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Cited by 169Musculoskeletal pain and rehabilitationPregnancy-related medical researchSpine and Intervertebral Disc Pathology

Pilates for low back pain

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Yamato, Tiê P, Maher, Christopher G, Saragiotto, Bruno T, Hancock, Mark J, Ostelo, Raymond WJG, Cabral, Cristina MN, Menezes Costa, Luciola C, Costa, Leonardo OP·2015·Cochrane Database of Systematic Reviews
DOI 10.1002/14651858.cd010265.pub2PMC PMC8078578
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Abstract

BACKGROUND: Non-specific low back pain is a major health problem worldwide. Interventions based on exercises have been the most commonly used treatments for patients with this condition. Over the past few years, the Pilates method has been one of the most popular exercise programmes used in clinical practice. OBJECTIVES: To determine the effects of the Pilates method for patients with non-specific acute, subacute or chronic low back pain. SEARCH METHODS: We conducted the searches in CENTRAL, MEDLINE, EMBASE, CINAHL, PEDro and SPORTDiscus from the date of their inception to March 2014. We updated the search in June 2015 but these results have not yet been incorporated. We also searched the reference lists of eligible papers as well as six trial registry websites. We placed no limitations on language or date of publication. SELECTION CRITERIA: We only included randomised controlled trials that examined the effectiveness of Pilates intervention in adults with acute, subacute or chronic non-specific low back pain. The primary outcomes considered were pain, disability, global impression of recovery and quality of life. DATA COLLECTION AND ANALYSIS: Two independent raters performed the assessment of risk of bias in the included studies using the 'Risk of bias' assessment tool recommended by The Cochrane Collaboration. We also assessed clinical relevance by scoring five questions related to this domain as 'yes', 'no' or 'unclear'. We evaluated the overall quality of evidence using the GRADE approach and for effect sizes we used three levels: small (mean difference (MD) < 10% of the scale), medium (MD 10% to 20% of the scale) or large (MD > 20% of the scale). We converted outcome measures to a common 0 to 100 scale when different scales were used. MAIN RESULTS: The search retrieved 126 trials; 10 fulfilled the inclusion criteria and we included them in the review (a total sample of 510 participants). Seven studies were considered to have low risk of bias, and three were considered as high risk of bias.A total of six trials compared Pilates to minimal intervention. There is low quality evidence that Pilates reduces pain compared with minimal intervention, with a medium effect size at short-term follow-up (less than three months after randomisation) (MD -14.05, 95% confidence interval (CI) -18.91 to -9.19). For intermediate-term follow-up (at least three months but less than 12 months after randomisation), two trials provided moderate quality evidence that Pilates reduces pain compared to minimal intervention, with a medium effect size (MD -10.54, 95% CI -18.46 to -2.62). Based on five trials, there is low quality evidence that Pilates improves disability compared with minimal intervention, with a small effect size at short-term follow-up (MD -7.95, 95% CI -13.23 to -2.67), and moderate quality evidence for an intermediate-term effect with a medium effect size (MD -11.17, 95% CI -18.41 to -3.92). Based on one trial and low quality evidence, a significant short-term effect with a small effect size was reported for function (MD 1.10, 95% CI 0.23 to 1.97) and global impression of recovery (MD 1.50, 95% CI 0.70 to 2.30), but not at intermediate-term follow-up for either outcome.Four trials compared Pilates to other exercises. For the outcome pain, we presented the results as a narrative synthesis due to the high level of heterogeneity. At short-term follow-up, based on low quality evidence, two trials demonstrated a significant effect in favour of Pilates and one trial did not find a significant difference. At intermediate-term follow-up, based on low quality evidence, one trial reported a significant effect in favour of Pilates, and one trial reported a non-significant difference for this comparison. For disability, there is moderate quality evidence that there is no significant difference between Pilates and other exercise either in the short term (MD -3.29, 95% CI -6.82 to 0.24) or in the intermediate term (MD -0.91, 95% CI -5.02 to 3.20) based on two studies for each comparison. Based on low quality evidence and one trial, there was no significant difference in function between Pilates and other exercises at short-term follow-up (MD 0.10, 95% CI -2.44 to 2.64), but there was a significant effect in favour of other exercises for intermediate-term function, with a small effect size (MD -3.60, 95% CI -7.00 to -0.20). Global impression of recovery was not assessed in this comparison and none of the trials included quality of life outcomes. Two trials assessed adverse events in this review, one did not find any adverse events, and another reported minor events. AUTHORS' CONCLUSIONS: We did not find any high quality evidence for any of the treatment comparisons, outcomes or follow-up periods investigated. However, there is low to moderate quality evidence that Pilates is more effective than minimal intervention for pain and disability. When Pilates was compared with other exercises we found a small effect for function at i

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  • The overview authors report that the Yamato 2015 review did not perform subgroup analysis by pain duration, which made it difficult to extract appropriate data, and that the review presented results altogether as chronic pain.

    “There was no subgroup analysis to differentiate between acute, subacute, and chronic pain made it difficult to extract appropriate data for this review (one included study had subacute back pain (> 6 weeks), all others were chronic back pain (> 12 weeks)) but results are presented altogether as chronic pain”

    From Physical activity and exercise for chronic pain in adults: an overview of Cochrane Reviews (2017) · cites this paper as Yamato 2015

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4 of the 65 references couldn’t be matched to a known paper.

Research works printed but not linked: 4

  1. Anderson BD, Spector A. Introduction to Pilates‐based rehabilitation. Orthopaedic Physical Therapy Clinics of North America 2000;9:395‐410. [Google Scholar]
  2. Delitto A, George SZ, Dillen LR, Whitman JM, Sowa G, Shekelle P, et al. Orthopaedic Section of the American Physical Therapy, Association. Low back pain. Journal of Orthopaedic & Sports Physical Therapy 2012;42(4):A1‐57. [DOI] [PMC free article] [PubMed] [Google Scholar]
  3. COST Action B13 working group. European Guidelines for the Management of Non‐Specific Low Back Pain. European Spine Journal 2006;15(Suppl 2):S1‐S300. [Google Scholar]
  4. Waddell G. The Back Pain Revolution. Churchill Livingstone, 2004. [Google Scholar]

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Authors
Yamato, T. P., Maher, C. G., Saragiotto, B. T., Hancock, M. J., Ostelo, R. W., Cabral, C. M., Menezes Costa, L. C., & Costa, L. O.
Affiliations
  • The University of Sydney (AU)
  • Macquarie University (AU)
  • Amsterdam Public Health (NL)
  • Universidade Cidade de São Paulo; Masters and Doctoral Programs in Physical Therapy; Rua Cesário Galeno,448 São Paulo Brazil 03071-000
ORCID
Venue
Cochrane Database of Systematic Reviews
Publisher
Wiley
Published
2015-07-02
Volume
2015
Issue
7
Pages
CD010265-CD010265
ISSN
  • 1361-6137 (ISSN-L)
  • 1465-1858
DOI
10.1002/14651858.cd010265.pub2
PMC
PMC8078578
OpenAlex
W2803560529
Cited by
169
References
65
Citations by year
2026: 4 · 2025: 15 · 2024: 15 · 2023: 18 · 2022: 19 · 2021: 17 · 2020: 21 · 2019: 22 · 2018: 15 · 2017: 9 · 2016: 11 · 2015: 2 · 2014: 1
FWCI
1.54
Type
journal article
Language
en
Open access
Locations
  • Cochrane Database of Systematic Reviews (publishedVersion)
  • PubMed Central (publishedVersion)
  • PubMed (publishedVersion)
  • Amsterdam UMC (VU Amsterdam) - Institutional Repository (publishedVersion)
  • Pure Amsterdam UMC (submittedVersion)
  • VU Research Portal (submittedVersion)
  • Data Archiving and Networked Services (DANS) (submittedVersion)
Topics
  • Health Sciences › Medicine › Pharmacology › Musculoskeletal pain and rehabilitation
  • Health Sciences › Medicine › Public Health, Environmental and Occupational Health › Pregnancy-related medical research
  • Health Sciences › Medicine › Pathology and Forensic Medicine › Spine and Intervertebral Disc Pathology
Keywords
Pilates, non-specific low back pain, exercise therapy, analgesia, disability, quality of life, acute low back pain, chronic low back pain, subacute low back pain, risk of bias, clinical relevance, quality of evidence, GRADE
MeSH terms
Humans, Time Factors, Randomized Controlled Trials as Topic, Low Back Pain, Exercise Movement Techniques

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