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Effects of Pilates Exercises in Low Back Pain: A Systematic Review Ballard, Beth; Carey, Tina; Clayton, Gillian; Lenz, Angela; Mayall, Erika; Wall, Mike; Dean, Elizabeth; Westby, Marie 2007-07-30

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Effects of Pilates on Low Back Pain: A systematic review Elizabeth Ballard Tina Carey Gillian Clayton Angela Lenz Erika Mayall Michael Wall Outline { Introduction { Methods { Results { Discussion { Limitations { Conclusion { Future Research { Clinical Message Definition { Low Back Pain z Pain in the area between the inferior-most aspect of the scapula and gluteal folds, with or without radiation to the lower extremities (Van Tulder, 2004) Low Back Pain { Contributors z sedentary lifestyle z poor posture z age z excessive body weight z strength of abdominal and back muscles z history of smoking z anxiety z depression z occupational factors z psychosocial factors z trauma z pathological Low Back Pain { Prevalence z 4 out of 5 North Americans experience LBP at least once in their lifetime (Luo et al, 2004) { Recurrence of LBP (Woolf and Pfleger, 2003) z 20-44% within one year z 85% during lifetime { Cost z Total cost $8.1 billion annually in Canada z total direct health care costs represent 1% of the Gross National Product of Canada (Woolf and Pfleger, 2003) Joseph H. Pilates { Inventor of Pilates Method (WW1) { Introduced to dancers and actors What is Pilates? { Approximately 500 exercises that are performed on mats or specialized apparatus { Available through videos, books, and gym classes Definitions { Core z The inner unit is comprised of the muscles of the pelvic floor, transversus abdominis (TA), multifidus, the diaphragm and the posterior fibers of psoas. z The outer unit is comprised of several slings or systems of muscles (global stabilizers and mobilizers) (Gibbons and Comerford, 2001) { ‘Powerhouse’ z The connection between the upper torso and the pelvis.  In a motor control model, this includes the relationship between the TA, internal and external abdominal obliques, diaphragm, and pelvic floor muscles (Anderson, 2005) Goals of Pilates Exercise { To stabilize the ‘powerhouse’ by strengthening the abdominal, lower spine and pelvic floor muscles { To train the active and neural local spinal musculature, incorporating breathing patterns, while inhibiting the global musculature { xXyuLc0 Pilates Industry { In 2003, Pilates exercise was the fastest growing fitness activity in North America { Stott Pilates increased their sales by 1147% between 1997 and 2002 { In 2000, the Pilates trademark ended which may have resulted in the boom in the industry Pilates and Physiotherapy { Pilates exercise training has now become common practice for many physiotherapists in the treatment of many conditions including LBP Research { Joseph H. Pilates did little research to support the effectiveness of his programs in rehabilitation { The usage of Pilates exercise in physiotherapy rehabilitation continues to increase { Is there research to support Pilates exercise use in physiotherapy? Review Question To determine if Pilates exercise has an effect on pain and/or function in individuals with LBP compared with no treatment or other treatments. Methods Paper Identification { Conducted between July 2006 and June 2007 { Selected databases { Grey literature search z Google z Google Scholar z Pilates Exercise Magazines { Experts in the field { Hand search from identified studies Databases { MEDLINE (1966-present) { EMBASE (1980- present) { CINAHL (1982-present) { SPORTDiscus (1830-present) { ProQuest (1980-present) { PEDro { Academic Search Premier { Cochrane Central Register of Controlled Trials { Cochrane Database of Systematic Reviews Search Strategy { Title screen { Abstract screen { Full text screen z Screening tools were developed z Two independent reviewers screened at each level z Inconsistency was resolved through discussion Key Terms { Population z low back pain, back pain, back ache { Intervention z pilates, pilates-based, pilates exercise, lumbo- pelvic, core (strength, strengthening, stability, stabilization), trunk (stabilization, stability, strength), lumbar (strength, stabilization), muscle (strength, strengthening, function), spine stabilization, lumbar spine muscle recruitment, stabilization exercises, stability, and kinesiotherapy. Inclusion Criteria { Low back pain as defined earlier { Any duration (acute, subacute, chronic, recurrent) { Any type { No discrimination based on funding { Adults over 18 years of age { Pilates method intervention { Outcome measures of pain and/or function Exclusion Criteria { Non-English { Pregnancy related pain Outcomes { Pain z An unpleasant sensory and emotional experience associated with actual or potential tissue damage or described in terms of such damage (International Association for the Study of Pain) z Measured by any valid and reliable pain scale Outcomes { Function z A complex interaction between the health condition of the individual and the contextual factors of the environment as well as personal factors (Stucki, Cieza, & Melvin, 2007). z Measured by any subjective or objective scale validated for the LBP population Quality Assessment { RCTs were assessed using the modified van Tulder scale { Case study was assessed using the Case Study Methodological Quality Assessment Tool { Levels of evidence assigned using guidelines developed by Phillips (2001) Data Extraction & Analysis { Data were extracted from the selected studies using the Data Extraction Form { Two independent reviewers extracted relevant data { In situations where results were inconsistent, the two reviewers referred to the study to come to a consensus { Best evidence synthesis was performed Results Search Strategy Flow Diagram Study Design and Quality Author, year Study Design Quality Assessment Level of Evidence Anderson, 2005 RCT 5/10 Level 2b Gagnon, 2005 RCT 5/10 Level 2b Hawson, 2002 Case series 5/7 Level 4 Quinn, 2005 RCT 3/10 Level 2b Rydeard et al, 2006 RCT 8/10 Level 1b Population Author, year Sample Size (male:female) Mean Age (yrs) Duration of LBP Anderson, 2005 n= 10 I n= 11 C (11:10) I= 42.4 C= 44 >3 months Gagnon, 2005 n= 6 I (1:5) n= 6 C  (1:3) I= 36 C= 30.33 >3 months Hawson, 2002 n= 5 (2:3) 36 (range19-48) >3 months Quinn, 2005 n= 15 I n= 7 C I= 46.3 C= 34.7 >6 months Rydeard et al, 2006 n= 21 I(8:13) n= 18 C(1:2) I= 34 C= 37 >6 weeks Intervention Author, year Description Frequency Duration (session, total) Anderson, 2005 I=Pilates, Pilates instructor, Allegro Reformer C=Massage, Massage Therapist, gluteal folds to head 2x/week 50 minutes 6 weeks 30-45 min 7.3 weeks Range 2.5 – 5 weeks 45-60 min 12 weeks 1 hour – clinic 15 min – hour 4 weeks Gagnon, 2005 I=Pilates, Stott Pilates instructor, mat Pilates C=Traditional physio, AT/Ex Phys/PT, mat exercises ~1.5x/week Hawson, 2002 I=Traditional physio & Pilates, Pilates instructor, reformer/wall unit/combo chair 6 treatments Quinn, 2005 I=Pilates, certified instructor, mat exercises C=no exercise, normal daily activities 2x/week Rydeard et al, 2006 I=Pilates, clinic & home, PT, mat/reformer/video C=No exercise, treatment from health care professionals as needed 3x/week – clinic 6x/week – home Intervention Author, year Compliance Drop out rate Anderson, 2005 N/A 32% 43% 44.4% 31.3% 0% Gagnon, 2005 n=1 non compliant Hawson, 2002 N/A Quinn, 2005 Attendance 87.5% Rydeard et al, 2006 100% Outcomes Author, year Pain Intervention Pain Control Function Intervention MBI Pain   ↓ 35.1% (0.54) SF-36 Pain ↑ 7.9% (0.32) ODQ   ↓ 18.1% (0.35) MBI-D ↓ 32.4% (0.39) RODI   ↓ 55.8% (1.09) ODQ   ↓ 38.9% (N/A) ODQ   ↓ 57.9% (2.15) RMQ/RMDQ-HK ↓ 35% (1.57) VAS     ↓ 51.2% (1.07) VAS     ↓ 39.2% (N/A) N/A NRS-101   ↓ 20.4% (1.83) Function Control Anderson, 2005 MBI Pain ↓ 8.7% (0.26) SF-36 Pain  ↓ 2.0% (0.04) ODQ ↓ 2.9% (0.64) MBI-D ↓ 26.1% (0.42) Gagnon, 2005 VAS     ↓ 60.2% (0.60) RODI  ↓ 46.6% (1.79) Hawson, 2002 N/A N/A Quinn, 2005 N/A ODQ    ↓ 18.2% (0.65) Rydeard et al, 2006 NRS-101 ↑ 11.5% (4.67) RMQ/RMDQ-HK ↓ 23.8% (3.43) Summary Author, year Summary Statement Anderson, 2005 Not statistically significant, but PE subjects showed greater improvement on all pain outcomes (MBI Pain & SF-36) and disability outcomes (MBI Disability & ODQ) Gagnon, 2005 PE group improved in measures of pain and function equal to traditional physiotherapy (VAS & RODI) Hawson, 2002 4/5 subjects reported a decrease in pain intensity (VAS) Quinn, 2005 Significant change in pre-post ODQ scores within PE group. No statistical significance in ODQ between PE and control groups. Rydeard et al, 2006 PE significantly reduces LBP intensity and functional disability levels in comparison to usual care. (NRS- 101, RMQ/RMDQ-HK) Discussion Study Quality { Strengths z Groups similar at baseline for prognostic indicators z Randomization and timing of outcome assessment adequate z 3/4 had treatment allocation concealment { Concerns z Lack of blinding z Level of adherence z Drop out rate z Presence of co-interventions z Lack of intention-to-treat analysis { Peer-reviewed article higher quality Population { Male:female subjects consistent with gender distribution of LBP in population { Mean age of studies was lower than LBP population reported { Subjects were no longer in acute stage of healing, but in the repair or remodeling stage { Sample sizes were small { All subjects were volunteers with relatively mild LBP Intervention { Pilates exercise protocols varied z Type, frequency, duration, certification of instructor, progression { Intensity of intervention { Presence of co-interventions { Lack of long-term follow-up { Adverse effects and safety Comparisons { Variability of control groups z Massage and lumbar stabilization z No active treatment { Lack of details of control group parameters Outcomes { No single outcome measure was used in all studies { Some overlap of outcome measures used between studies { Outcome measures validated in the LBP population { Sensitive enough to show change in less severely effected subjects? Limitations { Broad selection criteria { No limits set for study design { No limits set for quality assessment score { Heterogeneity of included studies { Bias in quality assessment tool modifications { Limited outcomes investigated { Effect size calculator Conclusion { There is limited evidence to support the efficacy of a Pilates exercise intervention in the management of LBP when compared to no treatment { There is no evidence that Pilates exercise is superior to lumbar stabilization exercises or massage therapy in the treatment of LBP Future Research { Higher quality studies should incorporate: z Thorough study design z Larger sample sizes z Variation in intervention protocols z Variation in control groups z Use of a standardized outcome measure to facilitate comparison z Long term follow-up Clinical Message { Pilates exercise may be an effective therapeutic intervention for the chronic LBP population when provided by a Pilates certified physiotherapist Acknowledgements We would like to say a BIG “Thank You” to: z Marie Westby z Dr. Elizabeth Dean z Dr. Susan Harris z Dr. Angela Busch z Charlotte Beck Questions? References Anderson BD  2005  Randomized clinical trial comparing active versus passive approaches to the treatment of recurrent and chronic low back pain.  Dissertation - University of Miami, pp. 1-206 Arokoski JP, Valta T, Ariaksinen O, Kankaanpaa M  2001  Back and abdominal muscle function during stabilization exercises.  Archives of Physical Medicine and Rehabilitation 82: 1089-1098 Baechle TR, Earle RW  2000  Essentials of strength and conditioning, 2nd edn.  Champaign, Human Kinectics. Beurskens,A J, de Vet HC, Koke AJ 1996 Responsiveness of functional status in low back pain: a comparison of different instalments. Pain 65: 71-76 Boditree Pilates and Healing. Accessed online August 1st, 2006 at Bogduk N, 2004  Management of chronic low back pain.  The Medical Journal of Australia 180: 79-83 Carlsson AM  1983  Assessment of chronic pain. Aspects of the reliability and validity of the visual analogue scale.  Pain 16: 87–101 Collins SL, Moore RA, McQuay HJ. 1997  The visual analogue pain intensity scale: what is moderate pain in millimeters? Pain 72: 95–97 Coyte PC, Asche CV, Croxford R, Chan B  1998  The Economic cost of musculoskeletal disorders in Canada. Arthritis Care and Research 11: 315-325 Dean E, Arscott S, Desaulles P, Hughes K, Kotzo S, Preto R  (2006)  The effects of manual therapy on dorsiflexion range of motion following lateral ankle sprains: A systematic review.  Unpublished. Environics Research Group Limited  2003  Survey of Canadian adults: Back pain.  Toronto, Environics Research Group Limited. Fairbank JC, Couper J, Davies JB, O'Brien JP 1980  The Oswestry low back pain disability questionnaire.  Physiotherapy 66: 271-27 Furlan A, Brosseau L, Imamura M, Irvin E  2002  Massage for low-back pain: A systematic review within the framework of the Cochrane Collaboration Back Review Group.  Spine 27: 1896-1910 Gagnon LH  2005  Efficacy of Pilates exercises as therapeutic intervention in treating patients with low back pain.  Dissertation - The University of Tennessee, pp. 1-107 Gibbons S, Comerford M 2001 Strength versus stability Part I; Concept and terms, Part II Limitations and benefits. Orthopaedic Division Review. CPA March/April Hawson S  2002  Efficacy of Pilates-based exercises on the treatment of chronic low back pain.  Dissertation - California State University, pp. 1-41 Hong Kong Hospital Authority  1999  Examining reliability, validity and responsiveness of Hong Kong version of Roland-Morris Disability Questionnaire (RMDQ-HK) as an outcome measure of patients with low back pain: a multicentre study. Hong Kong, Working Group on Low Back Pain Outcomes Assessment, Coordinating Committee for Physiotherapists. Kisner C, Colby LA  2002  Therapeutic exercise foundations and techniques, 4th edn.  Philadelphia, FA Davis Company. Leclaire R, Blier F, Fortin L, Proulx R 1997  A crosssectional study comparing the Oswestry and Roland-Morris Functional Disability scales in two populations of patients with low back pain of different levels of severity.  Spine 22: 68-71 Lee D  2004  The pelvic girdle: An approach to the examination and treatment of the lumbopelvic-hip region, 3rd edn.  London, Churchill Livingstone. Liddle SD, Baxter GD, Gracey JH 2004  Exercise and chronic back pain: what works?  Pain 107: 176-190 Luo X, Pietrobon R, X Sun S, Liu GG, Hey L  2004  Estimates and patterns of direct health care expendictures among individuals with back pain in the United States.  Spine 29: 79-86 Martin CW, Noertjojo K, Dunn CT. Low Back Pain. 2002. Accessed online July 31st, 2006 at McDonald JC, Lundgren KL  1998  The progressive dynamic lumbar stabilization program for the treatment of musculoskeletal dysfunctions that contribute to mechaical low back pain.  Journal of Sports Chiropractic and Rehabilitation 12: 55-64 Merritew M  2003  Comprehensive Matwork.  Toronto, Merrithew Corp. Pilates Association of Canada. (2006). Frequently asked questions. Accessed on line August 2nd 2006, at: References Phillips B, Ball C, Sackett D, Badenoch D, Straus S, Haynes B, Dawes M  2001  Levels of evidence and grades of recommendation.  Centre for Evidence-Based Medicine.  Accessed July 20, 2007. Portney LG, Watkins MP 2000  Foundations of clinical research: Applications to practice, 2nd edn.  Upper Saddle River, Prentice Hall Health. Quinn JV  2005  Influence of Pilates-based mat exercise on chronic lower back pain.  Dissertation - Florida Atlantic University, pp. 1-64 Revill SI, Robinson JO, Rosen M, Hogg MI  1976  The reliability of a linear analogue for evaluating pain.  Anaesthesia 31: 1191–1198 Roach K, Calang A, Redmond G, Campos F, Yadao C.  2000  Concurrent validity of the Miami Back Index.  Physical Therapy 81: A28 Roach K, Carreras K, Lee, Reed L, Zimmerman G.  2001  Development and reliability of the Miami Back Index.  Journal of Orthopaedic and Sports Physical Therapy 31: P097 Rocchi MB, Sisti D, Benedetti P, Valentini M, Bellagamba S, Federici A  2005  Critical comparison of nine different self-administered questionnaires for the evaluation of disability caused by low back pain.  Europa Medicophysica 41: 275-281. Roland M, Fairbank J  2000  The Roland-Morris Disability Questionnaire and the Oswestry Disability Questionnaire. Spine 25: 3115-3124. Rydeard R, Leger A, Smith D 2006 Pilates-based therapeutic exercise: Effect on subjects with nonspecific chronic low back pain and functional disability: A randomized controlled trial.  Journal of Orthopaedic and Sports Physical Therapy 36: 472-484 Slade SC, Keating JL 2006 Trunk-strengthening exercises for chronic low back pain: A systematic review.  Journal of Manipulative and Physiological Therapeutics 29: 163-173 Sriwatanakul K, Kelvie W, Lasagna L, Calilim JF, Weis OF, Mehta G  1983  Studies with different types of visual analog scales for measurement of pain. Clinical Pharmacology and Therapeutics 34: 234–239 Statistics Canada, Back Pain. Accessed online July 31st, 2006 at MIE/2006003/backpain.htm Stratford P, Gill C, Westaway M,  Binkley J 1995  Assessing disability and change on individual patients: a report of a patient specific measure. Physiotherapy Canada 47: 258-263 Stott Pilates. Biography of Joseph H. Pilates. Accessed Aug 2nd 2006 online at: Stott Pilates. Background, Stott Pilates and Merrithew Corporation. Accessed Aug 2nd 2006 online at: Stott Pilates. Fact Sheet: 2004-2005. Accessed Aug 2nd 2006 online at: Stucki G, Cieza A, Melvin J  2007  The International Classification of Functioning, Disability and Health: a unifying model for the conceptual description of the rehabilitation strategy.  Journal of Rehabilitation Medicine 39: 279-285 Taylor SJ, Taylor AE, Foy MA, Fogg AJ  1999  Responsiveness of common outcome measures for patients with low hack pain. Spine 247: 1805-1812 Van Tulder M, Furlan A, Bombardier C, Bouter L 2003  Updated method guidelines for systematic reviews in the Cochrane Collaboration Back Review Group.  Spine 28: 1290-1298 Von Korff M, Jensen MP, Karoly P  2000  Assessing global pain severity by self-report in clinical and health services research.  Spine 25: 3140-3151 Ware JE, Sherboume CD  1992  The MOS 36-item short-form health survey (SF-36). A conceptual framework and item selection. Medical Care 30: 473 - 483. Woolf AD, Pfleger B  2003  Burden of major musculoskeletal conditions.  World Health Organization Bulletin 81: 646-656


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