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27-03-2013 | Pain medicine | Article

Motor control exercises superior for chronic low-back pain


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medwireNews: Motor control exercises (MCEs) appear to be superior to general exercises, manual therapy, and minimal intervention in reducing pain and disability in patients with chronic and recurrent low-back pain, findings from a literature review and meta-analysis suggest.

"The results of the present study contrast with the opinion that any effects of MCE are merely due to the general effects of physical exercise," say Eva Rasmussen-Barr (Karolinska Institute, Huddinge, Sweden) and colleagues.

They explain in Spine that, "compared with other exercises, MCEs are more body specific and performed with greater awareness and control. MCE may, therefore, have a greater effect on self-efficacy, a psychosocial factor proposed to be important in the rehabilitation of musculoskeletal disorders."

The researchers pooled the results of 16 studies identified through a search of randomized controlled trials clearly distinguishing MCE from other treatments. The studies were generally of high quality, scoring an average of 6.4 on the Physiotherapy Evidence Database PEDro scale.

Pain and disability outcomes from the studies were converted to a 0 to 100 scale, from which weighted mean differences (WMDs) between MCE and five different control interventions were determined.

MCEs outperformed general exercises, including sling exercise and a combination of general strengthening and stretching, with regard to disability in the short (between 6 weeks and 4 months), intermediate (4 to <8 months), and long term (8 to <15 months), with WMDs ranging from -4.65 to -4.86. They were also superior to general exercises for pain in the short (WMD=-7.80) and intermediate (WMD=-6.06) term.

MCE was associated with better outcomes than spinal manual therapy for disability at all time periods (WMDs from -5.27 to -6.12), but not for pain. Compared with minimal intervention, MCE was superior at all time points for disability (WMDs from -5.62 to -9.00) and pain (WMDs from -10.18 to -13.32).

The researchers note that due to a shortage of randomized controlled trials, no conclusions could be drawn on the effectiveness of MCE compared with multimodal physical therapy or as part of a multimodal treatment.

Rasmussen-Barr and colleagues conclude: "One area of high priority in future research is the development of clinical methods to assess deficits in motor control.

"Such methods would allow subclassification of patients and the identification of those in need of MCE."

By Lucy Piper, Senior medwireNews Reporter