Motor control exercise for acute non‐specific low back pain

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

doi:10.1002/14651858.CD012085

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Figure 1

Study flow diagram.

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Figure 2

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

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Figure 3

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

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Figure 4

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

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Analysis 1.1

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

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Analysis 1.2

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

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Analysis 2.1

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

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Analysis 2.2

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

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Analysis 3.1

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

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Analysis 3.2

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

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Analysis 3.3

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

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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)	⊕⊕⊝⊝ Low^a,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)	⊕⊕⊝⊝ Low^a,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)	⊕⊕⊝⊝ Low^a,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

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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)	⊕⊕⊕⊝ Moderate^a
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)	⊕⊕⊝⊝ Low^a,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)	⊕⊕⊕⊝ Moderate^a
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)	⊕⊕⊝⊝ Low^a,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)	⊕⊕⊝⊝ Low^a,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

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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 low^a,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 low^a,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 low^a,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

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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]

Comparison 1. Motor control exercise vs spinal manipulative therapy

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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]

Comparison 2. Motor control exercise vs other exercises

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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]

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

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