio: Ohio State University; 2009.

NCT00201513 {published data only}

NCT00201513. Anticipatory muscle control and effect of stabilizing exercises in patients with subacute and chronic low back pain. https://clinicaltrials.gov/ct2/show/NCT00201513 (accessed 25 June 2015).

NCT00555802 {published data only}

NCT00555802. The effect of motor control exercise versus general exercise on lumbar local stabilizing muscles thickness. https://clinicaltrials.gov/ct2/show/NCT00555802 (accessed 25 June 2015).

NCT00624533 {published data only}

NCT00624533. Efficiency of GDS method for lumbar stabilization for non‐specific low back pain in primary care. https://clinicaltrials.gov/ct2/show/NCT00624533 (accessed 25 June 2015).

NCT01061632 {published data only}

NCT01061632. High (deadlift) versus low intensity motor control exercises on low back pain. https://clinicaltrials.gov/ct2/show/NCT01061632 (accessed 25 June 2015).

NCT01124201 {published data only}

NCT01124201. Lumbar stabilization, strengthening and stretching in chronic low back pain. https://clinicaltrials.gov/ct2/show/NCT01124201 (accessed 25 June 2015).

NCT01362049 {published data only}

NCT01362049. Mechanisms of specific trunk exercises in low back pain. https://clinicaltrials.gov/ct2/show/NCT01362049 (accessed 25 June 2015).

NCT02112760 {published data only}

NCT02112760. Specific stabilization exercise with ultrasound feedback for patients with recurrent low back pain. https://clinicaltrials.gov/ct2/show/NCT02112760 (accessed 25 June 2015).

NCT02170753 {published data only}

NCT02170753. Regional manual therapy and motor control exercise for chronic low back pain. https://clinicaltrials.gov/ct2/show/NCT02170753 (accessed 25 June 2015).

NCT02200913 {published data only}

NCT02200913. Effects of core stabilization exercise on balance. https://clinicaltrials.gov/ct2/show/NCT02200913 (accessed 25 June 2015).

NCT02221609 {published data only}

NCT02221609. Movement system impairment based classification versus general exercise for chronic non‐specific low back pain: a randomised controlled trial. https://clinicaltrials.gov/ct2/show/NCT02221609 (accessed 25 June 2015).

NCT02374970 {published data only}

NCT02374970. Transversus abdominis muscular training and chronic low back pain. https://clinicaltrials.gov/ct2/show/NCT02374970 (accessed 25 June 2015).

NCT02398760 {published data only}

NCT02398760. Relationship between clinical tests and clinical outcomes after motor control exercises intervention. https://clinicaltrials.gov/ct2/show/NCT02398760 (accessed 25 June 2015).

Nelson 1995 {published data only}

Nelson BW, O'Reilly E, Miller M, Hogan M, Wegner JA, Kelly C. The clinical effects of intensive, specific exercise on chronic low back pain: a controlled study of 895 consecutive patients with 1‐year follow up. Orthopedics 1995;18:971‐81.

Nelson‐Wong 2009 {published data only}

Nelson‐Wong E. Biomechanical predictors of functionally induced low back pain, acute response to prolonged standing exposure, and impact of a stabilization‐based clinical exercise intervention. Dissertation.. University of Waterloo (Canada), Waterloo, Ontario, Canada: University of Waterloo; 2009.

Niemisto 2003 {published data only}

Niemisto L, Lahtinen‐Suopanki T, Rissanen P, Lindgren KA, Sarna S, Hurri H. A randomized trial of combined manipulation, stabilizing exercises, and physician consultation compared to physician consultation alone for chronic low back pain. Spine 2003;28:2185‐91.

Niemisto 2004 {published data only}

Niemisto L, Sarna S, Lahtinen‐Suopanki T, Lindgren KA, Hurri H. Predictive factors for 1‐year outcome of chronic low back pain following manipulation, stabilizing exercises, and physician consultation or physician consultation alone. Journal of Rehabilitation Medicine 2004;36:104‐9.

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Niemisto L, Rissanen P, Sarna S, Lahtinen‐Suopanki T, Lindgren KA, Hurri H. Cost‐effectiveness of combined manipulation, stabilizing exercises, and physician consultation compared to physician consultation alone for chronic low back pain: a prospective randomized trial with 2‐year follow‐up. Spine 2005;30:1109‐15.

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Norris C, Matthews M. The role of an integrated back stability program in patients with chronic low back pain. Complementary Therapies in Clinical Practice 2008;14:255‐63.

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O'Sullivan PB, Phyty GD, Twomey LT, Allison GT. Evaluation of specific stabilizing exercise in the treatment of chronic low back pain with radiologic diagnosis of spondylolysis or spondylolisthesis. Spine 1997;22:2959‐67.

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Oguzhan H, Ozyurek S, Kaya E. Effectiveness of back school program to quality of life and disability in patients with chronic low back pain. European Journal of Pain Supplements. Conference: 7 Congress of the European Federation of Pain Chapters: Pain in Europe VII, EFIC. Hamburg, Germany, 2011.

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Ota M, Kaneoka K, Hangai M, Koizumi K, Muramatsu T. Effectiveness of lumbar stabilization exercises for reducing chronic low back pain and improving quality of life. Journal of Physical Therapy Science 2011;23:679‐81.

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Pereira NT, Ferreira LAB, Pereira WM. Effectiveness of segmental stabilization exercises on mechanical‐postural chronic low back pain [Efetividade de exercícios de estabilização segmental sobre a dor lombar crônica mecânico‐postural]. Fisioterapia em Movimento 2010;23:605‐14.

Puntumetakul 2013 {published data only}

Puntumetakul R, Areeudomwong P, Emasithi A, Yamauchi J. Effect of 10‐week core stabilization exercise training and detraining on pain‐related outcomes in patients with clinical lumbar instability. Patient Preference and Adherence 2013;7:1189‐99.

Rabin 2014 {published data only}

Rabin A, Shashua A, Pizem K, Dickstein R, Dar G. A clinical prediction rule to identify patients with low back pain who are likely to experience short‐term success following lumbar stabilization exercises: a randomized controlled validation study. Journal of Orthopaedic & Sports Physical Therapy 2014;44:6‐B13.

Rasmussen‐Barr 2003 {published data only}

Rasmussen‐Barr E, Nilsson‐Wikmarn L, Arvidsson I. Stabilizing training compared with manual treatment in sub‐acute and chronic low‐back pain. Manual Therapy 2003;8:233‐41.

Rasmussen‐Barr 2009 {published data only}

Rasmussen‐Barr E, Ang B, Arvidsson I, Nilsson‐Wikmar L. Graded exercise for recurrent low‐back pain: a randomized, controlled trial with 6‐, 12‐, and 36‐month follow‐ups. Spine 2009;34:221‐8.

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Rhee HS, Kim YH, Sung PS. A randomized controlled trial to determine the effect of spinal stabilization exercise intervention based on pain level and standing balance differences in patients with low back pain. Medical Science Monitor 2012;18:CR174‐81.

Riipinen 2005 {published data only}

Riipinen M, Niemisto L, Lindgren KA, Hurri H. Psychosocial differences as predictors for recovery from chronic low back pain following manipulation, stabilizing exercises and physician consultation or physician consultation alone. Journal of Rehabilitation Medicine 2005;37:152‐8.

Rydeard 2006 {published data only}

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. Journal of Orthopaedic & Sports Physical Therapy 2006;36:472‐84.

Saner 2011 {published data only}

Saner J, Kool J, de Bie RA, Sieben JM, Luomajoki H. Movement control exercise versus general exercise to reduce disability in patients with low back pain and movement control impairment. A randomised controlled trial. BMC Musculoskeletal Disorders 2011;12:207. [DOI: 10.1186/1471‐2474‐12‐207]

Saner 2015 {published data only}

Saner J, Kool J, Sieben JM, Luomajoki H, Bastiaenen CH, de Bie RA. A tailored exercise program versus general exercise for a subgroup of patients with low back pain and movement control impairment: a randomised controlled trial with one‐year follow‐up. Manual Therapy 2015 Feb 26 [Epub ahead of print].

Shakeri 2013 {published data only}

Shakeri H, Fathollahi Z, Karimi N, Arab AM. Effect of functional lumbar stabilization exercises on pain, disability, and kinesiophobia in women with menstrual low back pain: a preliminary trial. Journal of Chiropractic Medicine 2013;12:160‐7.

Shaughnessy 2004 {published data only}

Shaughnessy M, Caulfield B. A pilot study to investigate the effect of lumbar stabilisation exercise training on functional ability and quality of life in patients with chronic low back pain. International Journal of Rehabilitation Research 2004;27:297‐301.

Shnayderman 2013 {published data only}

Shnayderman I, Katz‐Leurer M. An aerobic walking programme versus muscle strengthening programme for chronic low back pain: a randomized controlled trial. Clinical Rehabilitation 2013;27:207‐14.

Smeets 2009 {published data only}

Smeets RJEM. Do lumbar stabilising exercises reduce pain and disability in patients with recurrent low back pain?. Australian Journal of Physiotherapy 2009;55:138.

Smith 2011 {published data only}

Smith D, Bissell G, Bruce‐Low S, Wakefield C. The effect of lumbar extension training with and without pelvic stabilization on lumbar strength and low back pain. Journal of Back and Musculoskeletal Rehabilitation 2011;24:241‐9.

Sokunbi 2008 {published data only}

Sokunbi O, Watt P, Moore A. A randomised controlled trial (RCT) on the effects of frequency of application of spinal stabilisation exercises on multifidus cross sectional area (MFCSA) in participants with chronic low back pain. Physiotherapy Singapore 2008;11:9‐16.

Stankovic 2012 {published data only}

Stankovic A, Lazovic M, Kocic M, Dimitrijevic L, Stankovic I, Zlatanovic D, et al. Lumbar stabilization exercises in addition to strengthening and stretching exercises reduce pain and increase function In patients with chronic low back pain: randomized clinical open‐label study. Turkish Journal of Physical Medicine and Rehabilitation 2012;58:177‐83.

Streicher 2014 {published data only}

Streicher H, Matzold F, Hamilton C, Wagner P. Comparison of group motor control training versus individual training for people suffering from back pain. Journal of Bodywork and Movement Therapies 2014;18:489‐96.

Stuge 2004 {published data only}

Stuge B, Laerum E, Kirkesola G, Vollestad N. The efficacy of a treatment program focusing on specific stabilizing exercises for pelvic girdle pain after pregnancy: a randomized controlled trial. Spine 2004;29:359.

Suni 2006 {published data only}

Suni J, Rinne M, Natri A, Statistisian MP, Parkkari J, Alaranta H. Control of the lumbar neutral zone decreases low back pain and improves self‐evaluated work ability: a 12‐month randomized controlled study. Spine 2006;31:E611‐20.

Teyhen 2010 {published data only}

Teyhen DS, Usalis J, Szymanek EB, Paschall JC, Meagher MS, Harvey AD, et al. Rehabilitative ultrasound imaging assessment of the lumbar multifidus during stabilization exercises in healthy adults. Journal of Orthopaedic & Sports Physical Therapy 2010;40:A39.

Torstensen 1998 {published data only}

Torstensen TA, Ljunggren AE, Meen HD, Odland E, Mowinckel P, Geijerstam S. Efficiency and costs of medical exercise therapy, conventional physiotherapy, and self‐exercise in patients with chronic low back pain. A pragmatic, randomized, single‐blinded, controlled trial with 1‐year follow‐up. Spine 1998;23:2616‐24.

Trampas 2014 {published data only}

Trampas A, Mpeneka A, Malliou V, Godolias G, Vlachakis P. Immediate effects of core stability exercises and clinical massage on dynamic balance performance of patients with chronic specific low back pain. Journal of Sport Rehabilitation 2014 Dec 4 [Epub ahead of print].

Tsauo 2009 {published data only}

Tsauo JY, Chen WH, Liang HW, Jang Y. The effectiveness of a functional training programme for patients with chronic low back pain – a pilot study. Disability and Rehabilitation 2009;31:1100‐6.

Unsgaard‐Tondel 2010 {published data only}

Unsgaard‐Tondel M, Fladmark AM, Salvesen O, Vasseljen O. Motor control exercises, sling exercises, and general exercises for patients with chronic low back pain: a randomized controlled trial with 1‐year follow‐up. Physical Therapy 2010;90:1426‐40.

Vasseljen 2010 {published data only}

Vasseljen O, Fladmark AM. Abdominal muscle contraction thickness and function after specific and general exercises: a randomized controlled trial in chronic low back pain patients. Manual Therapy 2010;15:482‐9.

Vasseljen 2012 {published data only}

Vasseljen O, Unsgaard‐Tondel M, Westad C, Mork PJ. Effect of core stability exercises on feed‐forward activation of deep abdominal muscles in chronic low back pain. Spine 2012;37:1101‐8.

Wang 2012 {published data only}

Wang X, Zheng J, Bi X, Liu J. Effect of core stability training on patients with chronic low back pain. HealthMED 2012;6:754‐9.

Willemink 2012 {published data only}

Willemink MJ, van Es HW, Helmhout PH, Diederik AL, Kelder JC, van Heesewijk JP. The effects of dynamic isolated lumbar extensor training on lumbar multifidus functional cross‐sectional area and functional status of patients with chronic nonspecific low back pain. Spine 2012;37:E1651‐8.

Williamson 2008 {published data only}

Williamson W. Effect of supervised and directed exercise on low back pain and functional activity. Dissertation.. Oklahoma State University, Stillwater, Oklahoma: Oklahoma State University; 2008:118.

Xueqiang 2012 {published data only}

Xueqiang W, Jiejiao Z, Xia B, Jing L. Effect of core stability training on patients with chronic low back pain. HealthMED 2012;6:759.

Yang 2010 {published data only}

Yang EJ, Park WB, Shin HI, Lim JY. The effect of back school integrated with core strengthening in patients with chronic low‐back pain. American Journal of Physical Medicine & Rehabilitation 2010;89:744‐54.

Yelland 2004 {published data only}

Yelland MJ, Glasziou PP, Bogduk N, Schluter PJ, McKernon M. Prolotherapy injections, saline injections, and exercises for chronic low‐back pain: a randomized trial. Spine 2004;29:9‐16.

Yoo 2012 {published data only}

Yoo YD, Lee YS. The effect of core stabilization exercises using a sling on pain and muscle strength of patients with chronic low back pain. Journal of Physical Therapy Science 2012;24:671‐4.

You 2014 {published data only}

You JH, Kim SY, Oh DW, Chon SC. The effect of a novel core stabilization technique on managing patients with chronic low back pain: a randomized, controlled, experimenter‐blinded study. Clinical Rehabilitation 2014;28:460‐9.

Zhang 2015 {published data only}

Zhang Y, Tang S, Chen G, Liu Y. Chinese massage combined with core stability exercises for nonspecific low back pain: a randomized controlled trial. Complementary Therapies in Medicine 2015;23:1‐6.

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Characteristics of studies

Characteristics of included studies [ordered by study ID]

Aluko 2013

Methods

Randomised controlled trial

Participants

33 participants were recruited between July 2008 and June 2010 from within a primary care musculoskeletal physiotherapy service in the London borough of Hillingdon

Participants were excluded if they demonstrated evidence of any of the following: degenerative conditions affecting the spine, diabetes, pregnancy, underlying neurological conditions, active treatment of an ongoing spinal condition, active legal/compensation procedures, a history of depression, a history of multiple recurrent episodes of LBP and involvement in other research studies. Participants for whom English was not their primary language were also excluded

Interventions

All patients referred for treatment of non‐specific low back pain within physiotherapy service providers were assessed and subsequently offered a place in a “core stability” class consisting of both specific and global trunk exercises. Participants in both groups received this protocol as minimum intervention. The intervention group received further instruction on 8 specific exercises for stabilisation of muscles involving the transversus abdominis (TrA) and the lumbar multifidus (LM)

Core stability exercises (CSEs): Selection of exercises used in this study therefore relied on current belief systems, suggesting that isolation of TrA and LM is important for trunk stability. These exercises included the following: abdominal hollowing in prone lying, alternate straight‐leg raise in supine, abdominal hollowing in sitting, Crook lying–alternate heel slide, 4‐point kneeling pelvic shift (side to side), trunk curl in crook lying, pelvic tilt in sitting and alternate knee raise in sitting. Exercises met suggested criteria for safety, including avoidance of active hip flexion with fixed positioning of feet and pulling with the hands behind the head, while ensuring knee and hip flexion during all upper body exercises. Intervention group participants were required to perform 10 repetitions of each of the above exercises 3 times a day. To facilitate compliance, participants were required to complete a compliance diary. The diary method was chosen to avoid adding to participants' perceived barriers to exercise by impinging on available time to do the exercise routine

Outcomes

Pain: assessed by a VAS comprising a 100‐mm line with no numbers

Disability: assessed by the Roland Morris Disability Questionnaire

Both outcomes were measured at the start of the study and at 3, 6 and 12 weeks subsequently

Notes

No funding sources or conflicts of interest were reported for this study

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

"The randomization was done by a colleague independent and blind to the study using concealed envelopes within which the group description was randomly placed within them. The envelopes were numbered sequentially and chosen by the participants in the order in which they were recruited"

Allocation concealment (selection bias)

Low risk

"The randomization was done by a colleague independent and blind to the study using concealed envelopes within which the group description was randomly placed within them. The envelopes were numbered sequentially and chosen by the participants in the order in which they were recruited"

Blinding of participants and personnel (performance bias)
All outcomes

Low risk

"Although the participants were randomly allocated as they were recruited and blinded to the study, it was not possible to blind the assessment process"

Blinding of personnal/care provider (performance bias)
All outcomes

High risk

Care provider was not blinded

Blinding of outcome assessment (detection bias)
All outcomes

High risk

"Data were collected by the researcher who was therefore not blinded to the grouping of any of the participants"

Incomplete outcome data (attrition bias)
All outcomes

Unclear risk

Not described

Intention‐to‐treat analysis

High risk

Not considered. "An intention‐to‐treat analysis was used with missing data replaced with the Last Observation Carried Forward for incomplete data sets".

Selective reporting (reporting bias)

Low risk

Published report clearly included all expected outcomes

Group similarity of baseline (selection bias)

Low risk

Participants did not differ in baseline characteristics, as shown in Table 2

Co‐interventions (performance bias)

Unclear risk

Not described

Compliance (performance bias)

Unclear risk

Not described

Timing of outcome assessment (detection bias)

Low risk

All important outcomes assessments for both groups were measured at the same time

Brennan 2006

Methods

Randomised controlled trial

Participants

123 participants. Primary recruitment occurred at a single clinic between January 1, 2000, and July 1, 2003. Additional recruitment occurred at 2 other clinics between January 1, 2002, and September 1, 2002. Each clinic was located in Utah and was affiliated with Intermountain Health Care System

Inclusion criteria: Patients between 18 and 65 years of age with a primary complaint of LBP of less than 90 days' duration, with or without referral into the lower extremity, and an Oswestry Disability score of 25% were eligible

Exclusion criteria: visible lateral shift or acute kyphotic deformity, signs of nerve root compression (positive straight‐leg raise test and reflex or strength deficits), any red flags indicating serious pathology such as spinal neoplasm, infection or fracture, inability to reproduce any symptoms with lumbar spine active range of motion (AROM) or palpation, current pregnancy, prior surgery to the lumbar and/or sacral region

Interventions

All participants were scheduled for treatment twice weekly for 4 weeks for a maximum of 8 sessions

Manipulation treatment group: Participants randomly assigned to the manipulation group were treated via manual therapy techniques, which could include thrust manipulation, or by low‐amplitude mobilisation procedures directed to the lumbosacral region, and were given instruction on a lumbar active range of motion exercise. The therapist providing treatment was permitted to reexamine the participant and could choose 1 of 2 manual therapy techniques. The decision on which technique to use was left to the therapist's discretion, but 1 of the 2 techniques had to be used. With the first technique, the participant was supine, with the lumbar spine placed into side‐bending and rotation to the opposite direction. The therapist delivered a force through the participant's pelvis in a posterior and inferior direction. For the second technique, the participant was side‐lying. The lumbar spine was positioned in flexion or extension followed by rotation in an attempt to isolate forces to a particular spinal level. The therapist delivered the force through the participant's pelvis and trunk. Selection of technique was left to the discretion of the therapist. AROM exercise was performed by instructing the participant to alternately flex and extend the lumbar spine while in a quadruped position.

Specific exercise treatment group: Participants in the specific exercise group received instruction on repeated range of motion (ROM) exercises into lumbar flexion or extension. All participants in this group had to be treated using directional exercises; however, the direction of the exercise was determined by the treating therapist on the basis of reassessment of the participant's response to movement testing and symptom response to the position of sitting, standing or walking. Flexion exercises were used for participants who centralised with or had a preference for flexion movements or positions (i.e. sitting), whereas extension exercises were used for participants who centralised or had a preference for extension (i.e. standing or walking). Flexion or extension exercises were used, but not both. Flexion exercises were performed with the participant sitting, supine or quadruped. Extension exercises were performed in prone, while using prone on elbows or prone press‐up activities

Stabilisation treatment group: Participants in the stabilisation group were treated with a programme of trunk strengthening and stabilisation exercises. Participants were instructed to perform abdominal bracing exercises in supine and quadruped positions, progressing to more functional positions and activities as described by Richardson and Jull. Participants were also instructed on alternating arm and leg extension exercises in quadruped to strengthen the lumbar extensor muscles. Strengthening for the oblique abdominals included curl‐up and side support exercises

Outcomes

Pain: 11‐point rating scale (0 no pain to 10 worst imaginable pain) to assess current pain intensity

Disability: Modified Oswestry Questionnaire (OSW) to assess disability related to LBP

Notes

Supported by a research grant from the Deseret Foundation. Foundation funds were received in support of this work. No benefits in any form have been or will be received from a commercial party related directly or indirectly to the topic of this study

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

"A random number generator was used to generate a randomization list before initiation of the study. The list was maintained by the secretarial staff of the participating clinics"

Allocation concealment (selection bias)

Unclear risk

Sequence generation procedure or method of allocation was not mentioned

Blinding of participants and personnel (performance bias)
All outcomes

High risk

No mention of any attempts to blind participants

Blinding of personnal/care provider (performance bias)
All outcomes

High risk

No mention of any attempts to blind care provider

Blinding of outcome assessment (detection bias)
All outcomes

High risk

"Baseline and follow‐up examinations were conducted by a physical therapist who remained blind to the treatment group assignment"; outcome measures were self reported, thus, assessor was not considered blinded

Incomplete outcome data (attrition bias)
All outcomes

High risk

"Eighty one patients (66%) completed the long‐term follow‐up, with no differences in the median number of days between baseline and follow‐up or the proportions of patients with completed follow‐up between patients receiving matched or unmatched treatments"

Intention‐to‐treat analysis

Low risk

"Analysis was performed using intention‐to‐treat principles, with the last available OSW score carried forward for any missing data"

Selective reporting (reporting bias)

Low risk

Published report clearly included all expected outcomes

Group similarity of baseline (selection bias)

Low risk

Participants did not differ in baseline characteristics, as presented in Table 1, and no differences were found in additional data provided by study authors

Co‐interventions (performance bias)

Unclear risk

Not described

Compliance (performance bias)

Low risk

Compliance was acceptable on the basis of reported intensity/dosage, duration, number and frequency for all 3 groups

Timing of outcome assessment (detection bias)

Low risk

All important outcomes assessments for both groups were measured at the same time

Hides 1996

Methods

Randomised controlled trial

Participants

41 patients recruited from an accident and emergency department at a hospital over a 6‐month period

Inclusion criteria: Men and women were eligible for the study in the first instance if they were 18 to 45 years of age and were experiencing their first episode of unilateral, mechanical LBP for less than 3 weeks

Exclusion criteria: previous history of LBP or injury, previous lumbar surgery, spinal abnormalities indicated on radiographs, neuromuscular or joint disease, reflex and/or motor signs of nerve root compression or cauda equina compression, evidence of systemic disease, carcinoma or organ disease, pregnancy, any sports or fitness training involving the low back muscles done in the past 3 months

Interventions

Medical management group: advice on bed rest and absence from work and prescription of medication. Minimal bed rest (1 to 3 days) and only minor analgesics were prescribed. These analgesics included aspirin, paracetamol, combinations of low doses of codeine and aspirin, non‐steroidal anti‐inflammatory agents, Digestics and Capadex. Prescription of Valium was also allowable

Exercise therapy: Therapeutic exercises were designed to re‐educate the multifidus muscle in its stabilising role. They involved facilitating an active, isometric multifidus contraction in co‐contraction with deep abdominal muscles. Participants performed the contraction in the standing position with the lumbar spine in a neutral position. Contraction of the multifidus was confirmed by real‐time ultrasound imaging

Outcomes

Pain: McGill Pain Questionnaire and visual analogue scales

Disability: Roland Morris Disability Index

Notes

Financial support from The Menzies Foundation, The JP Kelly Mater Research Foundation, The Wenkart Foundation, The Physiotherapy Research Foundation and the Manual Therapy Special Group (Australia)

Risk of bias

Bias

Authors' judgement

Support for judgement

Random sequence generation (selection bias)

Low risk

"Random assignment to the control or treatment group was achieved by selecting the group number from sealed, shuffled envelopes"

Allocation concealment (selection bias)

Low risk

"Random assignment to the control or treatment group was achieved by selecting the group number from sealed, shuffled envelopes"

Blinding of participants and personnel (performance bias)
All outcomes

High risk

No mention of any attempts to blind participants

Blinding of personnal/care provider (performance bias)
All outcomes

High risk

No mention of any attempts to blind care provider

Blinding of outcome assessment (detection bias)
All outcomes

High risk

"Assessments were performed by two independent examiners, who were blinded to group allocation and patient presentation"; outcome measures were self reported, thus, assessor was not considered blinded

Incomplete outcome data (attrition bias)
All outcomes

Low risk

Percentages of withdrawals and dropouts were within the acceptable rate

Intention‐to‐treat analysis

Unclear risk

Not described

Selective reporting (reporting bias)

Low risk

Published report clearly included all expected outcomes

Group similarity of baseline (selection bias)

High risk

Groups were not similar at baseline regarding outcome disability

Co‐interventions (performance bias)

Unclear risk

Not described

Compliance (performance bias)

Unclear risk

Not described

Timing of outcome assessment (detection bias)

Low risk

All important outcomes assessments for both groups were measured at the same time

AROM: active range of motion.

CSE: core stability exercise.

LBP: low back pain.

LM: lumbar multifidus.

OSW: Modified Oswestry Questionnaire.

ROM: range of motion.

TrA: transversus abdominis

Characteristics of excluded studies [ordered by study ID]

Study

Reason for exclusion

Aasa 2015

No MCE and no mixed intervention

ACTRN12609000293268

No MCE and no mixed intervention

ACTRN12609000334202

No MCE and no mixed intervention

ACTRN12609000343202

Chronic LBP

ACTRN12611000971932

Chronic LBP

Aggarwal 2010

No patients with non‐specific LBP

Ahmed 2014

All groups given MCE

Akbari 2008

Chronic LBP

Ali 2006

No MCE and no mixed intervention

Allison 2012

Not an RCT

Alp 2011

Chronic LBP

Alp 2014

Chronic LBP

Ammar 2011

No MCE and no mixed intervention

Andrusaitis 2011

No MCE and no mixed intervention

Appling 2009

Not an RCT

Areeudomwong 2012

Chronic LBP

Barbosa 2013

Not an RCT

Bayraktar 2013

Chronic LBP

Belcher 1998

No patients with non‐specific LBP

Bentsen 1997

No MCE and no mixed intervention

Bi 2013

No MCE and no mixed intervention

Bilgin 2013

No patients with non‐specific LBP

Bordiak 2012

No patients with non‐specific LBP

Bronfort 1996

No MCE and no mixed intervention

Bronfort 2011

No MCE and no mixed intervention

Brooks 2012

No MCE and no mixed intervention

Brox 2003

No MCE and no mixed intervention

Buchbinder 2002

Not an RCT

Byuon 2012

No MCE and no mixed intervention

Cairns 2003

No MCE and no mixed intervention

Cairns 2006

Chronic LBP

Carmo 2013

Chronic LBP

Chan 2011

No MCE and no mixed intervention

Childs 2009

No patients with non‐specific LBP

Childs 2010

No patients with non‐specific LBP

Cho 2014

No MCE and no mixed intervention

Chung 2013

No MCE and no mixed intervention

Costa 2009

Chronic LBP

Critchley 2007

Chronic LBP

Croft 1999

Not an RCT

Dehner 2009

Not an RCT

Descarreaux 2002

No MCE and no mixed intervention

Donzelli 2006

No MCE and no mixed intervention

Dufour 2010

No MCE and no mixed intervention

Durante 2010

No MCE and no mixed intervention

Dvorak 2011

No MCE and no mixed intervention

Earde 2014

No evaluation of relevant outcomes for this review

Ewert 2009

No patients with non‐specific LBP

Faas 1993

No MCE and no mixed intervention

Faas 1995

No MCE and no mixed intervention

Ferreira 2007

Chronic LBP

Franca 2010

Chronic LBP

Franca 2012

Chronic LBP

Freitas 2008

No MCE and no mixed intervention

Gagnon 2005

No MCE and no mixed intervention

Gatti 2011

No MCE and no mixed intervention

George 2011

No patients with non‐specific LBP

Goldby 2006

Chronic LBP

Gustafsson 2008

Not an RCT

Guven 2003

No patients with non‐specific LBP

Hagen 2010

No MCE and no mixed intervention

Hansen 1993

No MCE and no mixed intervention

Harkapaa 1989

No MCE and no mixed intervention

Harringe 2007

Not an RCT

Harts 2008

No MCE and no mixed intervention

Helewa 1999

No MCE and no mixed intervention

Helmhout 2004

No MCE and no mixed intervention

Hemmati 2011

Chronic LBP

Henchoz 2010

No MCE and no mixed intervention

Hides 2008

Not an RCT

Hosseinifar 2013

Chronic LBP

Hunter 2012

No MCE and no mixed intervention

Hurwitz 2005

Not an RCT

Hwang 2013

No MCE and no mixed intervention

Inani 2013

Chronic LBP

ISRCTN80064281

No MCE and no mixed intervention

Jang 2013

No MCE and no mixed intervention

Javadian 2012

Chronic LBP

Javadian 2015

No evaluation of relevant outcomes for this review

Johannsen 1995

No MCE and no mixed intervention

Johnson 2007

No MCE and no mixed intervention

Jones 2007

No MCE and no mixed intervention

Kaapa 2006

No MCE and no mixed intervention

Kachanathu 2012

Chronic LBP

Karimi 2009

Not an RCT

Kladny 2003

No patients with non‐specific LBP

Kline 2013

No MCE and no mixed intervention

Kofotolis 2008

No MCE and no mixed intervention

Koldas 2008

No MCE and no mixed intervention

Koumantakis 2005

Chronic LBP

Kumar 2009

Chronic LBP

Kumar 2010

Chronic LBP

Kumar 2011

No MCE and no mixed intervention

Kumar 2012

Not an RCT

Kuukkanen 1996

Not an RCT

Lee 2015

No patients with non‐specific LBP

Lewis 2005

All groups given MCE

Lie 1999

No MCE and no mixed intervention

Lomond 2015

Chronic LBP

Long 2004

No MCE and no mixed intervention

Macedo 2008

Chronic LBP

Macedo 2012

Chronic LBP

Magalhaes 2013

Protocol

Magnusson 2008

Not an RCT

Maher 2005

Chronic LBP

Mannion 1999

No MCE and no mixed intervention

Mannion 2009

Not an RCT

Mannion 2012

Not an RCT

Marshall 2008

No MCE and no mixed intervention

Meira 2013

Chronic LBP

Miller 2005

Chronic LBP

Mohseni‐Bandpei 2011

No MCE and no mixed intervention

Monteiro 2009

Not an RCT

Monticone 2004

No patients with non‐specific LBP

Moon 2013

Chronic LBP

Moseley 2002

No MCE and no mixed intervention

Moseley 2003

All groups given MCE

Moussouli 2014

Not an RCT

Navalgund 2009

Not an RCT

NCT00201513

Chronic LBP

NCT00555802

Chronic LBP

NCT00624533

No MCE and no mixed intervention

NCT01061632

All groups given MCE

NCT01124201

Chronic LBP

NCT01362049

Chronic LBP

NCT02112760

Chronic LBP

NCT02170753

Chronic LBP

NCT02200913

Chronic LBP

NCT02221609

Chronic LBP

NCT02374970

Chronic LBP

NCT02398760

Chronic LBP

Nelson 1995

No MCE and no mixed intervention

Nelson‐Wong 2009

Not an RCT

Niemisto 2003

No MCE and no mixed intervention

Niemisto 2004

No MCE and no mixed intervention

Niemisto 2005

No MCE and no mixed intervention

Norris 2008

Not an RCT

O'Sullivan 1997

No patients with non‐specific LBP

Oguzhan 2011

No MCE and no mixed intervention

Ota 2011

Not an RCT

Pereira 2010

Not an RCT

Puntumetakul 2013

Chronic LBP

Rabin 2014

Chronic LBP

Rasmussen‐Barr 2003

Chronic LBP

Rasmussen‐Barr 2009

Chronic LBP

Rhee 2012

Chronic LBP

Riipinen 2005

No MCE and no mixed intervention

Rydeard 2006

No MCE and no mixed intervention

Saner 2011

No MCE and no mixed intervention

Saner 2015

No MCE and no mixed intervention

Shakeri 2013

No patients with non‐specific LBP

Shaughnessy 2004

Chronic LBP

Shnayderman 2013

No MCE and no mixed intervention

Smeets 2009

Not an RCT

Smith 2011

No MCE and no mixed intervention

Sokunbi 2008

Not an RCT

Stankovic 2012

Chronic LBP

Streicher 2014

Not an RCT

Stuge 2004

No patients with non‐specific LBP

Suni 2006

No MCE and no mixed intervention

Teyhen 2010

No patients with non‐specific LBP

Torstensen 1998

No MCE and no mixed intervention

Trampas 2014

All groups given MCE

Tsauo 2009

Chronic LBP

Unsgaard‐Tondel 2010

Chronic LBP

Vasseljen 2010

Chronic LBP

Vasseljen 2012

Chronic LBP

Wang 2012

No MCE and no mixed intervention

Willemink 2012

No MCE and no mixed intervention

Williamson 2008

No MCE and no mixed intervention

Xueqiang 2012

No MCE and no mixed intervention

Yang 2010

Not an RCT

Yelland 2004

No MCE and no mixed intervention

Yoo 2012

No MCE and no mixed intervention

You 2014

No MCE and no mixed intervention

Zhang 2015

No MCE and no mixed intervention

LBP: low back pain.

MCE: motor control exercise.

RCT: randomised controlled trial.

Data and analyses

Open in table viewer
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

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 1 Pain.

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

Analysis 1.2

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

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

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]

Open in table viewer
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

Analysis 2.1

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

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

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

Analysis 2.2

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

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

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]

Open in table viewer
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

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 1 Pain.

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

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 2 Disability.

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

Analysis 3.3

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

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

3.1 Long term

1

39

Risk Ratio (M‐H, Random, 95% CI)

0.36 [0.18, 0.72]

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