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Title: Effectiveness of Pilates exercise in treating people with chronic low back pain: A systematic review of systematic reviews.
Epworth Authors: Hill, Bridget
Other Authors: Wells, Cherie
Kolt, Gregory
Marshall, Paul
Bialocerkowski, Andrea
Keywords: Exercise Therapy
Exercise Movement Techniques
Therapy, Exercise
Low Back Pain
Sports Medicine
Medicine, Sports
Review, Systematic
Pilates Training
Pilates-Based Exercises
Controlled Clinical Trials, Randomized
Pain Management
Massage Therapy
Trials, Randomized Clinical
Rehabilitation, Mental Health and Chronic Pain Clinical Institute, Epworth HealthCare, Victoria, Australia
Issue Date: Jan-2013
Publisher: BioMed Central / Springer
Citation: BMC Medical Research Methodology 2013 Jan 19;13:7
Abstract: BACKGROUND: Systematic reviews provide clinical practice recommendations that are based on evaluation of primary evidence. When systematic reviews with the same aims have different conclusions, it is difficult to ascertain which review reported the most credible and robust findings. METHODS: This study examined five systematic reviews that have investigated the effectiveness of Pilates exercise in people with chronic low back pain. A four-stage process was used to interpret findings of the reviews. This process included comparison of research questions, included primary studies, and the level and quality of evidence of systematic reviews. Two independent reviewers assessed the level of evidence and the methodological quality of systematic reviews, using the National Health and Medical Research Council hierarchy of evidence, and the Revised Assessment of Multiple Systematic Reviews respectively. Any disagreements were resolved by a third researcher. RESULTS: A high level of consensus was achieved between the reviewers. Conflicting findings were reported by the five systematic reviews regarding the effectiveness of Pilates in reducing pain and disability in people with chronic low back pain. Authors of the systematic reviews included primary studies that did not match their questions in relation to treatment or population characteristics. A total of ten primary studies were identified across five systematic reviews. Only two of the primary studies were included in all of the reviews due to different inclusion criteria relating to publication date and status, definition of Pilates, and methodological quality. The level of evidence of reviews was low due to the methodological design of the primary studies. The methodological quality of reviews varied. Those which conducted a meta-analysis obtained higher scores. CONCLUSION: There is inconclusive evidence that Pilates is effective in reducing pain and disability in people with chronic low back pain. This is due to the small number and poor methodological quality of primary studies. The Revised Assessment of Multiple Systematic Reviews provides a useful method of appraising the methodological quality of systematic reviews. Individual item scores, however, should be examined in addition to total scores, so that significant methodological flaws of systematic reviews are not missed, and results are interpreted appropriately.
DOI: 10.1186/1471-2288-13-7
PubMed URL:
ISSN: 1471-2288
Journal Title: BMC Medical Research Methodology
Type: Journal Article
Affiliated Organisations: School of Science and Health, University of Western Sydney, Penrith, NSW, Australia
Type of Clinical Study or Trial: Comparative Study
Appears in Collections:Pain Management

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