Effectiveness of movement control exercise on patients with non-specific low back pain and movement control impairment: A systematic review and meta-analysis.

BACKGROUND: Patients with low back pain (LBP) and movement control impairment (MVCI) show altered spinal movement patterns. Treatment that aims to change movement behaviour could benefit these patients. OBJECTIVE: To assess the effectiveness of movement control exercise (MVCE) in terms of clinically relevant measures (disability and pain) on patients with NSLBP. METHODS: A systematic review and meta-analysis were conducted. CINAHL, MEDLINE, PUBMED and PEDro databases were searched for RCT's evaluating MVCE treatment in patients with NSLBP from review inception to April 2017. Authors were contacted to obtain missing data and outcomes. PEDro was used to assess methodological quality of the studies and the GRADE approach was used to assess the overall quality of evidence Data were combined using a random effects meta-analysis and reported as standardized mean differences (SMD). RESULTS: Eleven eligible RCT's including a total of 781 patients were found. Results show 'very low to moderate quality' evidence of a positive effect of MVCE on disability, both at the end of treatment and after 12 months (SMD -0.38 95%CI -0.68, -0.09 respectively 0.37 95%CI -0.61,-0.04). Pain intensity was significantly reduced after MVCE at the end of treatment (SMD -0.39 95%CI -0.69, -0.04), but not after 12 months (SMD -0.27, 95%CI -0.62, 0.09). CONCLUSIONS: MVCE intervention for people with NSLBP and MVCI appears to be more effective in improving disability compared to other interventions, both over the short and long term. Pain was reduced only in the short term. An important factor is the initial identification of patients with MVCI. Registration of the study: The study protocol registration number is CRD42016036662 on PROSPERO.

Lumbar tactile acuity is near identical between sides in healthy pain-free participants.

A growing body of literature suggests that alterations in brain structure and function are a feature of chronic back pain. Tactile acuity is considered a clinical signature of primary somatosensory representation and offers a simple measure of cortical reorganisation. Clinical interpretation of test scores from an individual patient is hampered by variance in published normative values and less than ideal inter-rater reliability. These problems might be mitigated in people with unilateral back pain by using the patient as their own control and comparing tactile acuity at the painful site to performance at the corresponding position on the non-painful side. The first step in exploring this approach is to quantify the normal side-to-side difference in healthy populations. We pooled data from three previous studies that measured lumbar tactile acuity bilaterally in healthy controls using similar protocols. We calculated the mean and variance of the absolute error between sides, the standard error of measurement and the reliable change index (RCI). The mean difference between sides was 3.2 mm (±5.2) when assessed vertically and 1.9 mm (±3.2) when assessed horizontally. The standard error of measurement was 4.2 mm when assessed vertically and 2.7 mm when assessed horizontally. The RCI suggests that differences of greater than 13 mm when assessed horizontally and 17 mm when assessed vertically equate to 95% confidence that a difference truly exists. Several assumptions related to the application of this approach need to be investigated further.