Cited by 223Musculoskeletal pain and rehabilitationSpine and Intervertebral Disc PathologyPregnancy-related medical research

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An update of stabilisation exercises for low back pain: a systematic review with meta-analysis

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Smith, Benjamin E, Littlewood, Chris, May, Stephen·2014·BMC Musculoskeletal Disorders

DOI 10.1186/1471-2474-15-416PMC PMC4295260

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Abstract

BACKGROUND: Non-specific low back pain (NSLBP) is a large and costly problem. It has a lifetime prevalence of 80% and results in high levels of healthcare cost. It is a major cause for long term sickness amongst the workforce and is associated with high levels of fear avoidance and kinesiophobia. Stabilisation (or 'core stability') exercises have been suggested to reduce symptoms of pain and disability and form an effective treatment. Despite it being the most commonly used form of physiotherapy treatment within the UK there is a lack of positive evidence to support its use. The aims of this systematic review update is to investigate the effectiveness of stabilisation exercises for the treatment of NSLBP, and compare any effectiveness to other forms of exercise. METHODS: A systematic review published in 2008 was updated with a search of PubMed, CINAHL, AMED, Pedro and The Cochrane Library, October 2006 to October 2013. Two authors independently selected studies, and two authors independently extracted the data. Methodological quality was evaluated using the PEDro scale. Meta-analysis was carried out when appropriate. RESULTS: 29 studies were included: 22 studies (n = 2,258) provided post treatment effect on pain and 24 studies (n = 2,359) provided post treatment effect on disability. Pain and disability scores were transformed to a 0 to 100 scale. Meta-analysis showed significant benefit for stabilisation exercises versus any alternative treatment or control for long term pain and disability with mean difference of -6.39 (95% CI -10.14 to -2.65) and -3.92 (95% CI -7.25 to -0.59) respectively. The difference between groups was clinically insignificant. When compared with alternative forms of exercise, there was no statistical or clinically significant difference. Mean difference for pain was -3.06 (95% CI -6.74 to 0.63) and disability -1.89 (95% CI -5.10 to 1.33). CONCLUSION: There is strong evidence stabilisation exercises are not more effective than any other form of active exercise in the long term. The low levels of heterogeneity and large number of high methodological quality of available studies, at long term follow-up, strengthen our current findings, and further research is unlikely to considerably alter this conclusion.

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Figure 1 Study selection process.CC BY · PubMed Central

Figure 2 Forest plot of stabilisation versus alternative intervention: pain - long term. *Negative values favour stabilisation intervention, positive favour control.CC BY · PubMed Central

Figure 3 Forest plot of stabilisation versus other exercises: pain - long term. *Negative values favour stabilisation intervention, positive favour control.CC BY · PubMed Central

Figure 4 Forest plot of stabilisation versus alternative intervention: disability - long term. *Negative values favour stabilisation intervention, positive favour control.CC BY · PubMed Central

Figure 5 Forest plot of stabilisation versus other exercises: disability - long term. *Negative values favour stabilisation intervention, positive favour control.CC BY · PubMed Central

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Authors: Smith, B. E., Littlewood, C., & May, S.
Affiliations: London Road Community Hospital (GB)
University of Sheffield (GB)
Sheffield Hallam University (GB)
Corresponding author: Smith, Benjamin E
ORCID: Smith, Benjamin E
Littlewood, Chris
May, Stephen
Venue: BMC Musculoskeletal Disorders
Publisher: Springer Science and Business Media LLC
Published: 2014-12
Volume: 15
Issue: 1
Pages: 416-416
ISSN: 1471-2474 (ISSN-L)
DOI: 10.1186/1471-2474-15-416
PMC: PMC4295260
OpenAlex: W2069264694
Cited by: 207
References: 112
Citations by year: 2026: 9 · 2025: 17 · 2024: 10 · 2023: 19 · 2022: 24 · 2021: 26 · 2020: 26 · 2019: 21 · 2018: 11 · 2017: 21 · 2016: 19 · 2015: 4
FWCI: 1.88
Type: journal article
Language: en
Open access: gold
doi.org
Licence: cc-by
www.springer.com/tdm (unspecified)
Locations: BMC Musculoskeletal Disorders (publishedVersion, cc-by)
PubMed Central (publishedVersion, cc-by)
PubMed (publishedVersion)
White Rose Research Online (University of Leeds, The University of Sheffield, University of York) (acceptedVersion)
SHURA (Sheffield Hallam University Research Archive) (Sheffield Hallam University) (acceptedVersion)
Edge Hill University Research Information Repository (Edge Hill University) (submittedVersion, other-oa)
Topics: Health Sciences › Health Professions › Physical Therapy, Sports Therapy and Rehabilitation › Musculoskeletal pain and rehabilitation
Health Sciences › Medicine › Orthopedics and Sports Medicine › Spine and Intervertebral Disc Pathology
Health Sciences › Medicine › Obstetrics and Gynecology › Pregnancy-related medical research
Keywords: non-specific low back pain, core stability, physiotherapy, exercise therapy, pain, disability, long-term outcomes, treatment effectiveness
MeSH terms: Exercise Therapy, Humans, Randomized Controlled Trials as Topic, Treatment Outcome, Low Back Pain

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An update of stabilisation exercises for low back pain: a systematic review with meta-analysis

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