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Does motor control training improve pain and function in adults with symptomatic lumbar disc herniation? A systematic review and meta-analysis of 861 subjects in 16 trials
  1. Mohammadreza Pourahmadi1,
  2. Somayeh Delavari2,
  3. Jill A Hayden3,
  4. Abbasali Keshtkar4,
  5. Maryam Ahmadi5,
  6. Azadeh Aletaha6,7,
  7. Maryam Nazemipour8,
  8. Mohammad Ali Mansournia9,
  9. Sidney M Rubinstein10
  1. 1Rehabilitation Research Center, Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
  2. 2Center for Educational Research in Medical Sciences (CERMS), Department of Medical Education, School of Medicine, Iran University of Medical Sciences, Tehran, Iran
  3. 3Department of Community Health & Epidemiology, Dalhousie University, Halifax, Nova Scotia, Canada
  4. 4Department of Health Sciences Education Development, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
  5. 5Department of Physiotherapy, School of Rehabilitation Sciences, Iran University of Medical Sciences, Tehran, Iran
  6. 6Evidence Based Medicine Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
  7. 7Department of Medical Library and Information Science, School of Health Management and Information Sciences, Iran University of Medical Sciences, Tehran, Iran
  8. 8Osteoporosis Research Center, Endocrinology and Metabolism Clinical Sciences Institute, Tehran University of Medical Sciences, Tehran, Iran
  9. 9Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran
  10. 10Faculty of Science, Department of Health Sciences, Vrije Universiteit, Amsterdam, The Netherlands
  1. Correspondence to Professor Mohammad Ali Mansournia, Department of Epidemiology and Biostatistics, School of Public Health, Tehran University of Medical Sciences, Tehran, Iran (the Islamic Republic of); mansournia_ma{at}yahoo.com

Abstract

Objective To evaluate the effectiveness of motor control training (MCT) compared with other physical therapist-led interventions, minimal/no intervention or surgery in patients with symptomatic lumbar disc herniation (LDH).

Design Systematic review and meta-analysis.

Data sources Eight databases and the ClinicalTrials.gov were searched from inception to April 2021.

Eligibility criteria We included clinical trial studies with concurrent comparison groups which examined the effectiveness of MCT in patients with symptomatic LDH. Primary outcomes were pain intensity and functional status which were expressed as mean difference (MD) and standardised mean difference (SMD), respectively.

Results We screened 6695 articles, of which 16 clinical trials (861 participants) were eligible. Fourteen studies were judged to have high risk of bias and two studies had some risk of bias. In patients who did not undergo surgery, MCT resulted in clinically meaningful pain reduction compared with other physical therapist-led interventions (ie, transcutaneous electrical nerve stimulation (TENS)) at short-term (MD –28.85, –40.04 to −17.66, n=69, studies=2). However, the robustness of the finding was poor. For functional status, a large and statistically significant treatment effect was found in favour of MCT compared with traditional/classic general exercises at long-term (SMD −0.83 to –1.35 to −0.31, n=63, studies=1) and other physical therapist-led interventions (ie, TENS) at short-term (SMD −1.43 to –2.41 to −0.46, n=69, studies=2). No studies compared MCT with surgery. In patients who had undergone surgery, large SMDs were seen. In favour of MCT compared with traditional/classic general exercises (SMD −0.95 to –1.32 to −0.58, n=124, studies=3), other physical therapist-led interventions (ie, conventional treatments; SMD −2.30 to –2.96 to −1.64, n=60, studies=1), and minimal intervention (SMD −1.34 to –1.87 to −0.81, n=68, studies=2) for functional improvement at short-term. The overall certainty of evidence was very low to low.

Conclusion At short-term, MCT improved pain and function compared with TENS in patients with symptomatic LDH who did not have surgery. MCT improved function compared with traditional/classic general exercises at long-term in patients who had undergone surgery. However, the results should be interpreted with caution because of the high risk of bias in the majority of studies.

PROSPERO registration number CRD42016038166.

  • physical therapy specialty
  • rehabilitation
  • back
  • exercise therapy
  • exercise training

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Footnotes

  • Contributors MP, SD, AK and MAM conceived and designed the study. AA conducted the search while MP adjudicated. MP, SD and MA performed the screening, study selection and data extraction. MP and SD analysed and interpreted the data with input from JAH and SMR. MP drafted the manuscript with input from JAH, SMR, MN and MAM. All authors have read and approved the final version.

  • Funding This study received funding from Iran University of Medical Sciences (grant number #1400-2-99-21936).

  • Competing interests None declared.

  • Provenance and peer review Not commissioned; externally peer reviewed.

  • Supplemental material This content has been supplied by the author(s). It has not been vetted by BMJ Publishing Group Limited (BMJ) and may not have been peer-reviewed. Any opinions or recommendations discussed are solely those of the author(s) and are not endorsed by BMJ. BMJ disclaims all liability and responsibility arising from any reliance placed on the content. Where the content includes any translated material, BMJ does not warrant the accuracy and reliability of the translations (including but not limited to local regulations, clinical guidelines, terminology, drug names and drug dosages), and is not responsible for any error and/or omissions arising from translation and adaptation or otherwise.

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